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objective 12 Flashcards

1
Q

includes the brain and spinal cord

A

CNS

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2
Q

dura, arachnoid, and pia mater Along with the cerebrospinal fluid protect the CNS

A

meninges

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3
Q

12 pairs of cranial nerves; 31 pairs of spinal nerves; and all the
branches

A

PNS

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4
Q

what does the PNS carry?

A

1.Sensory (efferent) messages
2.Motor (efferent) messages
3.Autonomic messages

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5
Q

cerebrums outer later of the nerve cell bodies
centre for humans highest functions and governs: Thought, memory, reasoning, sensation, voluntary movement

A

cerebral cortex

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6
Q

what are the 4 lobes?

A

frontal, parietal, temporal, occipital

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7
Q

Form the “extrapyramidal system”. Control automatic
associated body movements

A

basal gangila

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8
Q

Main “relay station” for the nervous system

A

thalamus

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9
Q

Controls many vital functions (Blood pressure,
temperature, respirations etc.)

A

hypothalamus

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10
Q

Motor coordination of voluntary movements,
equilibrium, and muscle tone

A

cerebellum

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11
Q

central core of the brain

A

brainstem

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12
Q

what are the 3 areas of the brainstem?

A

midbrain, pons, medulla

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13
Q

Main pathway for ascending and descending fiber tracts
that connect the brain to spinal nerves

A

spinal cord

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14
Q

“The left cerebral cortex receives sensory information from, and controls
motor function to, the rights side of the body…” (p. 689)
* “The right cerebral cortex interacts with the left side of the body.”

A

crossed representation

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15
Q

Sensory fibers transmit the sensations of pain,
temperature, and crude or light touch

A

spinothalamic tract

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16
Q

Fibers conduct the sensations of position,
vibration, and finely localized touch

A

posterior columns

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17
Q

what are the sensory pathways?

A

spinothalamic tract
posterior columns

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18
Q

“Higher” motor
system, allows for very skilled and purposeful
movement

A

corticospinal or pyramidal tract

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19
Q

Maintain muscle tone and
control body movements

A

extrapyramidal tracts

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20
Q

Coordinates movement, maintains
posture and equilibrium

A

cerebellar system

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21
Q

what are the motor pathways?

A

corticospinal tract
extrapyramidal tracts
cerebellar system

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22
Q

Located completely within the CNS,
* Complex of all the descending motor fibres that influence the
lower motor neurons

A

upper motor neurons

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23
Q

Located mostly in the PNS,
* The “final common pathway”, provides final direct contact to
the muscles

A

lower motor neurons

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24
Q

Basic defense mechanism of the nervous system
* Involuntary
* Help maintain balance and muscle tone

A

reflexes

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25
Q

what are the types of reflexes

A

deep tendon, superficial, visceral, pathological

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26
Q

Enter and exit the brain
* 12 pairs of cranial nerves supply primarily the head and
neck (exception: Vagus nerve)

A

crainal nerves

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27
Q

31 pairs of spinal nerves
* Arise from the length of the spinal cord and named for the
region of the spine where they exit

A

spinal nerves

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28
Q

contain sensory and motor fibers

A

mixed nerves

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29
Q

Skin area that is supplied mainly from one spinal
cord segment through a particular spinal nerve

A

dermatome

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30
Q

if one nerve is severed most of the sensations will continue to be
transmitted by the nerve above and below

A

dermatomes overlap

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31
Q

what are the key landmarks?

A

C6,7,8 – thumb, middle finger, fifth finger
* T1 – axilla
* T4 – nipple
* T10 – umbilicus
* L1 – groin
* L4 - knee

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32
Q

what are the cultural considerations for infants?

A

The neurological system - not completely developed at birth
* Primitive reflexes direct movement in newborns
* During the first year the cerebral cortex develops and these reflexes
become inhibited and disappear
* Review the most commonly tested infant reflexes - Jarvis (2024), pp.
732-736
* Neurons are not yet myelinated
* Sensory and motor developments occur with the gradual acquisition of
myelin
* Myelinization follows a cephalocaudal order and a proximal to distal
order

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33
Q

what are the cultural considerations for older adults?

