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Nervous System

Health Assessment

The brain has four regions: cerebrum, diencephalon, brainstem, cerebellum
Cerebral Cortex: each half of the cerebrum is a hemisphere; the left hemisphere is dominant in most (95%) people, including those who are left handed.
Cerebral Cortex: the cerebral cortex is the center for humans' highest functions, governing thought, memory, reasoning, sensation, and voluntary movement.
Frontal: concerned with personality, behavior, emotions and intellectual function.
Parietal: primary center for sensation.
Occipital: primary visual receptor center.
Temporal: primary auditory reception center
Wernicke's Area: located in the temporal lobe, associated with language comprehensive.
Broca's Area: located in the frontal lobe, mediates speech.
Basal Ganglia: the basil ganglia are bands of gray matter buried deep within the two cerebral hemispheres that form the subcortical associated motor system (the extrapyramidal system). *They control automatic movements of body: arm swing with legs while walking
Thalamus: the thalamus is the main relay station for the nervous system.
Hypothalamus: the hypothalamus is a major control center with many vital functions: temperature, heart rate, blood pressure control, sleep center, anterior & posterior pituitary gland regulator, and coordinator of autonomic nervous system activity & emotional status.
Cerebellum: the cerebellum is a coiled structure located under the occipital lobe that is concerned with motor coordination of voluntary movements, equilibrium, and muscle tone.
Brain Stem: midbrain, pons, medulla, spinal cord
Spinal Nerves: the 31 pairs of spinal nerves arise from the length of the spinal cord and supply the rest of the body. (8 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal).
Cranial Nerves: On Occasion Our Trusty Truck Asks Funny A Good Vehicle Still However. (12 Total)
I: Olfactory (1) sensory smell *(testing smell)
II: Optic (2) sensory vision
Snellen Chart: testing visual acuity
Confrontation Test: peripheral vision
III: Oculomotor (3) mixed -> motor, parasympathetic (cranial nerves III, IV, VI) - {3,4,6}
Motor: most EOM movements, raise eyelids
Parasympathetic: pupil constriction, lens shape
EOM: extra ocular movement
PERRLA: pupils equal round reaction to light accomodation
IV: Trochlear (4) motor, down and inward movement of eye - EOM
V: Trigeminal (5) mixed, motor - muscles of mastication (chewing). sensory - sensation of face and scalp, cornea, mucous membranes of mouth and nose. (teeth clench, temporal muscles, sensory function - forehead, cheek, chin)
VI: Abducens (6) motor, lateral movement of eye - EOM
VII: Facial (7) Motor - facial muscles, close eyes, labial speech. Sensory - taste (sweet, salty, sour, bitter) on anterior 2/3 of tongue. parasympathetic -saliva & tear secretion (smile, frown, close eyes tightly, lift eyebrows, show/puff cheeks)
VIII: Acoustic (8) Sensory - hearing and equilibrium: Whispered voice test, Weber, Rinne
IX: Glossopharyngeal (9) mixed (CN IX, X): 9, 10 Motor: pharynx. Sensory: taste on posterior 1/3 of tongue, pharynx (gag reflex)
X: Vagus (10) "voice" mixed. Motor - pharynx and larynx. Sensory - general sensation from carotid body, carotid sinus, pharynx, viscera. ("ahhh" reflex, gag reflex)
XI: Spinal (11) motor - movement of trapezius and sternomastoid muscles: shrug shoulder against resistance, rotate head against resistance.
XII: Hypoglossal (12) motor - movement of tongue: protrude tongue.
Subjective Data: headache/head injury, dizziness/vertigo, seizures, tremors, weakness, coordination problems, difficulty swallowing, difficulty speaking, numbness/tingling anywhere in body, fainting/syncope/falls, past medical history, environmental/occupational hazards
Additional History for the Aging Adult: review power point slides
Neuro Exam (objective data): Mental Status Appearance/Behavior, Speech/Language, Mood, Cognitive Functions, Higher Cognitive Function
Appearance/Behavior: level of consciousness, posture/motor behavior, dress/grooming/hygiene, facial expression, manner and affect
Speech/Language: quantity, rate, articulation, fluency
Mood: thought, perception, thought processes/content, perceptions, insight, judgment
Cognitive Functions: orientation, attention (serial 7's, spelling backward), memory (recent, remote)
Higher Cognitive Function: information/vocabulary (who's president, etc.), calculating ability (make change), abstract thinking, constructional ability.
Cranial Nerves: CN I - CN XII (1-12): Motor Functioning and Coordination: Upper extremities - touch nose with alternating fingers, rapidly move index finger between nose and examiner's finger, rapidly alternate fingers to thumb, rapidly turn palms up and down on lap.
Coordination: Gait & balance - walk straight line, tandem walking, toe/heel walk, Romberg test, knee flexion-hop/shallow knee bend. Spine: w/ patient standing, inspect & palpate spine as patient bends over at waist. ROM - flexion, extension, lateral bending, rotation
Objective Information: cont Sensory function: superficial pain and light touch - arms and legs. Vibration - arms and legs. *Place tuning fork on bony prominence (wrist, ankles, great toe)
Reflexes: triceps, biceps, brachioradialis, patellar, Achilles. [4+ very brisk, 3+ brisker than average, 2+ normal, 1+ diminished, 0 absent].
Created by: mr209368