Objective Data - Neuro Slide Deck PDF

 Week 8: Objective Data in the Neurologic System Johns Hopkins School of Nursing Selected Learning Objectives 1. Perform a physical assessment of the neurologic system using the correct techniques 2. Differentiate between normal and abnormal findings of the...

 Week 8: Objective Data in the Neurologic System Johns Hopkins School of Nursing Selected Learning Objectives 1. Perform a physical assessment of the neurologic system using the correct techniques 2. Differentiate between normal and abnormal findings of the neurologic system 3. Describe findings frequently seen when assessing the older client’s nervous system 4. Analyze the data from the interview and physical assessment of the neurologic system to formulate valid clinical judgments 3 Collecting Objective Data: Physical Exam ►Mental status ►Cranial nerves ►Motor and cerebellar systems ►Sensory systems ►Reflexes 4 Collecting Objective Data: Equipment 5 Collecting Objective Data: Physical Exam ►Mental status ►Cranial nerves ►Motor and cerebellar systems ►Sensory systems ►Reflexes 6 Collecting Objective Data: Mental Status ► Mental Status Examination ► Screening tools MoCA Mini-Mental Status Exam (MMSE) Glasgow Coma Scale (GCS) ► Alert and oriented x4 (AOx4) To person, time, place, and situation 7 Collecting Objective Data: Mental Status ► Mental Status Examination ► Screening tools MoCA Mini-Mental Status Exam (MMSE) Glasgow Coma Scale (GCS) ► Alert and oriented x4 (AOx4) To person, time, place, and situation 8 Collecting Objective Data: Physical Exam ►Mental status ►Cranial nerves ►Motor and cerebellar systems ►Sensory systems ►Reflexes 9 Collecting Objective Data: Cranial Nerves ►Cranial Nerves (CN) I-XII I  Olfactory (cerebrum) – Sensory II  Optic (cerebrum) – Sensory III  Oculomotor (midbrain) – Motor IV  Trochlear (midbrain) – Motor V  Trigeminal (pons) – Mixed VI  Abducens (pons) – Motor VII  Facial (pons) – Mixed VIII  Acoustic or Vestibulocochlear (pons) – Sensory 10 Collecting Objective Data: Cranial Nerves ►Cranial Nerves (CN) I-XII IX  Glossopharyngeal (medulla) – Mixed X  Vagus (medulla) – Mixed XI  Spinal Accessory (medulla) – Motor XII  Hypoglossal (medulla) – Motor 11 Collecting Objective Data: Cranial Nerves 12 Collecting Objective Data: Cranial Nerves 13 Cranial Nerves (CN) I: Olfactory ► How to perform: Ask client to clear nose of any mucus, then to close eyes or not look at the object. Occlude one nostril and identify a scented object (e.g., coffee) Repeat for the other nostril. 14 Cranial Nerves (CN) II: Optic ► How to perform: Use a Snellen chart to assess vision in each eye (visual acuity) – OD: right eye – OS: left eye – OU: both eyes Assess visual fields of each eye by confrontation Use ophthalmoscope to view the retina and optic disc of each eye – Red reflex 15 Cranial Nerves (CN) II: Optic ► How to perform: Use a Snellen chart to assess vision in each eye (visual acuity) – OD: right eye – OS: left eye – OU: both eyes Assess visual fields of each eye by confrontation Use ophthalmoscope to view the retina and optic disc of each eye – Red reflex 16 Cranial Nerves (CN) II: Optic 17 Cranial Nerves (CN) II: Optic ► How to perform: Use a Snellen chart to assess vision in each eye (visual acuity) – OD: right eye – OS: left eye – OU: both eyes Assess visual fields of each eye by confrontation Use ophthalmoscope to view the retina and optic disc of each eye – Red reflex 18 Cranial Nerves (CN) III, IV, and VI ► How to perform: Inspect margins of eyelids Assess extraocular movements Assess pupillary response to light (direct/indirect) and accommodation in both eyes. – PERRLA: pupils are equal, round, and reactive to light and accommodation 19 Cranial Nerves (CN) III, IV, and VI 20 Cranial Nerves (CN) III, IV, and VI ► How to perform: Inspect margins of eyelids Assess extraocular movements Assess pupillary response to light (direct/indirect) and accommodation in both eyes. – PERRLA: pupils are equal, round, and reactive to light and accommodation 21 Cranial Nerves (CN) III, IV, and VI 22 Cranial Nerves (CN) III, IV, and VI ► How to perform: Inspect margins of eyelids Assess extraocular movements Assess pupillary response to light (direct/indirect) and accommodation in both eyes. – PERRLA: pupils are equal, round, and reactive to light and accommodation 23 Cranial Nerves (CN) V: Trigeminal ► How to perform: Test motor function – Ask client to clench teeth while you palpate the temporal and masseter muscles for contraction Test sensory function – Sharp/dull sensation – Light touch – Corneal reflex 24 Cranial Nerves (CN) V: Trigeminal ► How to perform: Test motor function – Ask client to clench teeth while you palpate the temporal and masseter muscles for contraction Test sensory function – Sharp/dull sensation – Light touch – Corneal reflex 25 Cranial Nerves (CN) VII: Facial ► How to perform: Test motor function: smile, frown, raise eyebrows/wrinkle forehead, puff out cheeks, purse lips, close eyes tightly – Stroke? Act FAST Test sensory function (not routinely tested): touch anterior two-thirds of tongue with salt, sugar, or lemon juice (ask to identify flavor). 