NRSG 301 Neuro (1) PDF

NEUROLOGICAL SYSTEM Chapter 25 Rae Marceau Gwen Keeler ERVOUS SYSTEM : WATCH 2 https://www.youtube.com/watch?v=R1_B5_ytWSc  STRUCTURE AND FUNCTION Central nervous system (CNS)...

NEUROLOGICAL SYSTEM Chapter 25 Rae Marceau Gwen Keeler ERVOUS SYSTEM : WATCH 2 https://www.youtube.com/watch?v=R1_B5_ytWSc  STRUCTURE AND FUNCTION Central nervous system (CNS) Hypothalamus Cerebral cortex Cerebellum Frontal lobe- personality Brainstem Parietal lobe- sensation Midbrain Occipital lobe- visual Pons Wernicke’s area- language Medulla comprehension Broca’s area-motor speech Spinal cord Basal ganglia -EPS Thalamus- relay station from spinal cord/brainstem Copyright © 2019 Elsevier, Inc.  Slide 23-4 STRUCTURE AND FUNCTION (CONT.) Pathways of the CNS  Crossed representation  Sensory pathways  Spinothalamic tract  Posterior (dorsal) column  Motor pathways  Corticospinal or pyramidal tract  Extrapyramidal tracts  Cerebellar system  Upper motor neurons  Lower motor neurons  STRUCTURE AND FUNCTION (3 OF 3) Peripheral nervous system Reflex arc Cranial nerves Spinal nerves Autonomic nervous system Copyright © 2019 Elsevier, Inc.  Slide 23-6 SUBJECTIVE DATA— HEALTH HISTORY QUESTIONS Headache Head injury Dizziness/vertigo Seizures Tremors Weakness  7 PHYSICAL EXAM Spinal Accessory Hypoglossal Nerve -CN XI -CN XII -Motor -motor -sternomastoid and trapezius muscle -inspect tongue -rotate head against -stick out tongue resistance -touch tongue to each cheek -shrug shoulders against while mouth is open resistance Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.  Slide 23-8 OBJECTIVE DATA— THE PHYSICAL EXAM  Preparation  Screening neurologic examination  Complete neurologic examination  Neurologic recheck  Equipment needed  Penlight  Tongue blade  Cotton swab  Cotton ball  Tuning fork (128 or 256 Hz)  Percussion hammer  Occasionally need: familiar aromatic substance  Slide 23-9 CRANIAL NERVES Test Cranial Nerves I—Olfactory  VII—Facial  Motor function II—Optic  Sensory function III—Oculomotor,  VIII—Acoustic IV—Trochlear, (vestibulocochlear) VI—Abducens  IX—Glossopharyngeal, V—Trigeminal X—Vagus  Motor function Motor function  Sensory function Sensory function  XI—Spinal accessory Corneal reflex  XII—Hypoglossal  CRANIAL NERVES 10 3,4, 6 Oculomotor Trochlear Abducens -CN III -CN IV -CN VI -Motor nerve -motor -motor -extrinsic eye -eye movement -eye movement movement down and laterally laterally -pupillary size and -extraocular eye -extraocular eye reactivity movements movements -eyelid movement -accomodation -direct and consensual light reactions Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.  11 CRANIAL NERVES 5, 7 Trigeminal Facial -CN V -CN VII -sensory – light touch with cotton -sensory – taste – do not ball in three locations, ophthalmic, test routinely, can ask if maxillary and mandibular any changes in taste -motor- muscles of mastication -motor-ask pt to smile, -corneal reflex- omit frown, close eyes tightly and try to open them, lift eyebrows, show teeth, puff cheeks Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.  12 CRANIAL NERVES 8, 9, 10 Vestibulocochlear Glossopharyngeal Vagus Nerve -CN VIII -CN IX -CN X -sensory -Motor and Sensory -Sensory and motor -whisper test, pick three -hold tongue down while -gag reflex easy words not in asking pt to say ahhhh sequence and whisper into pt ears, occlude other -Uvula and soft palate ear should rise -taste on posterior one third of tongue – hard to test Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.  13 CRANIAL NERVES 11 AND 12 Spinal Accessory Hypoglossal Nerve -CN XI -CN XII -Motor -motor -sternomastoid and trapezius muscle -inspect tongue -rotate head against -stick out tongue resistance -touch tongue to each cheek -shrug shoulders against while mouth is open resistance Copyright © 2014 Elsevier Canada, a division of Reed Elsevier Canada, Ltd.  