Neuromuscular Assessment 2 LAB Flashcards
Beginning Procedure
- Identify patient
- Explain procedure
2a. Are you comfortable? Do you know what day it is? Why are you here? Where are you? - Hand hygiene
- Neurological history? Stroke? seizures? TBI?
- Musculoskeletal history? Osteoporosis? Arthritis?
How to assess smell? Nerve?
Close eyes, wave scented pad under nose “Let me know what you smell, if you smell anything.”
Tests Cranial Nerve 1: Olfactory (S)
How to assess visual acuity? Nerve?
Snellen’s Chart.
Ask Pt to read line on chart.
Tests CN 2: Optic (S)
How to assess pupil reaction to light & accommodation?
What’s the P word?
What’s the nerve?
Pen light, checking both pupils constrict no matter which eye.
Tests CN III: Oculomotor (M)
How to assess eye movement? Nerves?
“Track the pen light w/o moving your head.” 6 cardinal positions of gaze.
Tests CN III - Oculomotor (M), IV-Trochlear (M), and V (M)I-Abducens
How to assess facial movement/sensation? Nerves?
Ask patient: smile, frown, poof cheeks, shrug your eyebrows up.
Touch areas on Pt Face w/pt eye closed to verify sensation.
Tests CN V-Trigeminal and VII-Facial.
How to assess hearing? Nerves?
Close eyes. Which side can you hear?
Tests Acoustic/Vestibulocochlear nerve(IIX).
Assessing 9&10? Name?
Stick out mouth, ahh. (Watching for uvula to rise)
Feel trachea during dry swallow
Glossopharyngeal-(IX), Vagus-X
Assessing CN11? Name?
Shrug shoulders against resistance, turn head against resistance.
Assessing CN12? Name?
Stick out tongue side to side
Hypoglossal (XII)
How to examine all major muscle groups of body
Assess for any wasted or highly developed muscles
How to assess UE?
a. Feel the tone of the muscle
b. Test for strength and resistance bilaterally
c. Palplate bones, muscles and joints during ROM
d. Assess for Pronator drift (arms out, palms up)
e. Assess hand grip strength billaterlly
How to assess LE?
a. Feel the tone of the muscle (flaccid, clonic, normal)
b. Test for strength and resistance bilaterally
c. Palpate bones, muscles, and joints during ROM
How to assess sensory superficial sensation and touch?
Ask patient to close their eyes. Lightly touch them and ask where they feel the sensation.
How to assess coordination?
a. supination and pronation with hands (patty cake)
b. rapid movement of fingers to thumb
c. finger to nose to finger.
How to assess balance?
ROMBERG Test
Stand up with feet together and close eyes.
How to assess gait?
heel-toe walking away, then have pt walk back with normal gait.
How to close the assessment?
a. Assist pt back to comfortable pos
b. Perform hand hygiene
c. Document assessment findings.
CN I Abnormal findings
Loss of smell may be caused by an olfactory tract lesion
Nasal allergies can impair ability to smell.
CN II Abnormal findings
Lesions in the CNS (tumors) may cause peripheral visual defects. Refer to ophthalmologist for further evaluation of vision and eye function when abnormalities are suspected.
CN III, CN IV, and CN VI abnormal findings
Eye movements that are not parallel indicate oxtraocular muscle weakness or dysfunction.
Report nystagmus other than that noted as normal.
Report ptosis (eyelid droop) that may occur with ocular myasthenia gravis.
CN V or CN VII Abnormal findings
Inequality in muscle contractions, pain, twitching or asymmetry is abnormal
Disorers of the pons may cause altered functino of these.
Tic/mimic spasm is involuntary movement of small muscles.
CN IIX Abnormal findings
Weber’s Test (lateralization of sound to unaffected ear
Rinne test
CN XI Abnormal findings
weakness or pain when pushing your hand or asymmetry
Unilaterail or bilateral muscle weakness or any pain/discomfort is abnormal.
Olfactory I
Sensory: smell reception and interpretation
Optic (II)
Sensory: Visual acuity and visual fields
Occulomotor (III)
Motor: Raise eyelids, most extraocular movements
Parasympathetic: Pupilllary constriction, change lens shape
Trochlear (IV)
Motor: Downward, inward eye movement
Trigeminal (V)
Motor: Jaw opening and clenching, chewing and mastication
Sensory: Sensation to cornea, iris, lacrimal glands, conjunctiva, eyelids, forehead, nose, nasal and mouth mucosa, teeth, tongue, ear, facial skin
Abducens (VI)
Motor: Lateral eye movement
Facial (VII)
Motor: Movement of facial expression muscles except jaw, close eyes, labial speech sounds (b, m, w, and rounded vowels)
Sensory: Taste - anterior 2/3 of tongue, sensation to pharynx
Parasympathetic: Secretion of saliva and tears
Vestibulocochlear=ACoustic (VIII)
Sensory: Hearing and equilibrium
Glossopharyngeal (IX)
Motor: Voluntary muscles for swallowing and phonation
Sensory: Sensation of nasopharynx, gag reflex, taste - posterior 1/3 of tongue
Parasympathetic: secretion of salivary glands, carotid reflex
Vagus (X)
Motor: Voluntary muscles of phonation (guttural speech sounds0 and swallowing)
Sensory: Sensation behind ear and part of eternal ear canal
Parasympathetic: Secretion of digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract
Accessory, SPinal, XI
Motor: Turn head, shrug shoulders, some actions for phonation
Hypoglossal XII
Motor: Tongue movements for speech sound articulation (l, t, n) and swallowing
