OMED 1401 - Advanced Patient Assessment (NEUROLOGICAL ASSESSMENT)

Question 1

What are Some Red Flags of a Neurological Episode?

Answer 1

Pupillary Changes
Abnormal Motor Function
Abnormal Sensation
Abnormal Tone
Increased CO2
Transient Loss of Consciousness
Reduced GCS
Memory Loss
Head Injuries
Asymmetrical Pupils (Do not React to Light) - Raised Inter-Cranial Pressure. §§§

Question 2

How to History Take in a Neurological Case?

Answer 2

Red Flags - Especially Impaired Mental Status, Headaches, Seizures, Syncope, Confusion.
Parathesis - Pins and Needles
Ataxia - Loss of Muscle Co-Ordination
Dysarthria - Difficulty Articulating Words
Dysphagia - Difficulty in Swallowing
Dysphasia - Difficulty in Speaking.

Question 3

What Vital Signs should be Gathered in a Neurological Episode?

Answer 3

AVPU/GCS
Blood Pressure
Pupils
Blood Glucose
Pulse
Respiratory Rate
Temperature
Oxygen Saturation
End-Tidal CO2

Question 4

What is SNOOP?

Answer 4

Systemic Signs
Neurological Symptoms
Onset new or Changed and Patient >50 Year Old
Onset in Thunderclap Presentation
Papiledema, Pulsate Tinnitus, Positional Provocation, Precipitated by Exercise.
Palpiedema - Swelling of the Optic Nerve causing Visual Disturbances.
Pulsatile Tinnitus - Sound of Blood Circulating in/Near Patients Ears.
Positional Provocation - Affected by Movement and Position.

Question 5

What is Meningitis and the Signs and Symptoms?

Answer 5

Viral Meningitis most Common, Followed by Bacterial Meningitis.
Most Common Types ate Meningococcal, Pneumococcal, TB, Group B Strep and E. coli.
No Vaccine Protects against all Types.
Bacteria can Lead to Septicaemia.
SIGNS AND SYMPTOMS
- Headaches
- Altered Mental Status
- Phonophobia
- Fatigue
- Severe Muscle Pain
- Dislike Bright Lights
- Nausea
- Vomitting
- Paleness
- Spots or Rash
- Blotchy.

Question 6

What are the Different Strokes?

Answer 6

Ischaemic Stroke - Caused by a Blockage Cutting off Blood Supply to the Brain.
Haemorrhage Stroke - Caused by a Bleed in/Around the Brain.
Transient Ischaemic Attack (TIA) - Temporary Blockage, Lasts <24 Hours.

Question 7

What are the Different Nerves, Functions and Assessments?

Answer 7

I. Olfactory (Sensory) - Smell. Have Patient Identify a Familiar Scent with Eyes Closed. (Usually Deferred)
II. Optic (Sensory) - Vision (Acuity and Field of Visions); Pupil Reactivity to Light & Accommodation (Afferent Impulse). Have Patient read from a Card or Newspaper, one Eye at a Time, Test Visual Fields by having Patient cover one Eye, Focus on your Nose, and Identify the Number of Finger you’re Holding up in each of Four Visual Quadrants.
III. Oculomotor (Motor) - Eyelid Elevation: Most EOMs; Pupil Size and Reactivity (Efferent Impulse). Check Pupillary Responses by Shining a Bright Light on One Pupil; Both Pupils shoul Constrict. Do the Same for the Other Eye. To Check Accomodation, move your Finger toward the Patient Nose, the Pupils should Constrict and Converge. Check EOMs by having Patient look up, down, Laterally and Diagonally.
IV. Trochlear (Motor) - EOM (Turns Eye Downward and Laterally). Have Patient Look Down and in.
V. Trigeminal (Both) - Chewing; Facial and Mouth Sensation; Corneal Reflex (Sensory). Ask Patient to Hold the Mouth Open while you try to Close it and to Move the Jaw Laterally against your Hand. With Patient’s eyes Closed, touch her Face with Cotton and have her Identify the Area Touched. In Comatose Patients, Brush the Cornea with a Wisp of Cotton, The Patient should Blink.
VI. Abducens (Motor) - EOM (Turns Eye Laterally). Have Patient move the Eyes from Side to Side.
VII. Facial (Both) - Facial Expression; Taste; Corneal Reflux (Motor) Eyelid and Lip Closure. Ask Patient to Smile, Raise Eyebrows and Keep Eyes and Lips Closed while you Try to Open them. Have Patient Identify Salt or Sugar Placed on the Tongue (Usually Deferred).
VIII. Acoustic/Vestibularcochlear (Sensory) - Hearing, Equilibrium. To Test Hearing, use Tuning Fork or Rub your Fingers, Place a Ticking Watch, or Whisper Near Each Ear. Equilibrium Testing is usually Deferred.
IX. Glossopharyngeal (Both) - Gagging and Swallowing (Sensory); Taste. Touch Back of Throat with Sterile Tongue Depressor or Cotton-Tipped Applicator. Have Patient Swallow.
X. Vagus (Both) - Gagging and Swallowing (Motor); Speech (Phonation). Assess Gag and Swallowing with CN IX. Assess Vocal Quality.
XI. Spinal Accessory (Motor) - Shoulder Movement, Head Rotation. Have Patient Shrug Shoulders and Turn Head from Side to Side (Not Routinely Tested).
XII. Hypoglossal (Motor) - Tongue Movement, Speech (Articulation). Have Patient Stick out Tongue and Move it Internally from Cheek to Cheek. Assess Articulation.
TEST NERVES 2,3,4,6 AT THE SAME TIME

Question 8

What is a Cerebellar Function Test?

Answer 8

Use in Patients Presenting with Neurological Signs Associated with the Cerebellum (Use Red Flags).
TEST THE GAIT
Ask the Patient to Stand Up - Observe Posture and Steadiness.
Ask the Patient to Walk (Allow Walking aid if Required) - Observe Heel Strike, Lift off - Observe arm Swing - Observe Turning Action to Return.
Ask Patient to Walk Heel to Toe to Access Balance.
Perform Romberg’s Standing Test.
Check for Tremor - Patients should place Hands outstretched and Check for Resting Tremor.
Test Tone (Arms, Shoulders, Elbow, Wrist)
Test Co-Ordination - Finger to Nose.

Question 9

What is Romberg’s Test?

Answer 9

Balance - Ask the Patient to Stand up, Plave Feet Together and Close their Eyes (Patient should Stand Completely Still). Abnormal Swaying = Cerebellar Ataxia.
Hand Co-Ordination - With Eyes still Closed, Patients should Raise their Arms fully Extended in Front of them - Patient should Hold Roughly at Same Level. Abnormal = Cerebellar Ataxia.
Movement - As Above, Now ask Patient to make a Fist, Sticking out Little Finger in Both Hands, then Touch tip of Nose in a Single Smooth Movement. Abnormal = Cerebellar Ataxia, Tumours, Lateral Damage.