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Health Assessment > Neurological System and Pain > Flashcards

Neurological System and Pain Flashcards

1
Q
  1. Central Nervous System (CNS) consists of?
A

Brain

spinal cord

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2
Q
  1. Peripheral Nervous system consists of?
A

cranial + spinal nerves

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3
Q

nervous system is responsible for?

A

control of cognitive function and voluntary and involuntary activities.

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4
Q

Identify PMHx that may predispose patients to neurological events:

Head?

A

History of TIA or CVA
Head injury/trauma
Seizures
ENT infection
Recurrent toothache/abcess

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5
Q

Identify PMHx that may predispose patients to neurological events:

Spinal cord?

A

Recent spinal tap
Low back pain/herniated disk
Recent back surgery
Spinal injury/trauma

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6
Q

Does your patient have Increased risk of bleeding related to?

A

– Blood abnormality
– History of alcoholism
– Medication that alters platelet function
eg •Warfarin
•NSAID (nonsteroidal anti-inflammatory drug)

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7
Q

Some diseases that increase risk of neurological complications
?

A
  • Hypertension •Lyme Disease
    * High cholesterol •Hepatitis C
    * Atrial fibrillation •HIV
    * Angioplasty +/- stent •HeatStroke
    * CABG +/- valve replacement •Metabolic acidosis
    * Endocrine history •Electrolyte imbalances •Thyroid •Vitamin deficiencies
    * Diabetes •Cancer
    * Cushing’s •Syphillis
    * Cardiac disease
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8
Q

Check for ABCGS

A 
airway
breathing
circulation
glucose
seizures
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9
Q

New Onset Symptoms of Concern?

A 
•Dizziness/Vertigo 
•Tremor 
•Paresthesia 
•Delirium 
•Headache 
•Weakness 
•Dizziness/Vertigo
•Tremor
•Paresthesia
•Unsteady Gait/ataxia
•Photophobia 
•Vomiting 
•Restlessness 
Neck stiffness 
•Vision problem 
•Altered LOC 
•Altered Mental status 
•Altered Language 
•Altered concentration 
•Aphasia/dysphasia 
•Breathing problem 
•Swallowing problem 
•Hallucinations 
•Lethargy 
•Irritability

persistent numbness/tingling sensation in feet,toes,hands,fingers

increasing sensation of pressure in the back of neck/head

loss of bowel/bladder control

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10
Q

Assessment of the neurological system occurs
?

A

In a cephalocaudal manner,
Distal to proximal,
Assessment of gross motor function to fine motor function
Always compare corresponding body parts.

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11
Q

Assessment techniques include?

A
  • Inspection
  • Palpation
  • Auscultation
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12
Q

Brain rest?

A

pt is sedated for first 48 hrs after brain trauma

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13
Q

Neurological examination begins with?

A 
Mental status
Cranial nerves
Motor function
Sensory function
Reflexes

Knowledge of the normal findings is essential in the interpretation of the data.

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14
Q

Mental status assessment?

A 
LOC (alert)
Assess speech and language abilities
Assess patients sensorium (O X3)
Assess memory
Ability to calculate problems (simple math problems)
Ability to think abstractly+
Assess mood and emotional state
Assess perceptions and thought processes
Assess patients ability to make judgments
Assess reasoning skills
	Various tools available to assess mental status
	e.g. Glasgow Coma Scale, Mini Mental
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15
Q

Decorticate posture?**

A

damage to one or both spinal tracts. hands are on chest with first clenched and turned in (flexed towards body)

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16
Q

Decerebrate posture?**

A

hands are rotated away from body. muscle tone decreases

17
Q

Cranial nerves?

