Neurological Assessment st-1.pptx

Neurological Assessment By Kim A. Stiles, PhD, RN, AHN-BC, CNE Nervous System Components https://www.teachoo.com/17800/3519/Human-Nervous-System/category/Concepts/ The Brain Brainstem: midbrain, pons, medulla Ventricles and cerebral spinal fluid Cerebellum Cerebrum: 2 hemispheres, 4 lobes Levels of...

Neurological Assessment By Kim A. Stiles, PhD, RN, AHN-BC, CNE Nervous System Components https://www.teachoo.com/17800/3519/Human-Nervous-System/category/Concepts/ The Brain Brainstem: midbrain, pons, medulla Ventricles and cerebral spinal fluid Cerebellum Cerebrum: 2 hemispheres, 4 lobes Levels of Conciousness Alert: responds to voice, purposeful movement Lethargic: Slow response to voice, sleepy, but appropriate spontaneous activity and purposeful movement Obtunded: responds to touch more than voice, decreased spontaneous activity, purposeful movement Stuporous: responds to pain only, no spontaneous activity Semi-coma: responds inconsistently to painful stimulus, purposeful movement varies Coma: unresponsive to stimuli, may be flaccid or postulating Glasgow Coma Scale https://biologydictionary.net/glasgow-coma-scale/ Brain Stem and Skull: Midbrain (Image credit: Science Museum, London/Wellcome Images) https://www.cancer.gov/publications/dictionaries/cancer-terms/def/brain-stem Cerebellum & Diencephalon Cerebellum: Coordination Balance Diencephalon: Hypothalamus & Thalamus https://anatomyinfo.com/cerebellum-function/ Posturing Decorticate https://www.ncbi.nlm.nih.gov/books/NBK559135/figure/article-20280.image.f1/ Decerebrate https://www.ncbi.nlm.nih.gov/books/NBK559135/figure/article-20280.image.f2/ Cerebellar function tests: Finger to nose Rapid alternating movements Heel to shin Romberg test, stand close so they don’t fall! Heel toe walking Pronator drift Limbic System Four Regions of the Cerebrum 1. The Cerebrum A. Frontal lobe B. Parietal lobe C. Temporal lobe D. Occipital lobe Cranial Nerves See article on Canvas for assessment! 12 paired nerves, some are only sensory, some are only motor, and some are both. “Some Say Money Matters But My Brother Says Better Borrow More Money” Cranial Nerves Memory Tip Cranial Nerves Quick Check: 1: have pt close eyes and smell/identify alcohol, soap, or coffee 2: check pt’s reading ability (clock)- with glasses if needed! 3, 4, 6: check EOM and PERRLA 5, 12: open mouth, stick out tongue 7: smile 8: see if pt can hear fingertips by ears with eyes closed 9,10: say aaah, ask to swallow 11: have pts shrug shoulders against resistance Spinal Nerves https://spinalcordinjuryzone.com/answers/9243/what-is-asia-impairment-scale https://link.springer.com/referenceworkentry/10.1007/978-0-387-79948-3_1793 Other tests of sensory function Sharp/soft, hot/cold, two-point discrimination Abnormal findings: Anesthesia Hyperesthesia Hypoesthesia Paresthesia (pins and needles sensation) Spinal Nerves https://www.slideserve.com/maleah/asia-impairment-scale Practice deep tendon reflexes: Bicep: C5-6 Tricep: C7-8 Brachioradialis: C5-6 Patellar: L2-4 Achilles: S1-2 Prep: watch video posted on Canvas! https://pngtree.com/freepng/reflex-hammer-vector-illustration-fit-for-neuro-health-education_9203508.html Babinski Reflex https://basicmedicalkey.com/b/ Use metal end of reflex hammer to stroke up firmly on lateral sole of foot towards toes in J shape Negative = normal in adults, toes curl in and down, foot everts Positive= abnormal in adults, toes fan out, damage to CNS (above picture) If +: can be temporary or permanent, can be + on one side or both, normal if less than 2 yrs old or in very deep sleep or after long periods of walking Peripheral Nerves Somatic Nervous System: regulates voluntary movements Receives external stimuli Coordinates body movements Autonomic Nervous System: regulates involuntary movements A. Sympathetic Nervous System (fight or flight)epinephrine B. Parasympathetic Nervous System (Rest and digest)acetylcholine Gerontological Assessment Differences See Table 60. 2 Lewis (12th ed) p. 1470. CNS: ↓ cerebral blood flow, cerebral tissue atrophies, ↓ neurotransmitters & neurons, ↓ oxygen. ↑ ventricle size. Leads to: longer response times (slower reaction time and reflexes), altered balance, changes in gait (widens), less proprioception, less sense of touch, increased postural hypotension, less ability to adapt to environmental temperature. Less smell, less stage 4 sleep (Reticular activating system changes), HTN. Brain Development across the Lifespan Kluger, J. (2009). Gray hair and wise brains. Your Brain: A User’s Guide. 58-61. Time Inc. Neuro Assessments to Review Aldrete Scale: postop recovery class Motor and Gait disturbances: Musculoskeletal class Eye assessment (EOM, cardinal fields of vision, PERRLA) : health assessment class Romberg test and CMST: Health assessment class Respiratory patterns: Oxygenation class Terminology check: Dizziness vs. vertigo? Syncope vs. fainting? Essential tremors? See video: Essential tremors Aphasia: receptive vs. expressive Dyskinesias and EPS Hallucinations vs. delusions Dysarthria Fasiculation Akathisia Resources Costello, K. J. (2023). Ch. 60: Assessment: Nervous system. In M. M. Harding, J. Kwong, D. Hagler, & C. Reinisch (Eds.) Lewis’s medical-surgical nursing (12th ed.), pp. 1461-1482. Elsevier. Fast facts for critical care (2003). Kathy White Learning Systems. Zarbano, C. (2013). Session 1: Mastering the neurological assessment. PESI Healthcare.