A

General atrophy occurs with aging, there is a steady
loss of neurons in the brain and spinal cord
* Results in: thinning of the cerebral cortex, reduced subcortical
brain structures, expansion of the ventricles
* Decreased muscle strength and impaired fine motor
coordination
* Dizziness and loss of balance with position change

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34
Q

Perform this examination for clients who seem healthy
and whose histories reveal no significant subjective
findings

A

neurological screening

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35
Q

Perform this examination for clients who have
neurological concerns such as headache or weakness,
or for clients who have shown signs of neurological
dysfunction.

A

complete neurological exam

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36
Q

Perform this examination for clients with demonstrated neurological
deficits who require periodic assessments.
* Hospitalized clients diagnosed with neurological deficits, such as
those caused by brain injury or disease, must be closely monitored

A

neurological recheck

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37
Q

what does monitoring of neurological recheck include?

A

Assessment for improvement or deterioration
* Assessment for signs of increased intracranial pressure
* An abbreviated neurological examination for hospitalized clients include the
following (please review pp. 738-741):
* Level of consciousnesses
* Motor function
* Pupillary response
* Vital signs

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38
Q

Used to asses the functional state of the brain as a whole
* Standardized assessment that defines level of consciousnesses
by giving it a numerical value
* Scale is divided into 3 areas: eye opening, motor response,
verbal response
* Each section scored separately and then all 3 numbers are
added together to give the total score which reflects the brain’s
function

A

glasgow coma scale

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39
Q

Valid, reliable, standardized neurological assessment tool
* Used to evaluate and monitor mentation (mental activity)
and motor function
* Can be used to predict client outcomes such as length of stay,
death, and dependency

A

canadian neurological scale

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40
Q

what equipment do we need to assess the neuro system?

A

Penlight
* Tongue blade
* Cotton swab
* Cotton ball
* Tuning fork (128 Hz or 256 Hz)
* Percussion hammer
* Familiar aromatic substances such as
peppermint and coffee
* Not routinely used (only used in certain
circumstances)

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41
Q

Not routinely tested

A

olfactory nerve (1)

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42
Q

how do we test the olfactory nerve (1)?

A

Assess the patency of each nostril first
* Ask the client to close their eyes and occlude one nostril
* Ask the client to smell a familiar aromatic substance through the open nostril

43
Q

what are the normal and abnormal findings when assessing the olfactory nerve?

A

Normal: Aromatic substance can be identified through each nostril
* Abnormal: Unilateral loss of smell when there is no nasal disease

44
Q

what do we review from the visual sensory system? (optic nerve)

A

Test visual acuity
* Test visual fields by confrontation
* Examine the ocular fundus

45
Q

what do we review when assessing nerves III, IV, VI (oculomotor, trochlear, abducens)?

A

Assess palpebral fissures
* Assess PERRLA
* Assess extraocular movements
* Assess for nystagmus

46
Q

how do we assess the trigeminal nerve motor function (V)?

A

Ask the client to clench their teeth
* The examiner palpates the temporal and masseter muscles
* The examiner tries to separate the jaws by pushing down on
the chin

47
Q

what are the normal and abnormal findings for the trigeminal nerve (V)?

A

Normal: Muscles equal in strength bilaterally, examiner
cannot separate the jaws by pushing down on the chin
* Abnormal: Decreased strength on one/both sides, asymmetry
of jaw movement, pain with clenching of the teeth

48
Q

how do we assess the trigeminal nerve (v) sensory function?

A

Tests all 3 divisions of the nerve – ophthalmic, maxillary,
mandibular
* To Test light touch sensation:
* Ask the client to close their eyes
* Brush a cotton wisp on the client’s forehead, cheeks, and
chin
* Ask the client to say “now” whenever the touch is felt

49
Q

Only perform this test if the client has abnormal facial sensation or
abnormal facial movements

A

corneal reflex?

