neurological assessment sp07 webversion

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The Neurological System

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Neurological Exam 5 Components

Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory

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Mental Status Examination

Examination - ABCTAppearanceBehaviorCognitionThought processes (thought content &

perceptions) Mini Mental State Exam Glasgow Coma Scale

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Assessing LOC:Glasgow Coma Scale

Eye opening

Verbal responsiveness

Motor responsiveness

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Glasgow Coma Scale

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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)

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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

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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”

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Physical ExaminationSensory Function Tests:

Touch Light touch 1st then Pain &

Temperature

Vibration Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination

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Sensory Function Tests:

Sensory Exam: Light Touch

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Sensory Function Tests:

Sensory Exam: Vibration

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Sensory Function Tests:

Proprioception: Position sense

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Sensory Function Tests:

Stereognosis

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Sensory Function Tests:

Graphesthesia

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Sensory Function Tests:

Two-point discrimination

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Sensory Function Tests:

Dermatomes

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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

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Cerebellar Function

1. Gait and postureHeel to toe in

straight lineWalking on toes

and heelsHop on one foot

Note width of gait

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Cerebellar Function, con’t

2. Coordination of hands and legsRAMnose to examiner’s

fingerheel to shin coordination

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Cerebellar Function, con’tRAM

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Cerebellar Function, con’tNose –to - Finger Test

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Cerebellar Function, con’tHeel to Shin

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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!

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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

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Reflexes-Cont: PERRL/PERRLA

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Reflexes-Cont:

Babinski’s Reflex (Adult)

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Reflexes-Cont: Reflex Arc – Deep Tendon Reflex

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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

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BRACHIORADIALIS BICEPS

TRICEPS

PATELLAR

ACHILLES/PLANTAR

DEEP TENDON REFLEXES

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Grading of DTRs

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

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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

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Assessment Guide : cont..

SeizureDescribe: tonic clonic, absence, status

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

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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.