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neuro assessment
foundations exam 3
| Question | Answer |
|---|---|
| CNS | brain and spinal cord |
| Peripheral nervous system | 12 pair of cranial nerves, spinal and peripheral nerves |
| What is an important skill that all health professionals should possess in conducting a neurological assessment? | the proper use of standardized assessment tools and other tools of neurological observations, plus accurate recording of the findings |
| Neurological assessment parameters | mental status, cranial nerves, motor system, sensory system, reflexes |
| assessing mental status | LOC, appearance/behavior, speech/language/communication, thought process/ judgement, mood |
| Assessing LOC | awake and alert? oriented x3? |
| desired assessment finding when assessing LOC | AAO x3 |
| A&O x3 | person, place, time |
| A&O x4 | person, place, time, event/situation |
| A&O person | the patient's own name, and the names of relatives and professional personnel |
| How to assess A&O person? | Can you tell me your name? |
| A&O place | the patient's residence, city, and state |
| How to assess A&O place? | What is your address? |
| A&O time | the time of day, day of the week, month, season, date and year, duration of hospitalization |
| How to assess A&O time? | Can you tell me what time it is now? and what day it is? |
| A&O situation | what just happened/ is happening (frequently used after an accident or anesthesia) |
| How to assess A&O situation | can you tell me what just happened? |
| What does 'lethargic' mean? | sleepy/drowsy, asleep more than awake, easily arousable with verbal and tactile stimuli, will respond to questions (may or may not be appropriate) |
| What does 'obtunded' mean? | patient will: open their eyes to verbal/tactile stimuli, look at you, respond (slowly, confused), become unresponsive if not stimulated |
| What does 'stuporous' mean? | no spontaneous movement if not aroused (must be shaken or shouted at), inappropriate verbal response, purposeful response to pain |
| a stuporous patient is nearly unconscious with... | apparent mental inactivity and reduced ability to respond to stimulation |
| What does 'comatose' mean? | patient will be unconscious and unresponsive, cannot be aroused even with pain |
| desirable neuro assessment | AAO x3, appropriate behavior, pleasant, cooperative, follows commands, |
| Why can low blood glucose cause neurologic alterations? | the brain can't store glucose |
| When should you focus your assessment on mental status? | patient is confused, family/patient concerns, acute behavioral changes, long or short term memory loss, aphasia |
| mental status beyond LOC assess | general appearance and behavior, speech and language, mood, cognitive function |
| speech | the "how", physical act of being able to produce words |
| language | the "what", rules of grammar and social aspect of being able to use words to communicate |
| mental status assessment: assessing appearance and behavior | patient has appropriate concerns regarding care, body movements, posture, gait, calm, restless, anxious, combative, eye contact, gathering info to identify a problem, grooming/dressing |
| Assessing body movement | control, symmetry, appropriate, full/limited ROM |
| assessing posture | upright, slumping |
| assessing gait | smooth, unassisted, assisted |
| assessing grooming/dressing | clean, age appropriate? weather appropriate? both sides equal?- ability, parietal lobe CVA |
| What may abnormal findings when assessing mental status be due to? | depression, schizophrenia, dementia, OCD, CVA, visual disturbances, MS |
| MS assessment: appearance and behavior | facial expression: appropriate, symmetrical |
| ptosis | eyelid drooping |
| MS assessment: speech and language (communication) | spontaneous/ coherent speech? effortless flow? normal intonations, rate, rhythm? content makes sense? able to comprehend and reply appropriately? |
| aphasia | loss of ability to understand or express speech, caused by brain damage, affects a patients ability to communicate |
| aphasia is an impairment of what function? | language |
| expressive aphasia | patient can not produce language, knows what to say but can't |
| receptive aphasia | patient can not understand language |
| causes of aphasia | CVA (stroke), head injury, brain tumor/ surgery, infection (temporary), migraine (temporary) |
| CNS infections | meningitis, migraines, encephalitis |
| Mental status assessment: appearance, behavior, speech | flat effect?- depends on culture; manic depressive (describe instead of diagnose); anger/ hostility (may escalate quickly, nothing between you and door) |
| mini mental status exam (MMSE) | brief questionnaire to assess mental status, can use to track dementia |
| Requirements for MMSE | must be fluent in english and have an 8th grade education |
| MMSE points | maximum of 30 points, 0-17 would indicate severe cognitive impairment |
| 5 components of the MMSE | appearance and behavior, speech and language, mood, thoughts and perceptions, cognitive function |
| MMSE cognitive function | orientation, memory, attention, and higher cognitive functions such as information and vocabulary, calculations, abstract thinking, and constructional ability |
| MS Assessment for cognition | mini cognitive test- mini cog |
