Week 5 - Neuro Flashcards by Eileen Goury

CNS

brain and spinal cord

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PNS

12 pairs of cranial nerves
31 pairs of spinal nerves

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cranial nerves

enter and exit the brain rather than spinal cord
(so when we are testing these it is a direct assessment of the brain). most supply the head and neck, except vagus nerve which travel to the:
- heart
- respiratory system
- stomach
- gallbladder

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spinal nerves

arise from the spinal cord and supply the rest of the body; contain both sensory and motor fibers

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neurological injuries and symptoms

Partial or complete paralysis.
Muscle weakness.
Partial or complete loss of sensation
Seizures
Difficulty reading and writing
Poor cognitive abilities
Unexplained pain
Decreased alertness
Head injuries (falls)
Headaches
Dizziness/vertigo/fainting
Tremors
Weakness (usually one-sided)/paralysis
Incoordination
Numbness/tingling sensation
Dysphagia
Aphasia (difficulty w/ speaking)
Falling
Confusion
Visual disturbances

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developmental considerations - older adults

General atrophy & loss of neurons in brain and spinal cord.
Decrease in weight and volume of brain.
Decreased muscle strength and impaired fine coordination.
Decreased muscle bulk.
Slowed reaction time.
Dizziness and loss of balance.
Senile tremors: benign tremors of hands, head nodding, tongue protrusion.
Slowed gait.

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subjective data - neuro

headache
head injury dizziness or vertigo
- vertigo = sensation of rotation spinning
seizures = involuntary movements with altered consciousness
tremors = involuntary movements
- shaking, vibrating, trembling while conscious
incoordination
numbness or tingling sensation
difficulty swallowing or speaking
significant past history
environmental or occupational hazards
Syncope

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screening neuro exam

health history in otherwise healthy patients

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complete neuro exam

neuro concerns, most detailed and through exam

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neuro re-check

those with deficits and require frequent rechecks p. 738-43

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critical findings that require immediate attention

-sudden decline in alertness or loss of consciousness
-sudden change in speech or a new onset of speech difficulties
-signs of stroke or TIA
-sudden onset of severe headache
-signs of raise intracranial pressure
-sudden onset weakness, numbness, eye movement problems, double vision
-seizures
-lethargy that persists beyond appropriate times and circumstances
-sudden loss of vision

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LOC

APVU
Alert, responds to Verbal or Painful stimuli or Unresponsive

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alert and oriented

person (first, last name, DOB, occupation, names of others)
place (building, city, province, country)
time (date, month, year, day of week, season)

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impaired LOC terms

Alert – opens eyes spontaneously, appears to be aware of person and surroundings

Lethargic – more than sleepy, may take a few tries to wake them, or require loud verbal stimuli

Obtunded – severe drowsiness, may rouse for brief periods with repeated painful stimuli

Stupor – mostly unresponsive, will only rouse with vigorous repeated painful stimuli and will immediately lapse back into unresponsiveness

Coma – unresponsive, cannot be roused with any stimuli, eyes remain closed

Acute delirium – a fast-developing type of confusion, often caused by an illness or environmental factors that disrupt brain function

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CN I

olfactory
smell not usually assessed

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CN II

optic
“how many fingers am I holding up?”
Cover one eye and wiggle your finger peripherally while look straight ahead of you

CN III, CN IV, CN VI

oculomotor
trochlear
abducens
III: PERRL, PERRLA, ptosis (eyelid droop)
IV: “can eyes track downward? have pt follow your finger from top to bottom”
VI: “can eyes track side to side? asses cardinal fields of gaze with letter H”

CN V

trigeminal:
- motor function
- sensory function
- corneal reflex
“sensation of forehead, cheek and jaw, assess jaw opening strength by having pt attempt to open jaw while you hold it closed”

VII

facial
- motor function
- sensory function
“assess facial symmetry, ask pt to show teeth, smile”

VIII

acoustic (vestibulocochlear)
“is patient able to hear you?”

IX, X

glossopharyngeal
vagus
- motor function
- sensory function
taste usually not assessed
“can pt swallow? does uvula lift symmetrically when pt says, Ahhh?”

spinal accessory
“raise your shoulders and turn head side to side with resistance applied”

XII

hypoglossal
“stick our tongue”

motor function

Gait/balance – cerebellar test as the cerebellum controls balance (ataxia = uncoordinated, unsteady)

Romberg test for loss of balance when standing on one foot with eyes closed (MS, alcoholism)

Finger-to-finger test (cerebellar disorders)
Finger to nose test (cerebellar disorders)
Heel to shin test for lower extremity coordination (cerebellar disorders)

voluntary movement

Check facial symmetry - Lift eyebrows, frown, bare teeth (presence of facial droop) Test hand grips “Squeeze my fingers”, lift hands/finger Test for pronator (palmer) drift Test straight leg raise strength to 90 degrees Test dorsiflexion “Lift your toes to your nose”, and plantarflexion “Push on the gas”

facial droop

Check facial symmetry - Lift eyebrows, frown, bare teeth (presence of facial droop) FAST risk for a stroke: CAD, cardiac failure, PAD, hypertension, smoker, diabetes, irregular cardiac rhythms, diet and nutrition, obesity, physical inactivity, history of TIA

pronator drift

Ask patient to close eyes, hold both arms out, at shoulder height with palms extended and supinated Watch for downward drift and pronation of a weak limb Suggests mild hemiparesis and lesion on opposite side "don't let me push your arm down"

bilateral strength

grip strength follows commands (LOC)

grading muscle strength

0 = no muscle contraction is seen 1 trace = flicker or trace of contraction is seen 2 poor = active movement only with gravity eliminated 3 fair = active movement against gravity but not resistance 4 good = active movement against gravity with some resistance 5 normal = active movement against gravity with full resistance

sensory assessment

Pain Temperature Touch Vibration Kinanesthesia Tactile discrimination Stereognosis - shape identification Graphesthesia - tracing numbers/letters Two point discrimination

basic neuro check in acute care

every 4 hours - LOC - motor function - pupillary response - vital signs

Glasgow Coma Scale

evaluating LOC, assess 3 aspects 1. eye opening - PERRL 2. verbal response 3. motor response Score 3-15 13-15 = mild impairment 9-12 = moderate impairment 3-8 = severe impairment or coma

eyes and GCS

4 eyes are open spontaneously 3 eyes open when you call your patients name or say hello 2 eyes open when painful stimuli is given 1 eyes don't open at all to verbal or painful stimuli

verbal response

5 oriented x3 4 confused 3 inappropriate speech 2 incomprehensible sounds 1 no response

motor response

6 patient does as requested 5 patient has a localized response to painful stimuli 4 patient has a withdrawal, or flexion response to painful stimuli 3 patient has an abnormal flexion response to painful stimuli 2 patient has an abnormal extension response to painful stimuli 1 no response

seizures

focal onset generalized onset unknown onset Tonic - muscle stiffing Myocronic - full body jerking

aphasia types

expressive (Broca's) aphasia - ability to form language and express thoughts is impaired: patent may become frustrated as they're aware of deficit receptive (Wernicke's) aphasia - ability to comprehend written or verbal language is impaired, speech is clear but words so not express clear sentence. global aphasia - all language functions are impaired

Objective data - neuro

Mental health/status LOC Cranial nerves Motor system Sensory system Reflexes GCS Vital signs Dysphasia Aphasia