A 
Olfactory
 Optic
 Oculomotor
 Trochlear 
Trigeminal 
Abducent
 Facial
vestibulocochlear
Glossopharyngeal
Vagus
Accessory
Hypoglossal
18
Q

PERRLA (CN# 3 – Oculomotor)?**

A 
Pupils 
Equal
Round
Reactive to
Light and
Accommodation (Which means the ability of the eyes to focus on objects that are close-up and/or far away) (pupil constricts and then dilates)

An eye exam is performed to verify how the nervous system is functioning, especially when;
head injury has occurred or is suspected
during serious illness

**This is a simple exam that can be performed at bedside as part of the Head to Toe assessment

19
Q
  1. Motor function?
A 
Perform the finger to nose test
Assess ability to perform a rapid alternating action
Assess gait and balance
Perform Romberg test 
Ask patient to perform heal to shin test

*upper motor neuron deficit (if unable to touch finger to nose properly)

20
Q

Romberg test?

A

pt stands with feet together, semi-tandem and tandem for 10 seconds each

21
Q
  1. Sensory Function?
A

Ability to identify light touch (touch patient with piece of gauze)

Ability to distinguish between dull and sharp (pencil prick and pencil eraser prick)

Ability to distinguish temperature (water of bed bath temperature)

Ability to assess vibrations (hear and feel vibrations)

Ability to assess stereognosis (ability to identify and object without seeing it)

Test graphesthesia (trace a letter on the palm of a patients hand, they should be able to identify what it is)

Ability to discriminate between two points (pt should be able to distinguish where they are being touched)

Assess topognosis (have sensation and feel touch)

Assess position sense of joint movement (flex pt foot or arm and they should be able to tell you what you did)

22
Q
  1. Reflexes?
A 
Assess biceps reflex
Assess triceps reflex
Assess brachioradialis reflex
Assess achilles tendon reflex
Assess patellar reflex  (hyper reflex: upper neuron abnormal disease)
Assess the plantar reflex
23
Q

Babinski test?

A

toes should curl down when plantar part of foot is stimulated

in babies up to 2 the toes will curl upwards

24
Q

Additional Assessment Techniques?

A

Carotid auscultation (listen to carotid artery with stethoscope) (should hear whooshing sound)

Bruit (thrill): sound of blood rushing through artery *abnormal

25
Q

-**Meningeal assessment (2 part assessment)?

A

C/O of pain or stiff neck:
have patient bring chin to chest and not have any stiffness or pain in back of neck. if yes, place pt in bed in supine position and bring their chin to chest, if there is flexion in the legs (brudzinski)** it is positive for meningitis (would chart that pt has stiffness in the neck + pain)

26
Q

Pain Assessment?

A

Pain History

  - OPPQRRSTU
  - Impact on ADL’s?
  - Coping strategies?
  - Emotional responses?

b) Health History

c) Physiological responses
Observe: 1. Behaviour (protecting specific part of body)
2. Physical responses

27
Q

*Factors that influence pain?

A

Developmental Considerations (age)

Psychosocial Considerations (cultural aspect)

Environmental Considerations(too much light/noise)

should look + calculate how much pain meds. the patient has had in the last 24hrs

start with the full dose of meds. for pain and work backwards to lower doses

28
Q

Unidemensional Tools – Assess only one aspect of pain?

A

numeric rating scale of pain

29
Q

Multidemsional Tools – Assess two or more elements of pain?

A

McGill pain questionnaire

30
Q

Acute Pain ?

A
  • sudden onset, sharp quality, < 3 months
31
Q

Chronic Pain?

A
  • sudden or gradual, > 3 months
32
Q

Cutaneous Pain?

A
  • originates from skin
33
Q

Deep Somatic Pain?

A
  • ligaments, bones, tendons, nerves
34
Q

Visceral Pain?

A
  • organ pain (abdominal cavity, thorax, cranium?)
35
Q

Radiating Pain?

A

extending to nearby tissue

36
Q

Referred Pain?

A

not associated with where pain is happening

37
Q

Intractable pain?

A

cannot be relieved

38
Q

Neuropathic/neurologic pain?

A

current or part damage to nerves of CNS. ex: phantom pain

Health Assessment (8 decks)

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