Assessment - neuro
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| where is the cardiac center, for control of heart rate | medulla ---vagus nerve has significance also
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| Where are the respiratory centers that regulate inspiration/expiration | medulla houses these centers
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| Where are the centers that regulate respiratory DRIVE (rate) | pons
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| What relays data regarding blood gases to medulla | vagus nerve
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| what area of brain controls most conscious processes | cortex
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| where is emotional expression and Broca's/expressive language located | frontal lobe
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| where is hearting/taste/smell/memory and language comprehension located (Wernicke's) | temporal lobe
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| the limbic system regulates (4) | emotions---sexual arousal---behavioral expression---recent memory
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| where does sensory input go | into the parietal lobe
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| where is RAS - reticular activating system | brainstem & cerbral cortex---hyperexcitabe neurons screens and channels incoming sensory
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| what structure controls ANS | hypothalamus, along with pituitary gland homeostasis
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| midbrain regulates (3) | visual---auditory---pupils/eye movements
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| medulla regulates (4) | heart rate---resp RATE---bp---protective reflexes (cough, sneeze, vomit etc)
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| pons regulats | respiratory FUNCTION --- facial/eye sensation and movement
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| What do DRTs assess | reflexes at various spinal cord segments
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| what are dermatones | regions of the body innervated by cutaneous branch of a single spinal nerve
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| see study guide for infants, children, pg, elderly | *****
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| If a pt c/o these subjective data, assess neuro | h/a, recent trauma, vision changes, medications, change in mentalstatus, dizz, HTN, numbness, change in any 5 senses
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| The nursing approach for physical assessment is | inspect---palpate---cerebral function---cranial nerves---sensory function---reflexes
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| dizziness defined as | faintng sensation
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| vertigo described as | spinning sensation
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| dizziness can lead to | syncope, which is a temporary Loss of Consciousness
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| paresthesia | numbness or tingling
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| Assessment of the 5 senses is a quick way to look at | cranial never function, as intact cranial nerves are responsible for many of the senses
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| pts with dysarthria (facial/motor/speech problems) often have dysphagia . . .which could lead to | dysphia (difficulty swallowing) puts at risk for aspiration
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| What do we assess for in a neuro exam | mental status---CN fxn---sensory fxn---reflex fxn
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| how do we evaluate LOC | with a brief mental status exam, evaluation of verbal responses
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| Aside from LOC and CN testing, what other screenings for neuro | motor (strength, gait)---sensory (tactile, pain)---reflexes
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| subtle changes in LOC could be indicative of | increased ICP - be alert for these changes (forgetful, resltess, suddenly quiet)
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| layman's term for syncope | "blacking out"
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| The Glasgow coma scale has a total of 15 points to assess for LOC. How does it evaluate | best eye response---best verbal response---best motor response on a scale off 3-15---3 is non-responsive------------15 is A&Ox4
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| mental status screening exam would include | asssessing for person (name)---time (date)---place---memory (how old are you)--remote memory (where were you born)---recent memory (what did you eat for breakfast)
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| Assessing for cerebral function with respect to thought process as well as evaluating | judgement---mathematical ability---memory---general knowledge---speech
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| three types of memory | immediate---recent---remote
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| Glascow assess what again (quick answer) | best eye-verbal-motor response
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| ways to assess for math/calculative scales | count backwards from 100---serial 7s---any simple math problem
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| how would you assess thought process? | assess appropriateness, organization and content of responses throughout assessment---involves pt considering options/choosing appropriate actions
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| how would you assess abstract reasoning? | use provers and ask for interpretation 'it's raining cats and dogs' for example----or---what do an apple, orange and pear have in common
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| can assess judgement by asking | a hypothetical situation---if you witnessed a car accident, what would you do?
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| what should I look for when assessing communication | not only the ability to speak, but the content---appropriateness---speed---quality of speech
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| How do we test for cerebellar function? | assess coordination/fine motor skills---balance
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| how do we test coordination? | rapid alternating movements - finger to nose---heel to shin
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| how do we test balance? | gait - note sequence, posture
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| The Rombereg test assesses both cerebellar and musculoskeletal functions. how do we do it | have pt stand with feet together and eyes open---then have him close the eyes. should maintain balance with minimal swaying which would be negative for Romberg
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| How do we assess sensory function? | light touch---pain---temp
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| if light touch sensation is intact distally, should we assume it is intact proximally? | nope
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| temp and pain run along same tract, so only need to test temp if | test only if pain sensation is NOT in tact
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| deep sensory sensations can be tested by | vibratory sensations (tuning fork to great toe)----kinesthetics (pt perception of position in space - move toe/finger in a direction and have pt identify it)
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| discriminatory sensations include | stereognosis---graphesthesia---Two-point discrimination---point localization---extinction
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| sterognosis | ability to recognize form of objects by touch
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| graphesthesia | recognize outlines/numbers written on skin
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| Two point discrimination | differentiating betw 2 points of simultaneous stimulation
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| point localization | ability to sense & locate area being stimulated
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| extinction | simultaneous touch both side of pts body, have pt point the where they were touched
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| how do we assess DTRs | on a scale of 0-4, 2 is normal
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| How do we test for meningeal signs (3) | nuchal rigidity---Kernig's sign---Brudzinski's sign
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| Nuchal rigidity | pronounced neck stiffness
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| Kernig's sign | supine/flex knees---apply pressure to knee while pt tries to extend leg---CONTRACTION & PAIN of hamstring and RESISTANCE in extension are POSITIVE signs of meningitis
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| Brudzinski's sign | pt supine---FLEX head to chest----if pt has HIP FLEXION---then POSITIVE for meningitis
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| What is the best test for assessing LOC | GCS = glascow Coma test is best
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| What is Babinski's test | a reflex test indicating ABN response---stroke sole of foot in arc---nml is toe flexion---abn is FANNING OF TOES W/ DORSIFLEXION of great toe
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| How do we assess for stroke | Use the NIH stroke scale ---(National Institute of Health )---assesses 12 categories with scores from ----ZERO IS NORMAL-----42 most severely impaired
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| types of categories assesson NIH stroke scale | LOC---vision---facial weakness---motor weakness---language
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