Chapter 60 Assessment of Neurologic Function PDF

Chapter 60 Assessment of Neurologic Function Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Structure and Function of the Nervous System Central nervous system o Brain and spinal cord Peripheral nervous system o Includes cranial and spinal nerves o Autono...

Chapter 60 Assessment of Neurologic Function Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Structure and Function of the Nervous System Central nervous system o Brain and spinal cord Peripheral nervous system o Includes cranial and spinal nerves o Autonomic and somatic systems Basic functional unit—neuron Controls all motor, sensory, autonomic, cognitive, and behavioral activities Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #1 Is the following statement true or false? The spinal cord is part of the central nervous system. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #1 True Rationale: The nervous system consists of two major parts: the central nervous system (CNS), including the brain and spinal cord, and the peripheral nervous system, which includes the cranial nerves, spinal nerves, and autonomic nervous system. Copyright © 2022 Wolters Kluwer · All Rights Reserved Neuron Copyright © 2022 Wolters Kluwer · All Rights Reserved Neurotransmitters Communicate messages from one neuron to another or to a specific target tissue Neurotransmitters can potentiate, terminate, or modulate a specific action or can excite or inhibit a target cell Many neurologic disorders are caused by an imbalance in neurotransmitters Refer to Table 60-1 Copyright © 2022 Wolters Kluwer · All Rights Reserved Brain Copyright © 2022 Wolters Kluwer · All Rights Reserved Medial View of the Brain Copyright © 2022 Wolters Kluwer · All Rights Reserved Bones and Sutures of the Skull Copyright © 2022 Wolters Kluwer · All Rights Reserved Meninges and Related Structures Copyright © 2022 Wolters Kluwer · All Rights Reserved Arterial Blood Supply of the Brain Copyright © 2022 Wolters Kluwer · All Rights Reserved Cross-Section of the Spinal Cord Showing the Major Spinal Tracts Copyright © 2022 Wolters Kluwer · All Rights Reserved Cranial Nerves Copyright © 2022 Wolters Kluwer · All Rights Reserved Dermatome Distribution Copyright © 2022 Wolters Kluwer · All Rights Reserved Autonomic Nervous System Functions to regulate activities of internal organs and to maintain and restore internal homeostasis Sympathetic nervous system o “Fight-or-flight” responses o Main neurotransmitter is norepinephrine Parasympathetic nervous system o Controls mostly visceral functions Regulated by centers in the spinal cord, brainstem, and hypothalamus Copyright © 2022 Wolters Kluwer · All Rights Reserved Anatomy of the Autonomic Nervous System Copyright © 2022 Wolters Kluwer · All Rights Reserved Neurologic Assessment: Health History Pain Seizures Dizziness (abnormal sensation of imbalance or movement) and vertigo (illusion of movement, usually rotation) Visual disturbances Weakness Abnormal sensations Past health, family, social history Copyright © 2022 Wolters Kluwer · All Rights Reserved Neurologic Assessment Consciousness and cognition: mental status, intellectual function, thought content, emotional status, language ability, impact on lifestyle Cranial nerves Motor system: muscle size, muscle tone and strength, coordination and balance, Romberg test Sensory system: tactile sensation, superficial pain, temperature, vibration and position sense (proprioception) Reflexes: DTRs, biceps, triceps, brachioradialis, patellar Achilles, superficial, pathologic, plantar (Babinski) Copyright © 2022 Wolters Kluwer · All Rights Reserved Figure Used to Record Muscle Strength Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #2 How many cranial nerves does the nurse have to assess? A. 10 B. 11 C. 12 D. 13 Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #2 C. 12 Rationale: There are 12 pairs of cranial nerves that emerge from the lower surface of the brain and pass through the foramina in the skull. Copyright © 2022 Wolters Kluwer · All Rights Reserved Gerontologic Considerations Important to distinguish normal aging changes from abnormal changes Structural and physiologic changes Motor and sensory alterations Temperature regulation and pain perception Determine previous mental status for comparison. Assess mental status carefully to distinguish delirium from dementia Copyright © 2022 Wolters Kluwer · All Rights Reserved Diagnostic Tests  Computed tomography (CT)  Positron emission tomography (PET)  Single-photon emission computed tomography (SPECT)  Magnetic resonance imaging (MRI)  Cerebral angiography  Myelography  Noninvasive carotid flow studies  Transcranial Doppler  Electroencephalography (EEG)  Electromyography (EMG)  Nerve conduction studies, evoked potential studies  Lumbar puncture, Queckenstedt test, and analysis of cerebrospinal fluid Copyright © 2022 Wolters Kluwer · All Rights Reserved Question #3 Is the following statement true or false? Cerebral angiography is a radiograph of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Copyright © 2022 Wolters Kluwer · All Rights Reserved Answer to Question #3 False Rationale: Myelography is a radiograph of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Cerebral angiography is a radiography study of the cerebral circulation with a contrast agent injected into a selected artery. Copyright © 2022 Wolters Kluwer · All Rights Reserved