Neurovascular and PEARRLA Flashcards

1
Q

Explain the word structure of “Neurovascular”.

As in, Neurovascular Assessment.

A

Neuro:
Sensory and Motor function.

Vascular:
Peripheral circulation.

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2
Q

What are we looking for when we perform a Neurovascular Assessment of the extremities?

A

We are looking for compromised blood flow and/or nerve damage.

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3
Q

What are the 5 P’s of a Neurovascular Assessment?

A
  1. Pain,
  2. Pallor/Circulation,
  3. Paralysis,
  4. Paresthesia,
  5. Pulse.
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4
Q
  1. What sensation do we commonly call Paresthesia?
  2. Paresthesia may also include…?
  3. Paresthesia may indicate…?
A
  1. “Pins and Needles”.
  2. May also include numbness or tingling.
  3. May indicate inadequate circulation or nerve damage.
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5
Q

Neurovascular Assessment - Pallor/Circulation.

What are 3 things we check when it comes to pallor?

Pallor = Paleness or lack of colour compared to normal

A
  1. Colour/appearance of extremity. ie. pink, pale, shiny, cyanotic.
  2. Temperature.
    ie. warm, cool, cold.
  3. Cap refill (All 10 toes on lower limb injuries).
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6
Q

Neurovascular Assessment - Pallor/Circulation.

Warm and cyanotic extremity may indicate what?

A

May indicate poor venous return.

AKA, Chronic Venous Insufficiency (CVI).

A condition in which veins have a hard time moving blood back to the heart.

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7
Q

Neurovascular Assessment - Pallor/Circulation.

Explain Cyanosis/Cyanotic

A

It’s a bluish-purple discolouration of the skin due to a lack of oxygen in the blood.

Most easily seen where the skin is thin.
eg. lips, mouth, earlobes, finger nails.

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8
Q

Neurovascular Assessment - Pulse

Looking for?

A
  1. Rate,
  2. Rhythm,
  3. Strength/Quality.

Check both injured and un-injured side.

  • Diminished or absent pulse distal to the injury may indicate vascular dysfunction.
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9
Q

Neurovascular Assessment - Paralysis

  1. How can we test this?
  2. What are we looking for?
  3. Loss of function may indicate what?
A
  1. Ask the pt to wiggle their toes.
  2. Checking if there is an inability to move the limb distal to the injury.
  3. Loss of function may indicate muscle and/or nerve damage.
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10
Q

For each of the 5 P’s of a Neurovascular Assessment, we must remember what?

A

Both the injured AND unaffected extremity should be checked.

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11
Q

Neurovascular Assessment - Paresthesia.

In addition to asking pt about numbness/tingling, What simple test can we do to check for altered sensation?

A

Check sensation by touching toes/heels and ask pt if they can feel it.

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12
Q

Why would we assess a patients pupils?

P E R R L A

A

Changes in a patient’s pupil reaction, size or shape, together with other neurological signs, may indicate raised intracranial pressure (ICP) and compression of the optic nerve.

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13
Q

P E R R L A

Pupil assessment assist in identifying ICP (increased intracranial pressure).

ICP may be a result of what?

A
  1. Bleed on the brain,
  2. Tumor,
  3. Aneurysm,
  4. Stroke,
  5. HTN,
  6. Brain infection
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14
Q

Direct light reflex

Consensual light reflex

A

Direct = Gauge the response of the pupil you shine light on.

Consensual = Gauge the response of pupil that is NOT being stimulated by the light (Should react he same).

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15
Q

Pupil accommodation

A

Refers to your eyes’ ability to change focus.

When you look at something far wary, your pupils dilate.

When you look at something that is near, your pupils constrict.

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16
Q

Pupil accommodation test technique

A

Pt focuses on object arms length from pt eyes.

Object is brought gradually closer to pt eyes.

Observe accommodation and convergence.

17
Q

What is Anasocoria?

“Ana-suh-kaw-ree-uh”

A

Unequal pupil size (at least 1mm different).

About 15% of ppl experience anasocoria at some point in their lives.

Anasocoria can be either physiological or physiological. Physiological anasocoria is more common.