1 The Neurological System
May 11, 2015
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The Neurological System
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Neurological Exam 5 Components
Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory
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Mental Status Examination
Examination - ABCTAppearanceBehaviorCognitionThought processes (thought content &
perceptions) Mini Mental State Exam Glasgow Coma Scale
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Assessing LOC:Glasgow Coma Scale
Eye opening
Verbal responsiveness
Motor responsiveness
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Glasgow Coma Scale
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Physical Examination
Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not
stimulated Obtunded- sleeps most times, difficult to
arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for
arousal; responds to stimuli Coma- no response
(Jarvis CH 2)
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Cranial Nerves“ On old Olympus’ Towering Tops a Finn
and German Viewed some hops.”
I – Olfactory VII - FacialII – Optic VIII – Auditory (V-C)III – Occulomotor IX - GlossopharyngealIV – Trochlear X - VagusV – Trigeminal XI – Spinal AccessoryVI – Abducens XII - Hypoglossal
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Neurological: Physical Examination
Sensory System Function
With eyes closedInterpret sensationsDiscriminate side to side
Examine in detail if:Reduced sensationNumbness or painMotor or reflex abnormalSkin changes
Be specific: “tell me where I touch”
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Physical ExaminationSensory Function Tests:
Touch Light touch 1st then Pain &
Temperature
Vibration Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination
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Sensory Function Tests:
Sensory Exam: Light Touch
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Sensory Function Tests:
Sensory Exam: Vibration
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Sensory Function Tests:
Proprioception: Position sense
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Sensory Function Tests:
Stereognosis
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Sensory Function Tests:
Graphesthesia
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Sensory Function Tests:
Two-point discrimination
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Sensory Function Tests:
Dermatomes
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Motor Examination
Symmetry, size, and presence f involuntary movements
Full ROM of joints Check strength against resistance
Neuro patients: Assess hand grips and foot pushes if bedridden
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Cerebellar Function
1. Gait and postureHeel to toe in
straight lineWalking on toes
and heelsHop on one foot
Note width of gait
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Cerebellar Function, con’t
2. Coordination of hands and legsRAMnose to examiner’s
fingerheel to shin coordination
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Cerebellar Function, con’tRAM
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Cerebellar Function, con’tNose –to - Finger Test
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Cerebellar Function, con’tHeel to Shin
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Cerebellar con’t
3. Romberg:
Stand upright, place feet together, then close eyes
loss of balance means + Romberg test
Be prepared to protect client from falling!
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4 types of Reflexes
Superficial (abdominal reflex, Cremasteric reflex)
Visceral (pupillary response to light) PERRL
Pathologic + Babinski in adults
DTRs (e.g. knee)
Abdominal Reflex
Cremastic Reflex
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Reflexes-Cont: PERRL/PERRLA
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Reflexes-Cont:
Babinski’s Reflex (Adult)
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Reflexes-Cont: Reflex Arc – Deep Tendon Reflex
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Reflexes-Cont: Deep Tendon Reflexes
Technique
Position limb so muscle is slightly stretched
Reflex hammer should strike tendon briskly to stretch tendon
Get patient to relax
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BRACHIORADIALIS BICEPS
TRICEPS
PATELLAR
ACHILLES/PLANTAR
DEEP TENDON REFLEXES
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Grading of DTRs
4+ very brisk 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 no response
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Assessment Guide: Neurological LOC: alert, comatose, lethargic,
obtunded GCS
Eye opening: spontaneously, to speech, to pain
Verbal Response: oriented, confused, inappropriate, incomprehensible
Motor Response: obeys, command, localizes pain, withdraws, flexion, extension
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Assessment Guide : cont..
SeizureDescribe: tonic clonic, absence, status
epilepticusTiming: once at 10 am; 2 pm and 2:45 pm
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Altered mental status: yes, no Aphasia: present, none Intelllectual functioning: intact;
short attention span, dementia, memory loss
Itnerventions in use:Seizure precautions: side rails
padded, oral airway at bedsideMed List: Klonopin, Aricept, Neurontin,
Dilantin, etc.