NM Examination Flashcards
Determine LOC (arousal)
7 levels
Alertness Lethargy Obtundation Stupor Coma Unresponsive vigilance (vegetative) state Minimally conscious state (MCS)
Pt can open eyes, look at examiner, respond fully/appropriately
Alert
Can be aroused from sleep only with painful stimuli, verbal responses slow/absent, pt returns to unresponsive state when stimuli are removed, demonstrates minimal awareness of self/environment
Stupor
Pt appears drowsy, can open eyes and look at examiner, respond to questions but falls asleep quickly
Lethargy
Can open eyes, look at examiner, responds slowly and is confused, demonstrates decreased alertness and interest in environment
Obtundunded
State of unconsciousness from which patient cannot be aroused, eyes remain closed, no response to external stimuli or environment
Coma
State characterized by return of sleep/wake cycles, normalization of vegetative functions (HR, resp, BP, digestion) and lack of cognitive responses (can be aroused but unaware)
Unresponsive vigilance (vegetative) state
Persistent vegetative state is lasting > __ for TBI and > __ for anoxic brain injury
1 year
3 months
state characterized by severely altered consciousness with minimal awareness but definite evidence of self or environmental awareness
Minimally conscious state (MCS)
Non-fluent aphasia/expressive aphasia
BROCA’S motor aphasia
Where is lesion for non-fluent aphasia
involves the 3rd convolution of the L hemisphere (Broca’s area)
Impairment of volitional articulation control secondary to cortical, dominant hemisphere lesion
Verbal apraxia
Impairment of speech production from damage to central or peripheral nervous system, causes paralysis, weakness, or incoordination of motor-speech system
Dysarthria
Fluent aphasia
Wernicke’s aphasia
Fluent aphasia is result of lesion where?
Posterior first temporal gyrus of L hemisphere (Wernicke’s area)
Period of apnea lasting 10-60 seconds followed by gradually increasing depth and frequency of respirations
Cheyene-Stokes respiration
Cheyenne-stokes accompanies depression of _____ lobe and _____ dysfunction
Frontal
Diencephalic
Hyperventilation accompanies dysfunction of ____ and ___
Lower midbrain, pons
Abnormal respiration marked by prolonged inspiration
Apneustic breathing
Apneustic breathing accompanies damage to ____
Upper pons
Increased temperature may indicate ____ (3)
Infection
Damage to hypothalamus
Damage to brainstem
What is Kernig’s Sign?
Pt in supine, flex hip and knee fully to chest, then extend knee
(+) is pain and increased resistance to extending the knee due to spasm of hamstring when bilateral suggests meningeal irritation
What is Brudzinski’s sign?
Pt supine, flex neck to chest
(+) causes flexion of hips and knees (drawing up) suggests meningeal irritation
8 things to assess for meningeal irritation or CNS infection
- Signs are global, not focal
- Neck mobility
- Kernig’s sign
- Brudzinski’s sign
- Irritability
- Slowed mental function
- Altered vital signs
- Generalized weakness
8 things to examine for increased ICP secondary to cerebral edema/brain herniation
- Altered level of consciousness
- Altered vital signs
- Headache
- Vomiting
- Pupillary changes (CN III signs)
- Papilledema at entrance to eye
- Progressive impairment of motor function
- Seizure activity
