NSG 316 Topics 6 and 7_Exam II.pdf

Health Assessment Study Guide Topic: PEERLA Dermatomes - Definition: Dermatomes refer to specific areas of skin supplied by a single spinal nerve. Understanding dermatomes is crucial in assessing sensory function and detecting potential nerve issues. - Cervical Dermatomes: Correspond to the neck and...

Health Assessment Study Guide Topic: PEERLA Dermatomes - Definition: Dermatomes refer to specific areas of skin supplied by a single spinal nerve. Understanding dermatomes is crucial in assessing sensory function and detecting potential nerve issues. - Cervical Dermatomes: Correspond to the neck and upper shoulders. - Lumbar Dermatomes: Correspond to the lower back and buttocks. - Thoracic Dermatomes: Correspond to the chest and abdomen. Whisper Test - Definition: A screening test used to assess hearing acuity. It involves whispering a set of words or numbers at a consistent volume from a specific distance behind the patient to evaluate their ability to hear whispered sounds. Resting Tremors vs. Intentional Tremors - Resting Tremors: Tremors that occur when the muscles are at rest and are typically associated with conditions like Parkinson's disease. - Intentional Tremors: Tremors that occur during voluntary movement and may indicate conditions such as essential tremor. Tinnitus - Definition: Perception of noise or ringing in the ears without an external source. Tinnitus can be subjective (only the patient hears it) or objective (both the patient and the examiner can hear it). Aura - Definition: Sensory disturbances that often precede a migraine headache. Auras can manifest as visual, sensory, or motor symptoms. Clonus - Definition: A rhythmic, involuntary muscular contraction and relaxation that occurs in response to sudden stretching of a muscle. Clonus is often associated with upper motor neuron lesions. Nystagmus - Definition: Involuntary, rhythmic movements of the eyes that can occur horizontally, vertically, or rotatory. Nystagmus can indicate vestibular dysfunction or neurological abnormalities. Vertigo - Definition: A sensation of spinning or dizziness, often described as feeling off-balance or as if the surrounding environment is moving. Vertigo can be caused by inner ear problems, neurological issues, or other systemic conditions. Snellen Eye Chart - Definition: A chart used to measure visual acuity. Patients are asked to read letters or symbols from a distance, with their vision assessed relative to what a person with normal vision can see at that distance. Screening/Recheck/Complete Examination - Screening: Initial assessment to identify potential health issues or abnormalities. - Recheck: Follow-up assessment to monitor changes or progress in a condition. - Complete Examination: Thorough assessment covering all aspects of a patient's health, including history-taking, physical examination, and diagnostic testing as needed. Sinusitis - Definition: Inflammation or infection of the paranasal sinuses, which can cause symptoms such as facial pain, pressure, nasal congestion, and headache. Cerumen - Definition: Earwax produced by glands in the ear canal. Cerumen can accumulate and cause hearing impairment or discomfort if not removed. Romberg Test - Definition: Neurological test used to evaluate balance and proprioception. The patient stands with feet together and eyes closed to assess the ability to maintain balance without visual input. Presbyopia - Definition: Age-related loss of near vision due to decreased flexibility of the lens in the eye. Presbyopia commonly occurs in individuals over the age of 40. Anisocoria - Definition: A condition characterized by unequal pupil sizes. Anisocoria can be benign or indicative of underlying neurological or ophthalmological issues. Glasgow Coma Testing - Definition: Assessment tool used to evaluate a patient's level of consciousness following a traumatic brain injury or other neurological event. It assesses eye opening, verbal response, and motor response to assign a numerical score. Different Forms of Hearing Loss - Conductive Hearing Loss: Caused by problems in the outer or middle ear, such as earwax buildup or middle ear infection. - Sensorineural Hearing Loss: Caused by damage to the inner ear or auditory nerve, often resulting from aging, exposure to loud noise, or certain medical conditions. - Mixed Hearing Loss: Combination of conductive and sensorineural hearing loss. - Central Hearing Loss: Caused by damage to the central auditory pathways in the brain, rather than the peripheral auditory system. CN Number Write Name of CN Circle Write Name of Test Performed CN I Name: Olfactory S/M/B Smell Test (e.g., identify smells) CN II Name: Optic S/M/B Visual Acuity and Fields Test CN III Name: Oculomotor S/M/B Pupillary Response, EOMs CN IV Name: Trochlear S/M/B EOMs, especially downward gaze CN V Name: Trigeminal S/M/B Facial Sensation, Muscles of Mastication CN VI Name: Abducens S/M/B Lateral Gaze CN VII Name: Facial S/M/B Facial Movements, Taste Ant. 2/3 Tongue CN VIII Name: Vestibulocochlear S/M/B Hearing