| mini cognitive test- "mini cog" | high sensitivity and specificity for detecting cognitive impairment |
| What does the "mini cog" screen for? | cognitive impairment in older individuals |
| Parts of the "mini cog" | 3 word recall test for memory, clock drawing test |
| mini cog- 3 word recall test for memory | recall of 3 unrelated words |
| mini cog- clock drawing test | draw a clock with numbers and hands to a specific time |
| How many cranial nerves are there? | 12 |
| How are cranial nerves grouped? | by how they are tested/assessed |
| What should you always assess for when assessing cranial nerves? | symmetry |
| functions of the cranial nerves | sensory, motor, or both |
| What do sensory cranial nerves do? | help a person to see, smell, and hear |
| What do motor cranial nerves do? | help control muscle movements in the head and neck |
| CN I | olfactory: smell |
| CN II | optic: vision |
| CN III | oculomotor: eye movement (most muscles), pupil constriction, eyelid elevation |
| CN IV | trochlear: down and inward movement of eye |
| CN V | trigeminal: facial sensation, muscles of chewing |
| CN VI | abducens: lateral movement of eye |
| CN VII | facial: facial expression/ movement, taste on anterior tongue, saliva and tear secretion |
| CN VIII | acoustic (vestibulocochlear): hearing and balance |
| CN IX | glossopharyngeal: taste on posterior tongue, swallowing, gag reflex, salivation |
| CN X | vagus: autonomic control of heart, lungs, GI tract, swallowing, speech, gag reflex |
| CN XI | spinal accessory: shoulder shrug and neck turn |
| CN XII | hypoglossal: tongue symmetry and position |
| What does neurological assessment provide important information about? | the functioning of the brain |
| What does the neurological assessment require? | multi-modal approach |
| What is the neurological assessment essential to? | establish a baseline on which to compare future assessments |
| Do we routinely check all 12 CN functions in the clinical setting? | no |
| Brief CN assessment | visual acuity: CN II; eye movements: CN III, IV, VI; sensation: CN V; tongue movement: CN XII; facial movement: CN VII; shoulder shrug, neck movement: CN XI |
| How to test visual acuity CN II? | snellen chart, confrontation |
| How to test eye movements CN III, IV, VI | 6 cardinal fields of gaze, PERRLA |
| What does 20/20 mean? | standing 20ft away you can see what a normal person sees at 20ft |
| What are we assessing for when assessing CN II- optic? | confrontation |
| How to assess confrontation | face pt at eye level, tell pt to look at you in eyes, have pt say "now" when the examiner's fingers enter from out of sight into their peripheral vision, repeat upper and lower temporal fields |
| What do the 6 cardinal fields of gaze assess? | extra ocular muscle function and the CNs that control them (CN III, IV, VI); smooth, coordinated eye movements in all 6 directions, look for symmetry |
| What should there not be when assessing 6 cardinal fields of gaze? | nystagmus, strabismus, diplopia |
| nystagmus | involuntary jerky eye movements |
| strabismus | misalignment/ crossing of eyes |
| diplopia | double vision reported by the patient |
| types of diplopia | horizontal binocular diplopia, vertical binocular diplopia, diagonal binocular diplopia |
| Checking pupils | ask pt to focus on object in distance, observe diameter of pupils in dimly lit room, note symmetry, shine penlight into one eye at a time and check direct and consensual light responses, not rate of reflexes |
| accomodation | the eye's ability to adapt for near vision |
| checking pupils: assessing accomodation | ask pt to focus on the light/object itself while the examiner moves it gradually closer to their nose |
| What should happen when assessing accomodation? | as you move the light/object closer to them, as the eyes accommodate to the near object and will constrict and converge |
| Ptsosis is a problem with what? | levator muscle |
| What CN controls the levator muscle? | CN III |
| Facial sensation | CN V- trigeminal |
| Assessing the motor function of CN V- trigeminal | palpate temporal and masseter muscles as patient clenches teeth, try to separate jaw by pushing down on chin |
| Assessing the sensory function of CN V- trigeminal | test light sensation with cotton ball over forehead, cheeks, chin |
| assessing facial movement CN VII | ask pt to: raise eyebrows, close eyes tightly, smile (show teeth), puff out cheeks |
| What CN is tongue movement? | CN XIII |
| assessing CN XI- spinal accessory | rotate head against resistance, shrug shoulders against resistance |
| normal findings after assessing CN XI- spinal accessory | shoulder shrug and head movement intact and equal bilaterally |
| Advanced CN testing | CN VIII- acoustic/ vestibulocochlear (hearing and balance), IX- glossopharyngeal, X- Vagus |
| Assessing CN VIII- acoustic/ vestibulocochlear | whisper test (hearing), rinne and weber, romberg (balance) |
| rinne and weber | use tuning fork to differentiate type of hearing loss |
| Assessing IX- glossopharyngeal, X- Vagus | taste, swallow, gag, voice; hoarse voice? dysphagia? |
| quick CN assessment | PERRLA, facial expression, speech, have patient smile/frown, stick out your tongue (side to side), assess hand grasps/pedal pulses |
