Neurological System and Pain Flashcards
- Central Nervous System (CNS) consists of?
Brain
spinal cord
- Peripheral Nervous system consists of?
cranial + spinal nerves
nervous system is responsible for?
control of cognitive function and voluntary and involuntary activities.
Identify PMHx that may predispose patients to neurological events:
Head?
History of TIA or CVA
Head injury/trauma
Seizures
ENT infection
Recurrent toothache/abcess
Identify PMHx that may predispose patients to neurological events:
Spinal cord?
Recent spinal tap
Low back pain/herniated disk
Recent back surgery
Spinal injury/trauma
Does your patient have Increased risk of bleeding related to?
– Blood abnormality
– History of alcoholism
– Medication that alters platelet function
eg •Warfarin
•NSAID (nonsteroidal anti-inflammatory drug)
Some diseases that increase risk of neurological complications ?
- 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
Check for ABCGS
airway breathing circulation glucose seizures
New Onset Symptoms of Concern?
•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
Assessment of the neurological system occurs ?
In a cephalocaudal manner,
Distal to proximal,
Assessment of gross motor function to fine motor function
Always compare corresponding body parts.
Assessment techniques include?
- Inspection
- Palpation
- Auscultation
Brain rest?
pt is sedated for first 48 hrs after brain trauma
Neurological examination begins with?
Mental status Cranial nerves Motor function Sensory function Reflexes
Knowledge of the normal findings is essential in the interpretation of the data.
Mental status assessment?
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
Decorticate posture?**
damage to one or both spinal tracts. hands are on chest with first clenched and turned in (flexed towards body)
Decerebrate posture?**
hands are rotated away from body. muscle tone decreases
Cranial nerves?
Olfactory Optic Oculomotor Trochlear Trigeminal Abducent Facial vestibulocochlear Glossopharyngeal Vagus Accessory Hypoglossal
PERRLA (CN# 3 – Oculomotor)?**
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
- Motor function?
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)
Romberg test?
pt stands with feet together, semi-tandem and tandem for 10 seconds each
- Sensory Function?
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)
- Reflexes?
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
Babinski test?
toes should curl down when plantar part of foot is stimulated
in babies up to 2 the toes will curl upwards
Additional Assessment Techniques?
Carotid auscultation (listen to carotid artery with stethoscope) (should hear whooshing sound)
Bruit (thrill): sound of blood rushing through artery *abnormal
-**Meningeal assessment (2 part assessment)?
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)
Pain Assessment?
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
*Factors that influence pain?
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
Unidemensional Tools – Assess only one aspect of pain?
numeric rating scale of pain
Multidemsional Tools – Assess two or more elements of pain?
McGill pain questionnaire
Acute Pain ?
- sudden onset, sharp quality, < 3 months
Chronic Pain?
- sudden or gradual, > 3 months
Cutaneous Pain?
- originates from skin
Deep Somatic Pain?
- ligaments, bones, tendons, nerves
Visceral Pain?
- organ pain (abdominal cavity, thorax, cranium?)
Radiating Pain?
extending to nearby tissue
Referred Pain?
not associated with where pain is happening
Intractable pain?
cannot be relieved
Neuropathic/neurologic pain?
current or part damage to nerves of CNS. ex: phantom pain