50
Q

how do we test corneal reflex?

A

If the client is wearing contact lens, ask the client to remove them
* Ask client to look forward
* Using a cotton wisp, approach from the side and lightly touch the
cornea (careful - do not touch the conjunctiva)

51
Q

what are the normal and abnormal findings for the corneal reflex?

A

Normal: Bilateral blinking
* Consideration: Reflex may be decreased in persons who wear
contact lens
* Abnormal: No blink occurs

52
Q

how do we test motor function of the facial nerve (VII)?

A

Ask the client to smile, frown, close eyes tightly (against examiner’s
attempt to open them), lift eyebrows, show teeth, puff cheeks
* The examiner presses the puffed cheeks in – note the escape of air

53
Q

what are the normal and abnormal findings when testing the motor function of the facial nerve (VII)?

A

Normal - Symmetry and mobility in all movements, air escapes
equally from both sides when puffed cheeks pressed in
* Abnormal: muscle weakness (i.e. facial drooping on one side, escape
of air form only one cheek that is pressed in), loss of
movement/asymmetry of movement

54
Q

how do we test the sensory function of the facial nerve (VII)?

A

Only performed when facial nerve injury suspected
* To test sense of taste:
* Apply a cotton tipped applicator soaked in a solution of
sugar, salt, or lemon juice, to the tongue
* Ask the client to identify the taste

55
Q

how do we test acoustic vestibulocochlear (VII) cranial nerve?

A

Review the following from the auditory sensory system:
* Test hearing acuity (client’s ability to hear normal
conversation)
* Whispered voice test

56
Q

how do we test motor function of the glossopharyngeal and vagus nerves (IX X)?

A

Depress the client’s tongue with the tongue blade
* Ask the client to say “ahh” - assess pharyngeal movement
* Check gag reflex by touching the posterior pharyngeal wall
* Assess the client’s voice for smoothness and strain

57
Q

what are the normal and abnormal findings when testing the motor function of the glossopharyngeal and vagus nerves?

A

Normal - Uvula and soft palpate rise in the midline and tonsillar pillars move
medially when client says “ahh”, presence of gag reflex, voice is smooth and not
strained
* Abnormal - Absence or asymmetry of soft palpate movement, uvula deviates to
one side, asymmetry of tonsillar pillar movement, hoarseness of the voice etc

58
Q

how do we test the spinal accessory (XI) nerve?

A

Review the following from the musculoskeletal system:
* Assess sternomastoid and trapezius muscles for
equal size
* Assess equal strength bilaterally through resistance
* Rotate head against resistance
* Shrug shoulders against resistance

59
Q

how do we assess the hypoglossal (XII) nerve?

A

Inspect the client’s tongue for wasting and tremors
* Ask client to stick out tongue - assess for forward thrust in
midline
* Ask client to say “light, tight, dynamite” – assess lingual
speech

60
Q

what are the normal and abnormal findings for assessing the hypoglossal nerve?

A

Normal - no wasting or tremors present, forward thrust of
tongue in midline, sounds of letters l, t, d are clear and
distinct
* Abnormal - atrophy, fasciculation’s, tongue deviation, lingual
speech is not clear or distinct

61
Q

how do we assess the size of the musculoskeletal system?

A

Assess all muscle groups for bilateral symmetry, and whether
within normal size limits for age
* Measure size if appear asymmetrical

62
Q

what are the normal and abnormal findings when assessing the size of the musculoskeletal system?

A

Normal - bilateral symmetry, size within normal limits for
age
* Abnormal - atrophy, hypertrophy

63
Q

how do we test strength of the musculoskeletal system and what are the normal and abnormal findings?

A

est the following muscle groups: Extremities, neck, and trunk
* Findings:
* Normal - equal bilaterally, fully resist opposing force
* Abnormal - paresis, paralysis (plegia)

64
Q

how do we test tone of the musculoskeletal system and what are the normal and abnormal findings?

