Neurovascular and PEARRLA

Question 1

Explain the word structure of “Neurovascular”.

As in, Neurovascular Assessment.

Answer 1

Neuro:
Sensory and Motor function.

Vascular:
Peripheral circulation.

Question 2

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

Answer 2

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

Question 3

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

Answer 3

1. Pain,
2. Pallor/Circulation,
3. Paralysis,
4. Paresthesia,
5. Pulse.

Question 4

1. What sensation do we commonly call Paresthesia?
2. Paresthesia may also include…?
3. Paresthesia may indicate…?

Answer 4

1. “Pins and Needles”.
2. May also include numbness or tingling.
3. May indicate inadequate circulation or nerve damage.

Question 5

Neurovascular Assessment - Pallor/Circulation.

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

Pallor = Paleness or lack of colour compared to normal

Answer 5

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).

Question 6

Neurovascular Assessment - Pallor/Circulation.

Warm and cyanotic extremity may indicate what?

Answer 6

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.

Question 7

Neurovascular Assessment - Pallor/Circulation.

Explain Cyanosis/Cyanotic

Answer 7

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.

Question 8

Neurovascular Assessment - Pulse

Looking for?

Answer 8

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.

Question 9

Neurovascular Assessment - Paralysis

1. How can we test this?
2. What are we looking for?
3. Loss of function may indicate what?

Answer 9

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.

Question 10

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

Answer 10

Both the injured AND unaffected extremity should be checked.

Question 11

Neurovascular Assessment - Paresthesia.

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

Answer 11

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

Question 12

Why would we assess a patients pupils?

P E R R L A

Answer 12

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.

Question 13

P E R R L A

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

ICP may be a result of what?

Answer 13

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

Question 14

Direct light reflex

Consensual light reflex

Answer 14

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).

Question 15

Pupil accommodation

Answer 15

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.

Question 16

Pupil accommodation test technique

Answer 16

Pt focuses on object arms length from pt eyes.

Object is brought gradually closer to pt eyes.

Observe accommodation and convergence.

Question 17

What is Anasocoria?

“Ana-suh-kaw-ree-uh”

Answer 17

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.