Central nervous system vidhya

BY

G.VIDHYA

PBBSC II yr

VCCON

NERVOUS SYSTEMThe nervous system consists of

1. The central nervous system (CNS)

2. The peripheral nervous system

3. The autonomic nervous system

NURSING ASSESSMENTHistory collection

Physical examination

Diagnostic evaluation

HISTORY COLLECTIONPast history

Fall or trauma that may have involved the head or spinal cord.

Family history

Alzheimer’s disease, epilepsy, parkinson’s disease, spina bifida, etc.

Personal history

Alcohol, medications and illicit drugs.

NEUROLOGICAL ASSESSMENTA complete neurological assessment consists of five

steps:

1. Consciousness and cognition assessment

2. Cranial nerve assessment

3. Reflex testing

4. Motor system assessment

5. Sensory system assessment .

CONSCIOUSNESS AND COGNITION ASSESSMENT

Cerebral abnormalities may cause disturbances in

mental status, intellectual functioning, thought

content and emotional status.

CRANIAL NERVES ASSESSMENT

EQUIPMENTS NEEDED FOR CNS ASSESSMENT

Tongue depressor

Flash light

Sugar and salt samples

Watch

Cotton – tipped swab

Snellen chart

Opthalmoscope

Samples of familiar odours

Tuning fork

Knee hammer

CRANIAL NERVE I (Olfactory )

CRANIAL NERVE II (optic)

CRANIAL NERVE III (Occulomotor)

CRANIAL NERVE IV (Trochlear)

CRANIAL NERVE (Trigeminal)

CRANIAL NERVE VI (Abducens)

CRANIAL NERVE VII (Facial)

CRANIAL NERVE VIII(Acoustic)

ROMBERG TEST

CRANIAL NERVE IX (Glossopharyngeal)

CRANIAL NERVE X (Vagus)

CRANIAL NERVE XI (Spinal accessory)

CRANIAL NERVE XII (Hypoglossal)

REFLEX TESTINGBiceps reflex

Triceps reflex

Brachioradialis reflex

Patellar reflex

Achilles reflex

BICEPS REFLEX

1- Have the patient's elbow at about a90° angle of flexion with the armslightly bent down as shown infigure 2-6 .

2- Grasp the elbow with your lefthand so the fingers are behind theelbow and your abductee thumbpresses the biceps brachial tendon .

3- Strike your thumb a series of blowswith the rubber hammer, varyingyour thumb pressure with eachblow until the most satisfactoryresponse is obtained .

4- Normal reflex is elbow flexion(bending(

TRICEPS REFLEX

Grasp the patient's wrist withyour left hand and pull hisarm across his chest so theelbow is flexed about 90° andthe forearm is partially bentdown .

Tap the triceps brachialtendon directly above theolecranon process. Thenormal response is elbow

extension .

Triceps reflex

Triceps jerk with one arm flexed

Triceps jerk with arms folded

BRACHIORADIALIS REFLEXWith the patient’s forearm resting on the lap or acrossthe abdomen, the brachioradialis reflex is assesses.

A gentle strike of the hammer 2.5 to 5 cm above thewrist results in flexion and supination of the forearm.

PATELLAR REFLEX

The patellar reflex is elicited bystriking the patellar tendon justbelow the patella. The patientmay be in a sitting or a lyingposition.

If the patient is supine, theexaminer supports the legs tofacilitate relaxation of themuscles.

Contraction of the quadricepsand knee extension are normalresponses.

ACHILLES REFLEXTo elicit an achilles reflex, thefoot is dorsiflexed at the ankleand the hammer strikes thestretched achilles tendon.This reflex normally producesflexion

Deep tendon reflexes should be graded on a scale of 0-4as follows:

=0 absent despite reinforcement

=1 present only with reinforcement

=2 normal

=3 increased but normal

=4 markedly hyperactive, with clonus

EXAMINING THE MOTOR SYSTEMMotor ability

Muscle strength

Balance and coordination

MOTOR ABILITYThe patient is instructed to walk across the room, if

possible while the examiner observes posture and

gait. the muscles are inspected and palpated if atrophy

or involuntary movements is noted.

Muscle strengthAsk client to flex muscle and then resist when you apply

opposing force against the muscles

Compare contralateral sides

Neck, Trapezius, arms (Biceps, Triceps), wrists, fingers, hips,

legs, ankles and feet

Balance and coordinationSeat the patient. Instruct him to pat his knees with hishands, palms down then palms up. Have him alternatepalms down and palms up rapidly.

Watch the patient to notice if his movements are stiff, slow,nonrhythmic, or jerky.

The movements should be smooth and rhythmic as he doesthe task faster.

EXAMINING THE SENSORY SYSTEMTactile sensation

Superficial pain

Temperature

Vibration and position sense

DIAGNOSTIC EVALUATIONSComputed tomography scanningMagnetic resonance imagingPositron emission tomographySingle photon emission computed tomographyCerebral angiographyMyelographyUltrasound imageryDopplerEEGEMGLP