NSG 1610 - Neurological System/Assessment Flashcards
What is the function of the cerebral cortex?
divides into left and right hemispheres with 4 lobes
What is the function of the basal ganglia?
controls autonomic associated movements (i.e., swinging arms while walking)
What is the function of the thalamus?
main relay station - sensory pathway to the brainstem and spinal cord
What is the function of the hypothalamus?
control center - temperature, HR, BP, sleep, pituitary gland (hormones), coordinates autonomic nervous system
What is the function of the cerebellum?
motor coordination and voluntary movements - equilibrium, muscle tone, coordinate and smooth movement
What is the function of the brainstem?
collection of nerve fibres, midbrain, pons, medulla
What is the function of the spinal cord?
main pathway for ascending and descending - connects the brain to the spinal nerves
what are the protective mechanisms of the brain?
CSF, blood-brain barrier, and meninges
What are the 12 cranial nerves?
I - olfactory
II - optic
III - oculomotor
IV - trochlear
V - trigeminal
VI - abducens
VII - facial
VIII - acoustic
IX - glossopharyngeal
X - vagus
XI - spinal
XII - hypoglossal
What is the function of cranial nerves I and II? Are they sensory, mixed, or motor?
- both are sensory
- smell and visual acuity
What is the function of cranial nerves III and IV? Are they sensory, mixed, or motor?
- Mixed and motor
- functions to control pupillary reflex and extraocular eye movement
- Controls lateral and downward movement of the eyeball
What is the function of cranial nerves V and VI? Are they sensory, mixed, or motor?
- mixed and motor
- sensations of the cornea, skin of the face, and nasal mucosa
- controls lateral movement of the eyeball
What is the function of cranial nerves VII and VIII? Are they sensory, mixed, or motor?
- mixed and sensory
- VII motor - movement and strength of the facial muscles
- VII sensory - taste on the anterior 2/3 of the tongue
- ability to hear
What is the function of cranial nerves IX and X? Are they sensory, mixed, or motor?
- both are mixed
- swallowing, allows the soft palate to rise symmetrically and the uvula to remain in midline & taste (sensory)
- pharynx/larynx for talking and swallowing (motor) & carotid body and carotid reflex (sensory)
What is the function of cranial nerves XI and XII? Are they sensory, mixed, or motor?
- both motor
- controls movement of the trapezius and sternomastoid muscles, which should be equal and strong
- supplies the intrinsic and extrinsic muscles of the tongue
How many pairs of spinal nerves are there? How many within each spinal region?
- 31 pairs
- Cervical (8)
- Thoracic (12)
- Lumbar (5)
- Sacral (5)
- Coccygeal (1)
What are dermatomes?
level of the skin innervated by specific spinal nerves
Dermatomes are the area of skin supplied by cutaneous branches of a single cranial or spinal nerve
What are the differences between somatic and autonomic nerve fibres?
- somatic is skeletal, voluntary muscles
- autonomic is smooth, involuntary muscles
What is the purpose of the sensory pathways in the CNS?
Focuses on skin, muscles, tendons, organs, and mucous membranes
Allow our body to monitor conscious sensations (perception of temperature and pain), internal organ functions, reflexes and body positions
What are assessing in the posterior (dorsal) columns of the brain?
Assessing the client’s ability to determine position without looking (proprioception), vibration (striking a tuning fork and placing it near either a toe or finger joint)
what is stereogenesis?
testing a client’s ability to close their hand around a common/familiar object and tell us what it is with their eyes closed
what are we assessing in the spinothalamic tract?
Assessing the client’s ability to have transmitting sensations of pain, temperature, crude or light touch (transmitted to the thalamus which travels to sensory cortex of the brain for interpretation)
what is the function of the corticospinal/pyramidal tract?
mediates voluntary movement, skilled and purposeful movements
what is the purpose of the extrapyramidal tracts?
maintains our muscle tone and allows us to have controlled body movements (no jerking or spasticity)
what is the function of the cerebellar system?
coordinates our movements, maintains equilibrium, and helps us to maintain posture
what is the function of the upper motor neurons?
influence or modify lower motor neurons and are originating from the upper spinal cord
what is the function of the lower motor neurons?
located mostly in the PNS and have control of the trunk/legs, along with some arm movements
Which part of the spine is associated with the biceps and brachioradialis reflex?
C5-C6
Which part of the spine is associated with the triceps reflex?
C7-C8
Which part of the spine is associated with the quadriceps/patellar reflex?
L2-L4
Which part of the spine is associated with the achilles reflex?
L5-S2
Which part of the spine is associated with the superficial plantar reflex?
L4-S2
Which of the reflexes are testing deep tendons?
biceps, triceps, brachioradialis, quadriceps/patellar
describe the reflex scale and what each number relates to
0 no detectable response
1+ sluggish, minimal response
2+ immediate, strong response (expected/normal)
3+ brisker than expected
4+ very brisk response, hyperactive, clonus observed
define ptosis
upper eyelid drooping
define strabismus
both eyes not lining up in the same direction
define atrophy
wasting away or degeneration of muscles, cells, etc.
define hypertrophy
increase of muscle mass - building of cells
define paresis
muscular weakness caused by nerve damage - partial paralysis
define flaccidity
condition of being soft or limp
define hypo/hyper algesia
capacity to feel pain
define hypo/hyper aesthesia
to experience sensation, perception, or sensitivity
What could difficulties in performing rapid alternating movements or finger-to-finger tests indicate damage in?
the cerebellum and coordination
What 12 questions should you ask when obtaining subjective data in a neuro assessment?
