The Neurological System
Neurological Exam 5 Components
Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory
Mental Status Examination
Examination - ABCT
Appearance Behavior Cognition Thought
processes (thought content & perceptions)
Mini Mental State Exam Glasgow Coma Scale
Assessing LOC: Glasgow Coma Scale
Eye opening
Verbal responsiveness
Motor responsiveness
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Glasgow Coma Scale
Physical Examination Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not stimulated Obtunded- sleeps most times, difficult to arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for arousal; responds to stimuli Coma- no response (Jarvis CH 2)
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Cranial Nerves
On old Olympus Towering Tops a
Finn and German Viewed some hops.
I Olfactory II Optic III Occulomotor IV Trochlear V Trigeminal VI Abducens
VII - Facial VIII Auditory (V-C) IX - Glossopharyngeal X - Vagus XI Spinal Accessory XII - Hypoglossal
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Neurological: Physical Examination
Sensory System Function
With eyes closed Interpret sensations Discriminate side to side Examine in detail if: Reduced sensation Numbness or pain Motor or reflex abnormal Skin changes
Be specific: tell me where I
Physical Examination Sensory Function Tests:
Touch
Light
touch 1st then Pain & Temperature
Vibration Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination
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Sensory Function Tests: Sensory Exam: Light Touch
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Sensory Function Tests: Sensory Exam: Vibration
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Sensory Function Tests: Proprioception: Position sense
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Sensory Function Tests: Stereognosis
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Sensory Function Tests: Graphesthesia
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Sensory Function Tests: Two-point discrimination
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Sensory Function Tests: Dermatomes
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Motor Examination
Symmetry, size, and presence f involuntary movements Full ROM of joints Check strength against resistance
Neuro patients: Assess hand grips and foot pushes if bedridden
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Cerebellar Function
1. Gait and posture Heel to toe in straight line Walking on toes and heels Hop on one foot Note width of gait
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Cerebellar Function, cont 2. Coordination of hands and legs RAM nose to examiners finger heel to shin coordination
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Cerebellar Function, cont RAM
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Cerebellar Function, cont Nose to - Finger Test
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Cerebellar Function, cont Heel to Shin
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Cerebellar cont
Romberg: Stand upright, place feet together, then close eyes loss of balance means + Romberg test
3.
Be prepared to protect client from falling!
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4 types of Reflexes
Abdominal Reflex
Superficial (abdominal reflex, Cremasteric reflex) Visceral (pupillary response to light) PERRL Pathologic
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Cremastic Reflex
Babinski in adults
DTRs (e.g. knee)
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Reflexes-Cont: PERRL/PERRLA
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Reflexes-Cont:
Babinskis Reflex (Adult)
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Reflexes-Cont: Reflex Arc Deep Tendon Reflex
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Reflexes-Cont:
Deep Tendon Reflexes
Technique
Position limb so muscle is slightly stretched Reflex hammer should strike tendon briskly to stretch tendon Get patient to relax
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BRACHIORADIALIS
BICEPS
ACHILLES/PLANTAR TRICEPS
PATELLAR DEEP TENDON REFLEXES
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Grading of DTRs
4+ 3+ 2+ 1+ 0
very brisk brisker than average average, normal diminished, low normal no response
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Assessment Guide: Neurological
LOC: alert, comatose, lethargic, obtunded GCS Eye opening: spontaneously, to speech, to pain Verbal Response: oriented, confused, inappropriate, incomprehensible Motor Response: obeys, command, localizes pain, withdraws, flexion, extension
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Assessment Guide : cont..
Seizure
Describe:
tonic clonic, absence, status epilepticus Timing: once at 10 am; 2 pm and 2:45 pm
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Altered mental status: yes, no Aphasia: present, none Intelllectual functioning: intact; short attention span, dementia, memory loss Itnerventions in use:
Seizure
precautions: side rails padded, oral airway at bedside Med List: Klonopin, Aricept, Neurontin, Dilantin, etc.
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