The Neurological System 1 Neurological Exam 5 Components Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory 2 Mental Status Examination Examination - ABCT Appearance Behavior Cognition Thought processes (thought content & perceptions) Mini Mental State Exam Glasgow Coma Scale 3
Assessing LOC: Glasgow Coma Scale Eye opening Verbal responsiveness Motor responsiveness 4 Glasgow Coma Scale 5 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) 6
Cranial Nerves On old Olympus Towering Tops a Finn and German Viewed some hops. I Olfactory II Optic III Occulomotor IV Trochlear V Trigeminal VI Abducens VII - Facial VIII Auditory (V-C) IX - Glossopharyngeal X - Vagus XI Spinal Accessory XII - Hypoglossal 7 Neurological: Physical Examination Sensory System Function With eyes closed Interpret sensations Discriminate side to side Examine in detail if: Reduced sensation Numbness or pain Motor or reflex abnormal Skin changes Be specific: tell me where I touch 8 Physical Examination Sensory Function Tests: Touch Light touch 1 st then Pain & Temperature Vibration Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination 9
Sensory Function Tests: Sensory Exam: Light Touch 10 Sensory Function Tests: Sensory Exam: Vibration 11 Sensory Function Tests: Proprioception: Position sense 12
Sensory Function Tests: Stereognosis 13 Sensory Function Tests: Graphesthesia 14 Sensory Function Tests: Two-point discrimination 15
Sensory Function Tests: Dermatomes 16 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 17 Cerebellar Function 1. Gait and posture Heel to toe in straight line Walking on toes and heels Hop on one foot Note width of gait 18
Cerebellar Function, con t 2. Coordination of hands and legs RAM nose to examiner s finger heel to shin coordination 19 Cerebellar Function, con t RAM 20 Cerebellar Function, con t Nose to - Finger Test 21
Cerebellar Function, con t Heel to Shin 22 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! 23 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 24
Reflexes-Cont: PERRL/PERRLA 25 Reflexes-Cont: Babinski s Reflex (Adult) 26 Reflexes-Cont: Reflex Arc Deep Tendon Reflex 27
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 28 BRACHIORADIALIS BICEPS ACHILLES/PLANTAR TRICEPS PATELLAR DEEP TENDON REFLEXES 29 Grading of DTRs 4+ 3+ 2+ 1+ 0 very brisk brisker than average average, normal diminished, low normal no response 30
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 31 Assessment Guide : cont.. Seizure Describe: tonic clonic, absence, status epilepticus Timing: once at 10 am; 2 pm and 2:45 pm 32 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 bedside Med List: Klonopin, Aricept, Neurontin, Dilantin, etc. 33