Neurologic Assessment PDF

Neurologic Dr. Rita A. DelloStritto Assessment Nurs 3151 Nervous System  It has 2 parts  Central Nervous System (CNS)  Spinal Cord and Brain  Peripheral Nervous System (PNS)  All the nerves...

Neurologic Dr. Rita A. DelloStritto Assessment Nurs 3151 Nervous System  It has 2 parts  Central Nervous System (CNS)  Spinal Cord and Brain  Peripheral Nervous System (PNS)  All the nerves and fibers coming off the CNS  12 pairs of Cranial Nerves  31 pairs of Spinal Nerves  Afferent – Sensory receptors  Efferent – Motor messengers Central Nervous System  Cerebral Cortex  Cerebral cortex is the cerebrum’s outer layer of nerve cells  Is the center of functions governing thought, memory, reasoning, sensation, and voluntary movement  Each half of cerebrum is hemisphere  Each hemisphere divided into four lobes:  Frontal  Parietal  Temporal  Occipital  What are the different Lobes Responsible for? Frontal lobe concerned with personality, behavior, emotions, and intellectual function  Broca’s area in frontal lobe mediates motor speech Parietal lobe’s postcentral gyrus is primary center for sensation Occipital lobe is primary visual receptor center Temporal lobe behind ear, has primary auditory reception center, taste, and smell  Wernicke’s area in the temporal lobe associated with language comprehension What if they Break it?  Damage to specific cortical areas produces a corresponding loss of function:  Motor weakness  Paralysis  Loss of sensation  Impaired ability to understand and process language  Damage occurs when highly specialized neurologic cells are deprived of blood supply, such as when a cerebral artery becomes occluded Cerebral Cortex  Basal Ganglia Gray matter in two cerebral hemispheres that form subcortical associated motor system (extrapyramidal system) Thalamus Main relay station where sensory pathways of spinal cord, cerebellum, and brainstem form synapses What’s your Hypothalamus Major respiratory center with basic function Function control and coordination Cerebellum CNS? Concerned with motor coordination and muscle tone of voluntary movements Brainstem Central core of the brain—contains midbrain, pons and medulla Spinal cord Main pathway for ascending and descending fiber tracts that connect brain to spinal nerves  Pathways of CNS Crossed representation of nerve Knowledge of where the fibers cross tracts. midline will help interpret clinical findings Left cerebral cortex receives sensory information from and controls motor function to the right side of the body Right cerebral cortex interacts with left side of body Sensory Pathways Sensation travels in afferent fibers in They, may take one of peripheral nerve through two routes: posterior (dorsal) root and into spinal cord Anterolateral Tract Posterior (Dorsal) Contains sensory fibers that Columns transmit sensations of pain, These fibers conduct temperature, and crude or sensations of position, light touch vibration, and finely localized touch Position (proprioception), vibration, and finely localized  Sensory Pathways  Corticospinal or Pyramidal (Py-ram-i-dal) Tract Fibers mediate voluntary movement Skilled, discrete, purposeful movements Motor Motor nerve  brainstem crossing to opposite, Pathways contralateral side,  pass  Extrapyramidal Tracts lateral column of spinal cord (outside corticospinal) subcortical motor fibers that maintain muscle tone and control body movements, especially gross automatic movements, such as walking  Motor Pathways - Continued  Cerebellar System  Coordinates movement, maintains equilibrium and posture  Receives information on position of muscles and joints, body’s equilibrium, and motor messages from cortex to muscles  Integrates information using feedback pathway to exert control  Reflexes  Reflexes: basic defense mechanisms of nervous system  Involuntary; below the level of conscious control permitting quick reaction to potentially painful or damaging situations  Three types of reflexes:  Stretch on/deep tendon (myotatic), e.g., knee jerk DTR has 5 components: intact sensory (afferent) nerve, functional synapse in the cord, intact motor (efferent) nerve, neuromuscular junction and competent muscle  Superficial (cutaneous), e.g., plantar reflex  Visceral (organ), e.g., pupillary response to light and accommodation Reflex Arc Cranial Nerve Mnemonic CN # CN Name Mnemonic I Olfactory On II Optic Old III Oculomotor Olympus IV Trochlear Towering V Trigeminal Tops VI Abducens A VII Facial Finn VIII Vestibulocochlear And (Acoustic) IX Glossopharyngeal German X Vagus Viewed XI (Spinal) Accessory Some XII Hypoglossal Hops Dermatomes  Dermatome  Circumscribed skin area supplied mainly from one spinal cord segment through a particular nerve  Dermatomes overlap; if one nerve is severed, most of sensations are transmitted by one above and one below.  Useful landmark dermatomes  Thumb, middle finger, fifth finger are C6, C7, and C8  Axilla at T1  Nipple at T4  Umbilicus at T10  Groin in region of L1  Knee at L4 Autonomic Nervous System  Peripheral Nervous System Cranial and Spinal Nerves  Fibers divided into two parts: Somatic: Voluntary Muscles Autonomic: Involuntary Muscles  Unconscious activity  Maintains homeostasis Subjective Data  Headache  Incoordination  Head injury  Numbness or tingling  Dizziness/vertigo  Difficulty swallowing  Seizures  Difficulty speaking  Tremors  Patient-centered care  Weakness  Environmental/occupational hazards  Subjective Data Collection onset, frequency, and severity Headache: Ask about location, quality description, and associated factors event history, type and description Head injury: Ask about loss of consciousness and recall of event onset, duration, description, and frequency associated with change in position Dizziness/vertigo: Ask about vertigo characteristics—objective or subjective vertigo  Subjective Data Collection Seizures: Ask about Tremors: Ask about Weakness: Ask about course and duration onset, type, duration, localized or motor activity in body and frequency generalized, distal or associated clinical precipitating and proximal presentations alleviating factors impact on mobility or postictal phase ADLs precipitating factors medication therapy coping strategies  Incoordination: Ask about Subjective problems with balance while standing or ambulating lateral drifting, stumbling, or falling Data legs giving way and/or clumsy movements Collection Numbness or tingling: Ask about onset, duration, and location whether it occurs with activity Difficulty swallowing: Ask about With solids or liquids Drooling Difficulty speaking: Ask about onset, pattern, and duration forming words or saying what you want to say Patient-centered care: Ask about information regarding past pertinent medical history