- headache
- head injury
- dizziness/vertigo
- seizures
- tremors
- weakness
- incoordination
- numbness/tingling sensations
- difficulty swallowing
- difficulty speaking
- significant past history
- environmental and occupational considerations
what are the two types of vertigo? describe them
- subjective - the individual feels they are spinning while the room stays still
- objective - the room is spinning while the individual remains still
What are 4 additional subjective data questions you would ask older adults during a neuro assessment?
- risk for falls
- cognitive function
- tremor
- vision (changes to)
When would you complete a screening neurological exam?
in a healthy pt. with no significant health hx issues
when would you complete a complete neurological exam?
pt. who has neurological concerns, noticing signs of dysfunction
when would you complete a neurological re-check exam?
pt. showing deficits or changes that need to be re-assessed (worsening or improving)
How would you test cranial nerve I?
OLFACTORY NERVE
client occludes one nostril, takes a deep breath in (both sides).
Then, pt. closes the eyes and is instructed to smell an object
How would you test cranial nerve II?
OPTIC NERVE
- use Snellen chart to determine visual acuity
How would you test cranial nerve III, IV, VI?
OCULOMOTOR, TROCHLEAR, ABDUCENS
inspect pt. for uniform opening of upper/lower eyelids (palpebral fissure). Assess PERRLA and six cardinal positions of gaze. Looking for nystagmus, unilateral drooping, and pupil size.
How would you test cranial nerve V?
TRIGEMINAL
(Motor) feel pt. open/close their jaw. Then, get pt. to grit their teeth and try to separate jaw. Looking for crepitus and other ailments.
(Sensory) Test sensation of 3 facial zones (forehead, middle face, and chin/lower jaw). Pt. closes eyes and you ask where you are touching w/ cotton ball.
How would you test cranial nerve VII?
FACIAL
pt. smiles, frowns, lifts their eyebrows, shows teeth, closes eyes (you try to force them open), and puffs cheeks (you try to press them in)
How would you test cranial nerve VIII?
VESTIBULOCOCHLEAR
complete the whisper voice test
How would you test cranial nerves IX and X?
GLOSSOPHARYNGEAL and VAGUS
depress pt. tongue and get them to say “ahh”. Looking for uvula to move up.
How would you test cranial nerve XI?
SPINAL ACCESSORY
pt. turns their head one way and you try to force their head the opposite way.
How would you test cranial nerve XII?
HYPOGLOSSAL
pt. sticks tongue out. Then with tongue in their mouth, pt. says “light, tight, dynamite”
What are we looking for during our inspection and palpation of the muscles in a neuro assessment?
size, strength, tone, and involuntary movements
What two tests should you perform to test balance and gait in a neurological assessment?
- gait - pt. walks 3-6m one way and back OR heel to toe test
- the romberg test - pt. has feet shoulder width apart, closes eyes and tries to stay standing in position (looking for loss of balance)
What 4 tests can we perform to test coordination and skilled movements during a neurological assessment?
- rapid alternating movements (palms on knees, alternate palmar and dorsal as fast as possible OR thumb to each consecutive finger)
- finger-to-finger test (pt. touches their finger to yours then touch their nose)
- finger-to-nose test (pt. stands with eyes closed and arms spread horizontally & touch R index finger to nose, followed by L)
- heel-to-shin test (pt. runs heel down shin in a proximal to distal motion)
What three things are we testing for in the spinothalamic tract (sensory) and how do we test them?
- pain (use sharp/dull ends of q-tip across pt. body and ask them which end is being used. Min. 2 secs between each test)
- temperature (only tested if pain results are abnormal)
- light touch (use cotton ball, ask pt. to tell you when they feel touch)
What three things are we testing for in the posterior column (sensory)? How do you test them?
- vibration - apply tuning fork on second joint of index finger and pt. states when the vibration starts and stops
- position (kinaesthesia) - pt. closes eyes, passively manipulate finger or big toe, ask whether pointing up or down
- tactile discrimination (fine touch) - has five tests (stereo genesis, graphesthesia, two-point discrimination, extinction, and point location)
How do you perform each of the five tactile discrimination tests?
- Stereognosis – pt. closes eyes, place familiar object in their hand and ask what it is
- Graphesthesia – pt. closes eyes, trace either a letter or number in their palm
- Two-point discrimination – can pt. recognize you are touching 2 points at a time
- Extinction – pt. states whether your are touching L/R or both sides
- Point location – touch pt. and they identify where they are being touched
What 4 things should you assess during a neurological re-check?
- LOC (person, place, time)
- motor function (facial movements, upper extremities, and lower extremities)
- pupillary response (PERRLA)
- vital signs (temp, pulse, resp.)
What is dysarthria?
Difficulty forming words
What is anosmia?
Decrease or loss of smell
List the three sections of the Glasgow Coma Scale
- Eye opening response
- Motor response
- Verbal response
Describe the eye opening response scale for GCS
4-point scale:
1. No response
2. Response to pain
3. Response to speech
4. Spontaneous
Describe the motor response scale for GCS
6-point scale:
1. No response
2. Abnormal extension
3. Abnormal flexion
4. Withdrawal flexion to stimulus
5. Localizes pain stimulus
6. Obeys verbal commands
Describe the verbal response scale for GCS
5-point scale:
1. No response
2. Speech incomprehensible
3. Speech inappropriate
4. Conversation confused
5. Oriented x3, appropriate
Match the following terms
- Expressive aphasia
- Wernicke’s aphasia
- Global aphasia
- Receptive aphasia
- Most common and severe
- Broca’s aphasia
- Broca’s aphasia = expressive aphasia
- Wernicke’s aphasia = receptive aphasia
- Global aphasia = Most common and severe