and Balance Tests CN IX Name: Glossopharyngeal S/M/B Gag Reflex, Taste Post. 1/3 Tongue CN X Name: Vagus S/M/B Gag Reflex, Voice Quality, Visceral Reflexes CN XI Name: Spinal Accessory S/M/B Shoulder Shrug, Head Turn Against Resistance CN XII Name: Hypoglossal S/M/B Tongue Movement EYE ASSESSMENT - What cranial nerve is involved, and what is the abnormal finding Nystagmus o Cranial Nerve: Involves CN VIII (vestibulocochlear nerve) but also relates to the function of CN III (oculomotor nerve), CN IV (trochlear nerve), and CN VI (abducens nerve). o Abnormal Finding: Involuntary rhythmic shaking or oscillation of the eyes. Corneal Reflex o Cranial Nerve: CN V (trigeminal nerve) for sensory input and CN VII (facial nerve) for motor response (blinking). o Abnormal Finding: Absence or asymmetry of the blinking response. CEREBELLAR FUNCTION TESTS - Describe abnormal findings Balance Test o Abnormal Findings: Loss of balance, unsteady gait, inability to walk straight, or requiring a wide base to stand. Romberg Test o Abnormal Findings: Swaying or falling when eyes are closed, indicating proprioceptive or vestibular dysfunction. Test for Coordination and Skilled Movements (name two additional tests and what each is testing) Rapid Alternating Movements (RAM) o Testing: Cerebellar function, specifically the ability to perform rapid, alternating movements smoothly. Finger-to-Nose Test o Testing: Coordination and precision of movements, pointing to cerebellar function or proprioceptive feedback. Heel-to-Shin Test o Testing: Lower limb coordination and the ability to perform smooth, accurate movements. Tactile discrimination (fine touch) Stereognosis o Normal Finding: The ability to recognize and identify common objects (such as a key or a coin) by touch and manipulation without the use of vision. o Abnormal Finding: Inability to recognize objects by touch. Graphesthesia o Normal Finding: The capacity to recognize writing on the skin (typically numbers or letters) purely by the sensation of touch. o Abnormal Finding: Difficulty in recognizing writing on the skin purely by the sensation of touch. Two-point Discrimination o Normal Finding: The ability to discern two distinct points when they are applied simultaneously at close proximity on the skin. The recognition threshold varies depending on the body region. o Abnormal Finding: Inability to distinguish two nearby points touching the skin. Extinction o Normal Finding: When two areas of the body are touched simultaneously, the person can correctly perceive both touches. o Abnormal Finding: Failure to perceive touch on one side when both sides are touched simultaneously. Point Location o Normal Finding: After a point on the skin is touched and the stimulus is removed, the person can accurately indicate where they were touched. o Abnormal Finding: Difficulty in identifying the exact point on the body that was touched. REFLEXES DTRs 4-Point Scale: Describe the scale o 4 = very brisk, hyperactive with clonus, indicative of disease o 3 = brisker than average, may indicate disease o 2 = Average, normal o 1 = diminished, low normal, or occurs with reinforcement o 0 = no response Define what nerve track is being tested and where on the body Deep tendon reflexes (myotatic): o Nerve Tract: These reflexes test the integrity of the spinal cord segments and corresponding nerve tracts. They are monosynaptic reflex arcs. o Body Areas Tested: Common sites include the biceps (C5-C6), triceps (C6-C7), brachioradialis (C5-C6), patellar (L2-L4), and Achilles (S1-S2). Superficial: o Nerve Tract: These reflexes involve a polysynaptic reflex arc and test the function of higher brain centers and the spinal cord. o Body Areas Tested: Examples include the abdominal reflexes (T8-T12), cremasteric reflex (L1-L2), and plantar reflex (L5-S1). Visceral: o Nerve Tract: Also known as autonomic reflexes, they test the autonomic nervous system and involve smooth muscle responses rather than skeletal muscle. o Body Areas Tested: These reflexes include pupillary response to light (optic nerve for sensory input and oculomotor nerve for motor response) and the reflexes controlling bowel and bladder functions. Pathologic (abnormal): o Clonus Nerve Tract: Indicates disruption of motor tracts, typically within the central nervous system. Body Areas Tested: Often tested at the ankles, where rapid flexion and extension of the foot can elicit rhythmic oscillations (clonus). o Dyskinesia Nerve Tract: Represents a dysfunction in the basal ganglia circuits, which are responsible for the regulation of voluntary motor movements and procedural learning. Body Areas Tested: It is not a specific reflex test but is assessed through observation of the movements of the limbs or body, typically presenting as a series of involuntary muscle movements. Define and describe the technique in assessment Biceps reflex, C5 to C6: o Support the person’s forearm on yours; place your thumb on biceps tendon and strike a blow on your thumb Normal response is contraction of biceps muscle and flexion of forearm Triceps reflex, C7 