Neuromuscular Flashcards
Neurological assessment components
Mental status exam
LOC
Cranial nerve assessment
Reflex testing
Sensory sys. assesment
Motor system assessment
Musculoskeletal assessment components
Inspection of skeleton and extremities for alignment and symmetry
Muscles for symmetry and size: should be bilaterally equal
Palpation of bones/joints for pain, temp, edema
ROM head to toe
Muscle strength 0-5 scale
Muscle strength grading scale
0: 0% normal strength, complete paralysis
1: 10% strength, no movement, muscle contraction is palpable/visible
2: 25% strength, full movement against gravity w/support
3: 50% strength, normal movement against gravity
4: 75% normal strength, full movement against gravity and min. resistance
5: 100% normal, full movement against gravity and full resistance
Present/past Hx to look for
Trauma, disease, congenital anomalies, migraines, strokes, surgeries, fractures/sprains/strains
Mental health hx
Medications
Family Hx to look out for
Migraines, seizures, stroke, brain tumors, MS, arthritis
Elderly life span changes
Decreased sens. to outside stimuli
Falls
May not realize temp is too hot/cold
vision worsens
Pupils smaller
Decreased hearing
Mental status exam
A&O x 4
Language
memory
attention span and calculation
Glasgow coma scale
Eye opening
Verbal response
Motor response
Declared coma from 3-8 points
If all cranial nerves are normal chart
“II-XII grossly intact”
CN IIOptic sensory nerve assessment
Snellen
Leave glasses/contacts on
Left eye then right eye
Peripheral vision
Opthalmoscope for red light reflex
CN III Oculomotor nerve assessment
PERRLA
Equal
Round
React to light
Accommodate to near/far vision
CN III (oculomotor), IV (trochlear), VI (Abducens) motor nerve asessment
Examined together, control of eyelid elevation, eye movement, and pupil constriction
Finger of penlight follow with just eyes
6 fields
Abnormal reaction: nystagmus
CN III eye movements
CNIII: Up and out Up and in Cross eyes Down and out
CN IV trochlear eye movements
Superior Oblique (down and in)
CN VI abducens eye movement
Lateral rectus (middle out)
CN V Trigeminal assessment
Corneal sensation (often deferred)
Palpate jaw/temples while patient clenches teeth
Cotton ball: swipe across different areas of face bilaterally
CN VII Facial (motor and sensory) assessment
Symmetry and mobility of face:
- smile
- frown
- close eyes
- lift eyebrows
- puff cheeks
Asymmetrical in trauma, bells balsy, CVA, tumor
Ability to taste (often deferred)
CN VIII assessment (sensory) vestibulocochlear
Ability to hear spoken word
Eyes closed
Whisper 6 words bilaterally or rub fingers near ears
Slowly move hand away while continuing to rub fingers
Repeat bilaterally
Abnormal finding caused by: Occlusion, drug toxicity, tumor
CN IX glossopharyngeal
and
CN X vagus
motor and sensory
Ability to swallow
Assess voice for hoarseness
Taste (often deferred)
Abnormal IX and X ( motor)
Motor deficits can indicate brain stem tumor or neck injury
CN XI spinal accessory assessment
Hands on patients cheek and see if they resist head turn
Hands on shoulders, gently push down shoulders while they shrug
CN XII hypoglossal assessment
Motor Assess tongue control
Have them stick it out straight, back and forth, up and down
Reflex grades
4+ hyperactive
3+ brisker than normal
2+ normal
1+ diminished
0 absent
Sensory neurological tests
Sharp and dull
-show patient difference between sharp and dull
- close their eyes
- touch arms/legs randomly
- Have them identify area and sensation
Cortical sensory function
Discriminatory sensory function
Both with eyes closed
Sterognosis (guess object in hand)
Graphesthesis (number written on hand)
Fine motor coordination test of upper extremities
Finger to finger test (eyes open and to examiners finger)
Finger to nose test (eyes closed)
Fine motor coordination test of lower extremities
Patient moves heel of one foot up and down shin of other foot
Fine motor tests for general coordination
Rapid alternating movements
Patient pats knees with both hands alternating supination and pronation
or
patient touches thumb to each finger on same hand
Romberg test
Tests for balance
Stand with feet together, arms at side and close eyes
Look for swaying or lack of balance for 30 seconds
Normal to have slight sway
