Health Assessment
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| The brain has four regions: | cerebrum, diencephalon, brainstem, cerebellum
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| 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.
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| Cerebral Cortex: | the cerebral cortex is the center for humans' highest functions, governing thought, memory, reasoning, sensation, and voluntary movement.
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| Frontal: | concerned with personality, behavior, emotions and intellectual function.
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| Parietal: | primary center for sensation.
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| Occipital: | primary visual receptor center.
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| Temporal: | primary auditory reception center
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| Wernicke's Area: | located in the temporal lobe, associated with language comprehensive.
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| Broca's Area: | located in the frontal lobe, mediates speech.
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| 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
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| Thalamus: | the thalamus is the main relay station for the nervous system.
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| 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.
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| 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.
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| Brain Stem: | midbrain, pons, medulla, spinal cord
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| 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).
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| Cranial Nerves: | On Occasion Our Trusty Truck Asks Funny A Good Vehicle Still However. (12 Total)
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| I: Olfactory (1) | sensory smell *(testing smell)
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| II: Optic (2) | sensory vision
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| Snellen Chart: | testing visual acuity
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| Confrontation Test: | peripheral vision
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| III: Oculomotor (3) | mixed -> motor, parasympathetic (cranial nerves III, IV, VI) - {3,4,6}
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| Motor: | most EOM movements, raise eyelids
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| Parasympathetic: | pupil constriction, lens shape
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| EOM: | extra ocular movement
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| PERRLA: | pupils equal round reaction to light accomodation
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| IV: Trochlear (4) | motor, down and inward movement of eye - EOM
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| 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)
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| VI: Abducens (6) | motor, lateral movement of eye - EOM
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| 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)
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| VIII: Acoustic (8) | Sensory - hearing and equilibrium: Whispered voice test, Weber, Rinne
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| IX: Glossopharyngeal (9) | mixed (CN IX, X): 9, 10 Motor: pharynx. Sensory: taste on posterior 1/3 of tongue, pharynx (gag reflex)
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| X: Vagus (10) | "voice" mixed. Motor - pharynx and larynx. Sensory - general sensation from carotid body, carotid sinus, pharynx, viscera. ("ahhh" reflex, gag reflex)
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| XI: Spinal (11) | motor - movement of trapezius and sternomastoid muscles: shrug shoulder against resistance, rotate head against resistance.
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| XII: Hypoglossal (12) | motor - movement of tongue: protrude tongue.
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| 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
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| Additional History for the Aging Adult: | review power point slides
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| Neuro Exam (objective data): Mental Status | Appearance/Behavior, Speech/Language, Mood, Cognitive Functions, Higher Cognitive Function
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| Appearance/Behavior: | level of consciousness, posture/motor behavior, dress/grooming/hygiene, facial expression, manner and affect
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| Speech/Language: | quantity, rate, articulation, fluency
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| Mood: | thought, perception, thought processes/content, perceptions, insight, judgment
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| Cognitive Functions: | orientation, attention (serial 7's, spelling backward), memory (recent, remote)
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| Higher Cognitive Function: | information/vocabulary (who's president, etc.), calculating ability (make change), abstract thinking, constructional ability.
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| 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.
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| 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
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| 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)
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| Reflexes: | triceps, biceps, brachioradialis, patellar, Achilles. [4+ very brisk, 3+ brisker than average, 2+ normal, 1+ diminished, 0 absent].
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