to C8: o Tell person to let arm “just go dead” as you strike triceps tendon directly just above the elbow Normal response is extension of forearm Brachioradialis reflex, C5 to C6: o Hold person’s thumbs to suspend forearms in relaxation and strike forearm directly, about 2 to 3 cm above radial styloid process Normal response is flexion and supination of forearm Quadriceps reflex, L2 to L4 (“knee jerk”): o Let lower legs dangle freely to flex knee and stretch tendons; strike tendon directly just below patella Normal response is extension of lower leg Achilles reflex, L5 to S2 (“ankle jerk”): o Position person with knee flexed; hold foot in dorsiflexion and strike Achilles tendon directly Normal response is foot plantar flexes against your hand Superficial Reflexes Abdominal Reflexes o Normal Finding: The abdominal muscles contract and the umbilicus moves towards the stimulus when the skin of the abdomen is lightly stroked. There are four quadrants to test, upper and lower on each side. o Abnormal Finding: Absence of contraction of the abdominal muscles and movement of the umbilicus in response to stroking the skin. Cremasteric Reflex o Normal Finding: A brisk elevation of the testicle on the same side when the upper inside of the thigh is stroked. This reflex is present in males. o Abnormal Finding: Lack of elevation of the testicle on the side stroked. Plantar Reflex, L4 to S2 o Normal Finding: Downward flexion of the toes when the sole of the foot is stimulated with a blunt object. The response is also known as the "downgoing toes." o Abnormal Finding: Extension of the big toe with fanning of the other toes (Babinski sign), which indicates central nervous system lesions in the corticospinal tract. Study and write down a brief definition and functions, procedures, and/or clinical findings for each key term. 1. Dizziness vs Vertigo a. Dizziness: A sensation of lightheadedness, faintness, or unsteadiness that does not involve the sensation of movement. 2. 3. 4. 5. 6. 7. b. Vertigo: A type of dizziness where there is a sensation of spinning or movement, either of oneself or the surroundings. Headaches a. Tension: A common type of headache characterized by dull, aching head pain and tightness or pressure across the forehead or on the sides and back of the head. b. Migraine: A neurological condition that can cause multiple symptoms but is mainly recognized by intense, debilitating headaches. Symptoms may include nausea, vomiting, difficulty speaking, numbness or tingling, and sensitivity to light and sound. c. Cluster: Severe headaches on one side of the head, often around the eye. They occur in groups or clusters and are accompanied by symptoms such as red or teary eyes, runny or stuffy nose, and flushing or sweating of the face. Inspecting the Head and Face a. Procedure: Observe the size, shape, and contour of the skull. Note any deformities, lumps, or tenderness. b. Expected findings: A symmetrical head and face, with no visible lesions or deformities. c. Abnormal findings: Asymmetry, lumps, depressions, or abnormal protrusions. Pupillary Tests a. Accommodation: The ability of the eye to change its focus from distant to near objects (and vice versa). b. Direct Response: Pupil constriction when light is shone directly into the eye. c. Consensual Response: Simultaneous constriction of the opposite pupil when light is shone into one eye. d. PERRLA: Pupils Equal, Round, and Reactive to Light and Accommodation, indicating normal function. e. Corneal Light Reflex: Reflection of light from the cornea, which should be in the same spot on each eye, indicating alignment. Inspecting the Nose a. Procedure: Visual inspection of the external nose for symmetry, deformities, or lesions; internal examination for mucosa color, septum deviation, or polyps. b. Expected findings: Symmetrical alignment, pink mucosa, no discharge, and patent nares. c. Abnormal findings: Deviated septum, polyps, or unusual nasal discharge. Discharge color and consistency may indicate various conditions, such as infection or allergy. Inspect Ears a. Tragus: A firm protrusion of cartilage on the outside of the ear; tenderness here can indicate infection. b. Auricle: Also known as the pinna, is the external part of the ear; should be symmetrical with no lesions or deformities. Palpating Lymph Nodes a. Occipital: Located at the base of the skull; palpable nodes may indicate an infection or other head/neck pathology. b. Posterior auricular: Located behind the ear; enlargement may indicate local infection. c. Preauricular: In front of the ear; swollen nodes may suggest infection in the eye, ear, or face. d. Tonsillar (Jugulodigastric): Under the angle of the mandible; often enlarged with pharyngeal or oral infections. e. Submandibular: Halfway between the angle and the tip of the mandible; enlargement can occur with infections of the head, neck, sinuses, ears, eyes, scalp, or pharynx. f. Submental: Midline, behind the tip of the mandible; may enlarge with infections of the lower lip, the floor of the mouth, or the tip of the tongue.