MOTOR FUNCTION Ability to follow commands Muscle tone Muscle strength Coordination Balance (Romberg test) Posturing (Decorticate, Decerebrate)  Slide 23-16 THE PHYSICAL EXAM MOTOR SYSTEM Motor System—Inspect and palpate Muscles  Cerebellar function Size  Balance tests Strength  Gait Tone  Tandem walking  Romberg’s test Involuntary  Shallow knee bend movements  Coordination and skilled movements  Rapid alternating movements  Finger-to-finger test  Finger-to-nose test  Heel-to-shin test  SENSORY FUNCTION Tactile sensation Pain Temperature Vibratory sensation Tactile discrimination  Slide 23-19 THE PHYSICAL EXAM SENORY SYSTEM Sensory System  Person is alert,  Posterior column cooperative, and tract comfortable  Vibration  Guidelines for  Position (kinesthesia) sensory testing  Tactile discrimination  Spinothalamic tract (fine touch)  Stereognosis  Pain  Graphesthesia  Temperature  Two-point discrimination  Light touch  Extinction  Point location  Slide 23-20 THE PHYSICAL EXAM REFLEXES  Test the stretch or deep  Test the superficial tendon reflexes reflexes  Technique  Abdominal reflex  Grading  Cremasteric reflex  Reinforcement  Plantar reflex  Biceps reflex  Triceps reflex  Brachioradialis reflex  Quadriceps reflex  Achilles reflex (“ankle jerk”)  Clonus  REFLEXES Superficial Deep tendon Biceps Triceps Patellar Achilles Plantar (Babinski Response)  Slide 23-23 NEURO PATIENT  Neurologic recheck  Level of consciousness  Person  Place  Time  Motor function  Pupillary response  Vital signs  Glasgow Coma Scale (GCS)  PUPILLARY CHANGES Oculomotor response (Cranial nerve III) Size, equality, and roundness of pupils assessed Size measured in millimeters Evaluated for symmetry in size and response to light stimulus Brisk, sluggish, non-reactive Consensual reaction of opposite pupil at same time PUPILLARY CHANGES TO LIGHT  PUPILLARY CHANGES Assess accommodation by holding finger 4-6 inches from client’s nose and then pull out to 18 inches. As finger moves away pupil will accommodate by dilating, as finger moves closer, constricting PEARLA- Pupils equal and reactive to light and accommodation  ASSESS SPEECH AND HEARING Clear and appropriate Confused Inappropriate Garbled Aphasia (Expressive, Receptive) Limited hearing Use of hearing aids  ADDITIONAL HEALTH HISTORY QUESTIONS For infants and Older adults children Risk for falls Maternal health Cognitive function Neonatal period Tremor Reflexes Vision Weakness and balance Seizures Physical development Environmental hazards Cognitive development Family history Copyright © 2019 Elsevier, Inc.  PROMOTING HEALTH: STROKE PREVENTION (1 OF 3) Early recognition of symptoms Most common symptoms Sudden weakness or numbness in face, arms, or legs, especially on one side of the body Sudden confusion, trouble speaking or understanding speech Sudden changes in vision Sudden trouble walking, dizziness, or loss of balance or coordination Sudden severe headache with no reason or explanation Less common symptoms Sudden nausea or vomiting Brief loss of consciousness, including fainting Copyright © 2019 Elsevier, Inc.  PROMOTING HEALTH: STROKE PREVENTION (2 OF 3) Modifiable risk factors for stroke Cardiovascular disease Dyslipidemia (coronary heart disease [CHD], heart failure [HF], Asymptomatic carotid peripheral arterial disease stenosis [PAD]) Sickle cell disease Hypertension Postmenopausal Smoking/second-hand hormone therapy exposure Diet and nutrition Diabetes Inactivity Atrial fibrillation Obesity (fat distribution) History of transient Other cardiac conditions ischemic attack (TIA) Copyright © 2019 Elsevier, Inc.  PROMOTING HEALTH: STROKE PREVENTION (3 OF 3) Nonmodifiable risk factors for stroke Age Gender Low birth weight Ethnocultural background Genetic factors Prevention (Canadian Best Practice Recommendations for Stroke Care, 2010) Diet Limit sodium intake Moderate exercise Maintain healthy weight Smoking cessation Limit alcohol intake Manage underlying medical conditions Copyright © 2019 Elsevier, Inc.  Slide 23-34 SAMPLE CHARTING  Slide 23-35 SAMPLE CHARTING (CONT.)  Slide 23-36 SAMPLE CHARTING (CONT.)  ABNORMAL FINDINGS (1 Abnormalities in muscle tone OF 7) Flaccidity Rest tremor Spasticity Intention tremor Rigidity Chorea Paralysis Fasciculation Tic Myoclonus Tremor 38 39 H  ABNORMAL FINDINGS (2 OF 7) Abnormal gaits Spastic hemiparesis Cerebellar ataxia Parkinsonian (festinating) Scissors Steppage or footdrop Waddling Short leg 41  ABNORMAL FINDINGS (3 OF 7) Characteristics of upper and lower motor neuron lesions Weakness or paralysis Location Muscle tone Bulk Abnormal movements Reflexes  ABNORMAL FINDINGS (4 Patterns of motor system dysfunction OF 7) Cerebral palsy Muscular dystrophy Hemiplegia Parkinsonism Cerebellar Paraplegia Multiple sclerosis  ABNORMAL FINDINGS (5 OF 7) Common patterns of sensory loss Peripheral neuropathy Individual nerves or roots Complete transection of spinal cord Thalamus Cortex  ABNORMAL FINDINGS (6 OF 7) Abnormal postures Decorticate rigidity Decerebrate rigidity Flaccid quadriplegia  46 Copyright © 2024 Elsevier Inc.  ABNORMAL FINDINGS (7 Speech disorders OF 7) Dysphonia Dysarthria Aphasia Global aphasia Broca’s aphasia Wernicke’s aphasia