+ All Categories
Home > Education > Neurological assessment sp07 webversion

Neurological assessment sp07 webversion

Date post: 11-May-2015
Category:
Upload: coolboy101pk
View: 1,927 times
Download: 3 times
Share this document with a friend
Popular Tags:
33
1 The Neurological System
Transcript
Page 1: Neurological assessment sp07 webversion

1

The Neurological System

Page 2: Neurological assessment sp07 webversion

2

Neurological Exam 5 Components

Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory

Page 3: Neurological assessment sp07 webversion

3

Mental Status Examination

Examination - ABCTAppearanceBehaviorCognitionThought processes (thought content &

perceptions) Mini Mental State Exam Glasgow Coma Scale

Page 4: Neurological assessment sp07 webversion

4

Assessing LOC:Glasgow Coma Scale

Eye opening

Verbal responsiveness

Motor responsiveness

Page 5: Neurological assessment sp07 webversion

5

Glasgow Coma Scale

Page 6: Neurological assessment sp07 webversion

6

Physical Examination

Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not

stimulated Obtunded- sleeps most times, difficult to

arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for

arousal; responds to stimuli Coma- no response

(Jarvis CH 2)

Page 7: Neurological assessment sp07 webversion

7

Cranial Nerves“ On old Olympus’ Towering Tops a Finn

and German Viewed some hops.”

I – Olfactory VII - FacialII – Optic VIII – Auditory (V-C)III – Occulomotor IX - GlossopharyngealIV – Trochlear X - VagusV – Trigeminal XI – Spinal AccessoryVI – Abducens XII - Hypoglossal

Page 8: Neurological assessment sp07 webversion

8

Neurological: Physical Examination

Sensory System Function

With eyes closedInterpret sensationsDiscriminate side to side

Examine in detail if:Reduced sensationNumbness or painMotor or reflex abnormalSkin changes

Be specific: “tell me where I touch”

Page 9: Neurological assessment sp07 webversion

9

Physical ExaminationSensory Function Tests:

Touch Light touch 1st then Pain &

Temperature

Vibration Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination

Page 10: Neurological assessment sp07 webversion

10

Sensory Function Tests:

Sensory Exam: Light Touch

Page 11: Neurological assessment sp07 webversion

11

Sensory Function Tests:

Sensory Exam: Vibration

Page 12: Neurological assessment sp07 webversion

12

Sensory Function Tests:

Proprioception: Position sense

Page 13: Neurological assessment sp07 webversion

13

Sensory Function Tests:

Stereognosis

Page 14: Neurological assessment sp07 webversion

14

Sensory Function Tests:

Graphesthesia

Page 15: Neurological assessment sp07 webversion

15

Sensory Function Tests:

Two-point discrimination

Page 16: Neurological assessment sp07 webversion

16

Sensory Function Tests:

Dermatomes

Page 17: Neurological assessment sp07 webversion

17

Motor Examination

Symmetry, size, and presence f involuntary movements

Full ROM of joints Check strength against resistance

Neuro patients: Assess hand grips and foot pushes if bedridden

Page 18: Neurological assessment sp07 webversion

18

Cerebellar Function

1. Gait and postureHeel to toe in

straight lineWalking on toes

and heelsHop on one foot

Note width of gait

Page 19: Neurological assessment sp07 webversion

19

Cerebellar Function, con’t

2. Coordination of hands and legsRAMnose to examiner’s

fingerheel to shin coordination

Page 20: Neurological assessment sp07 webversion

20

Cerebellar Function, con’tRAM

Page 21: Neurological assessment sp07 webversion

21

Cerebellar Function, con’tNose –to - Finger Test

Page 22: Neurological assessment sp07 webversion

22

Cerebellar Function, con’tHeel to Shin

Page 23: Neurological assessment sp07 webversion

23

Cerebellar con’t

3. Romberg:

Stand upright, place feet together, then close eyes

loss of balance means + Romberg test

Be prepared to protect client from falling!

Page 24: Neurological assessment sp07 webversion

24

4 types of Reflexes

Superficial (abdominal reflex, Cremasteric reflex)

Visceral (pupillary response to light) PERRL

Pathologic + Babinski in adults

DTRs (e.g. knee)

Abdominal Reflex

Cremastic Reflex

Page 25: Neurological assessment sp07 webversion

25

Reflexes-Cont: PERRL/PERRLA

Page 26: Neurological assessment sp07 webversion

26

Reflexes-Cont:

Babinski’s Reflex (Adult)

Page 27: Neurological assessment sp07 webversion

27

Reflexes-Cont: Reflex Arc – Deep Tendon Reflex

Page 28: Neurological assessment sp07 webversion

28

Reflexes-Cont: Deep Tendon Reflexes

Technique

Position limb so muscle is slightly stretched

Reflex hammer should strike tendon briskly to stretch tendon

Get patient to relax

Page 29: Neurological assessment sp07 webversion

29

BRACHIORADIALIS BICEPS

TRICEPS

PATELLAR

ACHILLES/PLANTAR

DEEP TENDON REFLEXES

Page 30: Neurological assessment sp07 webversion

30

Grading of DTRs

4+ very brisk 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 no response

Page 31: Neurological assessment sp07 webversion

31

Assessment Guide: Neurological LOC: alert, comatose, lethargic,

obtunded GCS

Eye opening: spontaneously, to speech, to pain

Verbal Response: oriented, confused, inappropriate, incomprehensible

Motor Response: obeys, command, localizes pain, withdraws, flexion, extension

Page 32: Neurological assessment sp07 webversion

32

Assessment Guide : cont..

SeizureDescribe: tonic clonic, absence, status

epilepticusTiming: once at 10 am; 2 pm and 2:45 pm

Page 33: Neurological assessment sp07 webversion

33

Altered mental status: yes, no Aphasia: present, none Intelllectual functioning: intact;

short attention span, dementia, memory loss

Itnerventions in use:Seizure precautions: side rails

padded, oral airway at bedsideMed List: Klonopin, Aricept, Neurontin,

Dilantin, etc.


Recommended