A

To test:
* Ask the client to relax
* Move the client’s extremities through passive ROM
* Findings:
* Normal - mild resistance to movement
* Abnormal - flaccidity, spasticity, and rigidity

65
Q

how do we test involuntary movements and what are the normal and abnormal findings?

A

If present, note the location, frequency, rate, amplitude,
and whether they can be controlled by the client
* Findings:
* Normal: none present
* Abnormal - presence of tic, tremor, fasciculation,
myoclonus etc.

66
Q

how to we assess gait?

A

Observe the client walk 3-6 meters, turn, and return to
where they started
* Ask the client to perform tandem walking (walking a
straight line, heel-to-toe)
* Ask the client to walk on their toes and then on their
heels for a few seconds

67
Q

what are the normal and abnormal findings when assessing gait?

A

Normal
* Gait: Gait and turn is smooth; gait is rhythmic, effortless,
opposing arm swing is coordinated, step length 30 cm from heel
to heel
* Tandem walking: Client walks straight and maintains their
balance
* Client is able to walk on their toes and heels
* Abnormal findings
* Gait: Stiff immobile posture, lack of arm swing, staggering,
requires a wide base of support, ataxia
* Tandem walking: Crooked line of the walk, staggering, widening
of base for support, ataxia
* Unable to toe and heel walk

68
Q

how do we do the Romberg test?

A

Ask the client to stand with their feet together and arms at their sides
* Ensure the client is in a stable position
* Instruct client to close their eyes and hold their position for
approximately 20 seconds

69
Q

what are the normal and abnormal findings for the Romberg test?

A

Normal - client can maintain their balance even with their eyes closed
* Normal variation - slight swaying may occur
* Abnormal - swaying, widening base of feet to avoid falling

70
Q

what is the shallow knee bend test?

A

Ask client to perform a shallow knee bend or to hop in place,
one leg at a time

71
Q

what are the normal and abnormal findings for the shallow knee test?

A

Normal - normal position sense, muscle strength, cerebellar
function
* Consideration - some clients may not be able to do this due to
aging or obesity
* Abnormal: Inability to perform knee bend related to weakness
in quadriceps muscle or hip extensors

72
Q

how do we assess rapid alternating movements, what are the normal findings?

A

Pat the knees with both hands, lift up and turn over the
hands, then pat knees with back of the hands
* Ask the client to increase the speed
Normal - Client is able to perform the actions with equal
turning and quick rhythmic pace

73
Q

what is another way to test rapid alternating movements? what are the normal and abnormal findings?

A

Touch their thumb to each finger on the same hand
* Instruct the client to start with the index finger then reverse
direction
* Findings:
* Normal - performed quickly and accurately
* Abnormal: Lack of coordination

74
Q

what is the finger-to-finger test? what are the normal and abnormal findings?

A

Keep their eyes open
* Instruct the client to touch their index finger to the
examiner’s finger and then to their nose
* After a few times, the examiner moves their finger to a
different spot
* Findings:
* Normal - movement is smooth and accurate
* Abnormal: Dysmetria and past pointing

75
Q

what is the finger-to-nose test? what are the normal and abnormal findings?

A

Ask the client to close their eyes and stretch out their arms
* Instruct the client to touch the tip of their nose with each
index finger, alternating hands
* Ask the client to increase the speed
* Findings:
* Normal - movement is smooth and accurate
* Abnormal - client’s finger misses their nose

76
Q

what is the heel-to-shin test? what are the normal and abnormal findings?

A

Ask client to lie supine and to place their heel on the opposite
knee
* Instruct the client to run their heel down the shin from the
knee to the ankle
* Findings:
* Normal - client can move their heel down their shin in a
straight line
* Abnormal - the client’s heel falls off their shin (lack of
coordination)

77
Q

how do we test pain? what are the normal and abnormal findings?