26 Cranial Nerves (CN) VII: Facial ► How to perform: Test motor function: smile, frown, raise eyebrows/wrinkle forehead, puff out cheeks, purse lips, close eyes tightly – Stroke? Act FAST Test sensory function (not routinely tested): touch anterior two-thirds of tongue with salt, sugar, or lemon juice (ask to identify flavor). 27 Cranial Nerves (CN) VII: Facial ► How to perform: Test motor function: smile, frown, raise eyebrows/wrinkle forehead, puff out cheeks, purse lips, close eyes tightly – Stroke? Act FAST Test sensory function (not routinely tested): touch anterior two-thirds of tongue with salt, sugar, or lemon juice (ask to identify flavor). 28 Cranial Nerves (CN) VIII: Acoustic or Vestibulocochlear ► How to perform: Test hearing ability in each ear Perform the Weber and Rinne Test 29 Cranial Nerves (CN) VIII: Weber Test 30 Cranial Nerves (CN) VIII: Rinne Test 31 Cranial Nerves (CN) VIII: Acoustic or Vestibulocochlear ► How to perform: Test hearing ability in each ear Perform the Weber and Rinne Test 32 Cranial Nerves (CN) IX & X ► How to perform: Test motor function: – Open mouth and say “ah” Test gag reflex: – Touch posterior pharynx with tongue depressor Test ability to swallow: – Drink water. Note voice quality. 33 Cranial Nerves (CN) XI: Spinal Accessory ► How to perform: Ask client to shrug shoulders against resistance to assess trapezius muscles Ask to turn head against resistance to assess sternocleidomastoid muscles. 34 Cranial Nerves (CN) XII: Hypoglossal ► How to perform: Ask client to protrude tongue and move it to each side against resistance with a tongue depressor 35  CRANIAL EVALUATION/TEST ABNORMAL FINDINGS NERVE I Olfactory (S) Sniff test Loss of smell II Optic (S) Snellen and/or Jaeger chart Trouble reading chart, missing some, squinting, Visual fields (confrontation) pulling away to read, loss of visual fields (retinal detachment) III Oculomotor (M) Extra-ocular movements Nystagmus, limited mvmt through 6 fields (ICP), IV Trochlear (M) Pupils PERRLA Pupils NO PERRLA (drugs, infection, brain tumor) VI Abducens (M) V Trigeminal (S/M) Have pt clench teeth while you palpate Asymmetrical strength, pain, weakness, jaw VII Facial (S/M) S: touch face w/ sharp & dull Cannot identify sensation (lesions in nerve M: have pt do facial movement tests tract) Asymmetry, can’t close eyes/raise forehead (Bell’s palsy) VIII Vestibulocochlear Weber, Rinne Vibration unequal in ears , BC>AC (S) Romberg Swaying/moving feet apart IX Glossopharyngeal Gag reflex, swallowing Dysphagia, absent gag reflex (S/M) X Vagus (S/M) Symmetric, bilateral soft palate/uvula Unilateral rise of soft palate, deviation of uvula 36 Collecting Objective Data: Physical Exam ►Mental status ►Cranial nerves ►Motor and cerebellar system ►Sensory systems ►Reflexes 37 Motor and Cerebellar Systems ►Gait and balance Tandem walking ►Romberg Test ►Hop on foot 38 Motor and Cerebellar Systems ► Coordination Finger-to-nose test 39 Motor and Cerebellar Systems ►Rapid alternating movements Finger to thumb Palms up and down ►Heel-to-shin test ►Posture Decorticate posturing Decerebrate posturing 40 Motor and Cerebellar Systems 41 Collecting Objective Data: Physical Exam ►Mental status ►Cranial nerves ►Motor and cerebellar systems ►Sensory systems ►Reflexes 42 Collecting Objective Data: Sensory Systems ►Assess light touch, pain, and temperature sensations 43 Collecting Objective Data: Sensory Systems ► Test vibratory sensation Tuning fork ► Test sensitivity to position ► Assess tactile discrimination (fine touch) Stereognosis 44 Collecting Objective Data: Sensory Systems ► Test point localization ► Test graphesthesia ► Two-point discrimination ► Test extinction 45 Collecting Objective Data: Physical Exam ►Mental status ►Cranial nerves ►Motor and cerebellar systems ►Sensory systems ►Reflexes 46 How to use the Reflex Hammer 47 Collecting Objective Data: Deep Tendon Reflexes ►Position the client ►Abnormal findings Hyporeflexia Hyperreflexia ►Reinforcement techniques 48 Collecting Objective Data: Deep Tendon Reflexes 49 Collecting Objective Data: Reflexes 50 Collecting Objective Data: Superficial Tendon Reflexes 51 Collecting Objective Data: Superficial Tendon Reflexes ►Abdominal reflex ►Cremasteric reflex 52  Tests for Meningeal Irritation or Inflammatio n 53  ► Weber, J. & Kelley, J. (2022). Health assessment in nursing (7th ed.). Philadelphia: Lippincott, Williams, & Wilkins. Referenc ► Image credits are listed in the notes section on applicable slides. es Otherwise, image credits are for Weber & Kelley, 2022. 54 Thank you