Neurological Unit- Assessment Flashcards
History taking
1.Hx
2. General Appearance
3. Hx of present illness (PQRST)
4. Past medical Hx
Family Hx
5. Medical Hx
6. Degree of stimuli
7. Social Hx
Degree of Stimuli
- Verbal Stimulation: Say something they open eyes
- Tactile Stimulation: Touch them they open eyes
- Painful Stimuli (Nocous stimuli): Sternum rub and trapezius squeeze
- Peripheral Stimuli: Pressure on nail beds
AS Decrease in list more stimuli is needed to elicit a response
Vital Signs: Cushing Triad
- Increased Systolic BP
- Widened pulse pressure
- Bradycardia
Vital Signs: Blood Pressure
Hypotension
Hypertension
Pulse Pressure
Hypotension: CANNOT b/c cranium is non expandable
Hypertension: Systolic bp increased
Pulse Pressure: NORM: 30-40
Temperature:
WHAT increases it?
Infection Subarachnoid Hemorrhage Seziures Restlessness Injury to Hypothalmus Neurological Fever: Swelling around the hypothalmus
Temperature:
WHAT decreases it?
Shock
Metabolic coma
Terminal Stages of neurologic disease
Level Of Conciousness
A state of awareness regarding self,enviroment, and response
LOC:
Arousal function of
Function of RAS
LOC:
Awareness Function of
Requires both intact RAS and crebral hemispheres
LOC:
Coma
The absence of awareness
Structural lesion
Metabolic or psychiatric disorder
Glasgow Coma Scale:
Definition
A method to standardize observation of responsiveness in neurologic patients
Best or highest response is recorded
Parameters
Min: 3
MAX: 15
Coma:8 or less
Clinical significance: change in 2 points
Glasgow Coma Scale: SCALE
EYE opening: 4: Spontaneously 3: To verbal command 2: To Pain 1: NONE 0: Untestable (if pt is on nuromusclar blockades or swollen eye) BEST VERBAL response: 5: Orientated and converses 4: Disorientated and converses 3: Inappropriate words: Calling things wrong name 2: Incomprehensible sounds: Slurred mumbling 1: NONE 0: Untestable: if have trach, intubated BEST MOTOR response: 6: Obeys 5: Localizes pain: pushes stimuli away 4: Withdrawls from pain 3: Abnormal flexion 2: Abnormal extension 1: NONE 0: Untestabe: On neuromuscluar blockade, spinal cord injury
Speech Disorders:
Dysphoniac
Difficulty producing sounds
Speech Disorders:
Dysarthria
Difficulty ariculating
Speech Disorders:
Dysprosody
Lack of inflection while talking
Speech Disorders:
Dysphasia
Difficulty understanding or expressing language
Speech Disorders: Aphasia 1. Receptive 2. Expressive 3. Global
1. Wernik : Difficult understanding Sensory 2. Broca: difficult cant get words out Motor 3. Both
Involuntary Movements
Abnormal flexion: Indicative of cerebral lesion
Abnormal Extension: Indicative of midbrain or brainstem lesion
Opisthotonos: Arching , indicative of brainstem injury
Abnormal Reflexes
Babinski - Fanning of toes
Grasp: Hold on but dont let go
Sucking: Start to do mouth care and pt starts sucking
Signs of Basilar Skull Fractures
Battle sign
Rhinorrhea
Otorrhea
Raccoon Eyes
Meningeal Irritation:
Nuchal rigidity
Nuchal rigidity: Inability to flex neck
Meningeal Irritation:
Kernig’s sign
Pain when go to raise leg up as pt is lying down
Meningeal Irritation:
Brudzinski sign
Bring neck forward pt pulls legs up
Clinical Indication of BRAIN DEATH
LOC Pupils (Fixed) Motor Reflexes - may have root reflexes Ventilation: Apneic Confirming Definitive Diagnosis studies: Cerebral angiography- look at blood flow (complication -bleeding) Transcranial Doppler- Look for blood flow (non invasive) Cerebral Blood flow study
Oculocephalic Reflex - DOLL EYES
See if intact cranial lobes or lesion near brain stem
Only do if pt is unconscious - suspect brain death
Normal: is looking away from the turn (turn head force eyes open)
Anormal- Looking toward turn or stationary eyes
(C- SPINE MUST BE INTACT)
Oculovestibular Reflex - Cold Caloric Test
Unconcious, suspect brain death
MUST HAVE INTACT TYMPANIC MEMBRANE
Putting ice cold water near - EXTREMELY painful
-Normal-Look toward the ear where water is inserted
ABNORMAL- eyes drift to other ear or none
TEST: CT
CT- FIRST TEST with change in LOC