A

Lightly touch the sharp point or dull end in a random order
* Leave 2 seconds between each application to avoid summation
* The sharp point tests for pain, the dull edge is a general test of the client’s
responses
* Ask the client to say “sharp” or “dull” to indicate the sensation felt
* Findings:
* Normal - able to perceive the stimulus of pain (correct identification)
* If this assessment reveals abnormal findings, perform an assessment of
temperature (p. 720)

78
Q

how to we test light touch? what are the normal an abnormal findings?

A

Brush a cotton wisp over the skin
* Use random sites at irregular intervals
* Include the forearms, hands, chest, thighs, and legs
* Ask client to say “now” when the touch is felt
* Findings:
* Normal - correct identification

79
Q

how do we test vibration? what are the normal and abnormal findings?

A

The examiner activates the tuning fork by striking it on the heel of
their hand
* Use a 128 or 256 Hz tuning fork because vibration has a slower
decay
* Hold the tuning fork over a bony surface on the client’s great toe or
fingers
* Ask client to state when the vibration starts and stops
* Findings:
* Normal - client feels vibration in these areas, no need to test
further
* Abnormal: inability to feel vibration

80
Q

how do we test tactile discrimination?

A

These tests also measure discrimination ability of the sensory
cortex
* Important prerequisite for testing: Client must have a normal
(or near normal) sense of touch and a normal position sense

81
Q

how do we test kinaesthesia? what are the normal and abnormal findings?

A

The examiner moves the client’s finger or great toe up and
down
* Vary the order of movement
* Hold the finger/great toe by the sides
* Ask the client to tell state which way it moved
* Findings:
* Normal - client can detect movement of a few millimeters
* Abnormal - loss of position sense

82
Q

how do we test stereognosis? what are the normal and abnormal findings?

A

Place a familiar object in the client’s hand and ask the
client to identify it
* Test a different object in each hand
* Findings:
* Normal - the client can identify the object by feeling it with
their fingers
* Abnormal - problems with tactile discrimination

83
Q

how do we test graphesthesia? what are the normal and abnormal findings?

A

Use a blunt instrument to trace a single-digit number or a
letter on the client’s palm
* Ask the client to identify the number or letter
* Findings:
* Normal - correct identification of the number or letter
* Abnormal: Inability to identify the number or letter

84
Q

what is two-point discrimination? what are the normal and abnormal findings?

A

Touch 2 points of an opened paper clip lightly to the skin
* Keep narrowing the distance between the 2 points
* Note the distance that the client no longer perceives the 2 separate
points
* The level of perception varies with the area being tested
* Fingertips (2-8 mm) most sensitive region
* Thigh/upper arms/back (40-75 mm) least sensitive regions
* Findings:
* Normal - Distance to identify two separate points within expected
range
* Abnormal - Distance to identify two separate points is increased

85
Q

how do we test extinction? what are the normal and abnormal findings?

A

At the same time, touch both sides of the body at the same
point
* Ask the client to state where and how many sensations are
felt
* Findings:
* Normal - both sensations are felt
* Abnormal - client only recognizes one sensation

86
Q

how do we test point location? what are the normal and abnormal findings?

A

Touch the client’s skin, then withdraw immediately
* Ask client to put their finger on the place where the
examiner touched their skin
* Findings:
* Normal - client correctly identifies the area
* Abnormal - client incorrectly identifies the area

87
Q

how do we test deep tendon reflexes?

A

Ensure the client’s limb is relaxed with the muscle partially
stretched
* Use the reflex hammer to deliver a short, snappy blow onto
the muscle’s insertion tendon
* Use a relaxed hold on the hammer with action taking place at
the wrist
* Strike a brief blow and bounce up promptly
* Use the appropriate part of the hammer for the target:
* Use the pointed end for aiming at smaller targets
* Use the flat end for aiming at a wider target, or to diffuse
impact and prevent pain

88
Q

what is the 5 point scale for deep tendon reflexes?