| assessing the motor system | body position, involuntary movements, tone, strength, equality, coordination |
| assessing body position | relaxed, normal position/shape; any involuntary movements? |
| involuntary movements | tremors, tics, fasciculation, dystonia |
| tics | brief repetitive movements, winks, shrugging |
| fasciculation | involuntary contraction/ twitching, under skin |
| dystonia | grotesque twisted postures |
| What else should we assess motor system for? | muscle atrophy/ wasting, hypotonic/ flaccid muscles, increased resistance- spasticity |
| terms to know- muscle movement | paresis, plegia |
| paresis | weakness |
| plegia | absence of strength or paralysis |
| hemiplegia | one side of the body |
| paraplegia | trunk and lower limbs |
| quadriplegia | all 4 limbs and torso |
| easy assessment for muscle movement | hand grasp and pedal pushes |
| What can muscle movement abnormalities be caused by? | stroke, SCI, neurological diseases, nerve damage |
| Motor system assessment of neuro status: what to assess for coordination | muscle strength, cerebellar system for rhythmic movement and steady posture, vestibular system for balance and coordinating eye, head and body movements, sensory sytem for position sense |
| how to assess coordination | rapid alternating movements, point to point |
| rapid alternating movements for assessing coordination | tapping alternating fingers together, right thumb to right fifth finger |
| point to point for assessing coordination | touching examiners finger with patient's finger then touching nose, decreased coordination when eyes are closed |
| How to assess coordination: gait | walk heel to toe, walk on heels, walk on toes, hop in place with shallow knee bend, step on stool or rise from seat without using arms |
| ataxia | gross lack of coordination of muscle movements |
| ataxia is a dysfunction of what? | parts of the nervous system that coordinate movement |
| Assessing stance/ balance | romberg's test, pronator drift test |
| romberg's test | eyes open- steady balance, eyes closed- patient will sway |
| pronator drift test | closed eyes, palms up= arms will pronate as they drift down |
| What is sensory? | pain, position and vibration, light touch, discrimination |
| pain (sensory system assessment) | is this sharp or dull, use a broken cotton swab or paper clip (sharp side is pain, smooth side is dull) |
| What should you avoid when assessing sensation? | the word "pain" |
| Why should you avoid the word pain when assessing sensation? | it isn't pain in the sense of what people think of pain, it is pain in a nerve sense; ask if it is sharp or dull |
| position- sensory system assessment | use patients great toes, make sure their eyes are closed, have the patient move it away from body, up and down, ask them to tell you if you are moving their toe up, down, left, right |
| vibration- sensory system assessment | use tuning fork, start distal to save time |
| light touch assessment | use a cotton ball, touch cotton ball to patient's skin, while their eyes are closed, have them tell the examiner when they feel the cotton touching their skin |
| discrimination assessment | stereogenesis, graphesthesia |
| stereogenesis | recognizing an object using the sense of touch |
| graphesthesia | recognize writing on the skin using the sense of touch |
| plantar reflex | stroke up the lateral side of the sole and across the ball of the foot to just below the great toe |
| normal response when testing plantar reflex | plantar flexion- negative babinski test |
| positive babinski | do not want to see in adult! abduction of the toes with dorsiflexion of the great toes |
| clonus | series of involuntary muscle contractions due to sudden stretching of the muscle |
| What does clonus cause? | large motions that are usually initiated by a reflex |
| Glascow Coma Score- GCS | 3 areas of assessment: eyes open, motor response, verbal scale |
| desired score for Glascow Coma Score | 15 |
| GCS eyes open | spontaneous=4 to verbal command= 3 to pain=2 no response=1 |
| GCS motor response | obeys command for movement=6; purposeful movement to painful stimulus= 5; withdraws in response to pain=4; flexion in response to pain=3; extension response in response to pain=2; no response=1 |
| decorticate posturing | closed hands, legs are internally rotated, feet turned inward, arms are abducted and flexed against the chest |
| decerebrate posturing | head and neck are arched, legs are straight, toes are pointed downwards, arms are straight, extended and hands are curled |
| GCS verbal scale | oriented=5, disoriented/confused=4, inappropriate words=3, incomprehensible sounds=2, no response=1 |
| stroke warning signs | sudden numbness or weakness especially on one side of the body, sudden confusion, trouble speaking/understanding, sudden trouble seeing, sudden trouble walking, dizziness, loss of balance/coordination, sudden severe headache with no known cause |
| F.A.S.T warning signs | F= face drooping, a= arm weakness, s=speech difficulty, t=time to call 911 |
| f F.A.S.T | face drooping: does one side of the face droop or is it numb? ask the person to smile. is the person's smile uneven? |
| A F.A.S.T | arm weakness, is one arm weak or numb? ask the person to raise both arms. Does one arm drift downward? |
| S F.A.S.T | speech difficulty, is speech slurred? |
Created by:
camrynfoster