A

4+ Very brisk, hyperactive with clonus, indicates disease
3+ Brisker than average, may indicate disease
2+ Average, normal
1+ Diminished, low normal
0 No response

89
Q

there is a wide range of normal responses.
Therefore, the results of this test should be used in
conjunction with other results obtained during the
neurological exam

A

normal response of deep tendone reflex

90
Q

exaggerated reflex, upper motor neuron
disease

A

hyperreflexia

91
Q

reduced functioning of the reflex, lower motor
neuron disease

A

hyporeflexia

92
Q

used to relax the muscles and enhance the
response

A

reinforcement

93
Q

how do we use reinforcement?

A

1.Ask the client to perform an isometric exercise (this should be performed in a
muscle group away from the one being tested)
2.Once the client is performing the exercise, strike the tendon
* Examples:
* To enhance a biceps response, ask client to clench their teeth
* To enhance a patellar response, ask client to lock their fingers together and
pull

94
Q

how do we test biceps reflex? what are the normal and abnormal findings?

A

Support client’s forearm on their forearm
* Place their thumb on the client’s biceps tendon
* Strikes their thumb with the reflex hammer
* Findings:
* Normal response - contraction of the client’s biceps muscle
and flexion of the client’s forearm

95
Q

how do we test triceps reflex? what are the normal and abnormal findings?

A

Hold the client’s upper arm to suspend it
* Instruct the client to let their arm “go limp”
* Strike the triceps tendon directly (location is just above the
elbow)
* Method Two (alternate method)
* To test, the examiner should:
* Hold the client’s wrist across their chest to flex the client’s
arm at the elbow
* Strike the triceps tendon directly
* Findings:
* Normal response - extension of the client’s forearm
12.8 Deep Tendon Reflexes

96
Q

how do we test brachioradialis reflex? what are the normal and abnormal findings?

A

Hold the client’s thumb to suspend and relax the forearm
* Strike the forearm directly 2-3 cm above the radial styloid
process
* Findings:
* Normal response - flexion and supination of the forearm

97
Q

how do we test quadriceps and archilles reflex? what are the normal and abnormal findings?

A

Ask the client to dangle their legs freely (this flexes the
client’s knee and stretches the tendon)
* Strike the quadriceps tendon directly (location is just below
the patella)
* Findings:
* Normal - extension of the lower leg; contraction of the
quadriceps muscle palpable

98
Q

how do we test achilles reflex? what are the normal and abnormal findings?

A

Position the client so their knee is flexed and their hip is
externally rotated
* Hold the client’s foot in dorsiflexion
* Strike the Achilles tendon directly
* Findings:
* Normal response - the examiner can feel the client’s foot
plantar flex against their hand

99
Q

located in the skin

A

sensory receptors

100
Q

localized muscle contraction

A

motor response

101
Q

how do we test abdominal reflex? what are the normal and abnormal findings?

A

Ask the client to lie in the supine position with their knees slightly
bent
* Use the handle of the reflex hammer to stroke the skin from the side
of the abdomen toward the midline
* This is performed at the upper level and lower level of the
abdomen
* Findings:
* Normal response - ipsilateral contraction of the client’s abdominal
muscle and an observed deviation of the umbilicus toward the stroke
* Abnormal response- absence of the reflex

102
Q

how do we test cremasteric reflex? what are the normal and abnormal findings?

A

Lightly stroke the inner aspect of the client’s thigh with the
reflex hammer
* Findings:
* Normal response - elevation of the ipsilateral testicle
* Abnormal response - absent reflex

103
Q

how do we test the plantar reflex? what are the normal and abnormal findings?

A

Place the client’s thigh in slight external rotation
* Use the handle of the reflex hammer (bottom part) to lightly stroke an upside
down J shape on the bottom of the foot
* Lightly stroke up the lateral side of the sole of the foot and continue inward
across the ball of the foot
* Findings:
* Normal response - plantar flexion of the toes; inversion and flexion of the
forefoot
* Abnormal response - positive Babinski sign
* A positive Babinski sign is dorsiflexion of the big toe and fanning of all toes

Health assessment (11 decks)

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