NURS 214 Neurological

What is some subjective data you can ask the patient about headaches?

Ask if they have headaches and know when it started and how often they are. If they have new onset severe headaches, they will need to be seen as this can mean a stroke. What kind of headache are they having (cluster headache, migraine).

What is some subjective data you can ask the patient about head injuries?

Know if they had an injury to the head and have them describe what happened along with symptoms they had after injury.

What is some subjective data you can ask the patient about dizziness/vertigo? 

Ask if they feel like they are going to pass out. Vertigo is a spinning sensation to the patient and can be seen due to middle ear issues. A syncopal episode means they passed out.

What is objective vertigo?

Feels like the room is spinning around them

What is subjective vertigo?

The patient feels like they are spinning

What is some subjective data you can ask the patient about seizures?

Know when it started and how often it is. Also know their history of seizures. Ask about duration and if they have any warning signs. Do they have a headache before and do they take medications to help with this.

What does aura mean?

Can be auditory, visual, or motor function issues before a seizure

What is a partial seizure?

Stares off and makes a clicking sound with no movement

What is a full seizure?

Affects the whole body and will be shaking

What is some subjective data you can ask the patient about tremors?

Do they have any shaking in the hands or face? Does anything make it worse or does anything relieve it. 

What is some subjective data you can ask the patient about weakness?

Know if they have any problems moving body parts and know if it is local (specific location) or generalized (whole body feels weak).

What is paresis?

Partial or incomplete paralysis

What is paralysis?

Loss of movement in that extremity and can’t move it at all

What is some subjective data you can ask the patient about incoordination?

Do they have any issues with balance while walking or standing? Do their legs give out while walking? Neurological disorders can affect coordination.

What is some subjective data you can ask the patient about numbness or tingling?

Do they feel pins and needles? Parastriate means numbness or tingling.

What is some subjective data you can ask the patient about difficulty swallowing?

Look for dysphasia and what kinds of foods cause this to happen. Biggest risk is aspiration and can be seen in stroke patients. 

What is some subjective data you can ask the patient about difficulty speaking?

Do they have issues with receptive or expressive aphasia. Strokes can cause garbled or slurred speech. Dysphasia means difficulty in speaking and making up words.

What is some subjective data you can ask the patient about environmental and occupational hazards?

Know the history to anything that can impact their neurological system. Are they taking any medications to help with this and do they have a history of using weed, alcohol, or cocaine. Lead is extremely toxic and can cause brain damage. 

For the aging adult, what subjective data would you ask about memory?

Do they have any memory loss? Is their recent or long-term memory okay?

When is a full neurological examination done?

Will be done for patients that have ongoing issues or the nurse has seen these issues like strokes, loss of function, or weakness.

What is included in a full neurological examination?

Mental status

Cranial nerves 

Motor system

Sensory system

Reflexes 

What is cranial nerve V and what does it test for?

Trigeminal nerve. This tests for motor function and sensory function. For motor, you will palpate the temporal and masseter muscles as the person clenches their teeth. For sensory, with the patients eyes closed, you will use light touch on the person forehead, cheeks, and chin.

What is cranial nerve XI and what does it test for?

Spinal accessory nerve. To test, examine sternomastoid and trapezius muscles for equal size and have the patient shrug their shoulders with and without resistance.

For muscles, what do you do when you are inspecting and palpating the size?

Inspect all muscle groups for symmetry bilaterally. Look for any atrophy or hypertrophy.

For muscles, what do you do when you are inspecting and palpating the strength?

Test muscle groups of extremities, neck, and trunk. Do they have any paralysis or weakness anywhere?

For muscles, what do you do when you are inspecting and palpating the tone?

Ask the patient to relax completely and move to each extremity smoothly through a full ROM. Do they have any contraction for rigidity. Blastid means no muscle tone

For muscles, what do you do when you are inspecting and palpating for involuntary movements?

Normally none occur, but if it is present note the location, frequency, rate, and amplitude. Note if the movements can be controlled at will.

What is RAM and what tests can be done?

Rapid alternating movements and the patient will pat their hands on their knees, then turn their hands over and pat knees again, then ask to do it faster. Some tests you can do is finger-to-finger test, finger-to-nose test, and heel-to-shin test. 

For cerebellar function test, what is included in balance tests?

Gait: observe as the person walks 10-20 feet, turns around, and returns to starting point. Normally the person moves with a sense of freedom and the gait is smooth, rhythmic, and effortless.

What is tandem walking?

Ask the patient to walk in a straight line in heel-to-toe fashion. Patient should not stagger around while doing this.

How would you test for Romberg sign?

Ask the person to stand up with feet together and arms at sides, then close their eyes and hold position for about 20 seconds. The person should not sway back and forth. If this happens, they have cerebellar disfunction.

How would you assess the sensory system?

Ask the person to identify various sensory stimuli in order to test intactness of peripheral nerve fibers, sensory tracts, and higher cortical discrimination. Compare sensation of symmetric parts of the body. Have the patient close their eyes and explain them what the procedure is.

To test the anterolateral tract, how would you test for pain?

Have a sharp and dull sensation and place it on the patients skin. Make sure their eyes are closed so they don’t know whether it’s sharp or dull. 

What does hypoalgesia and hyperalgesia mean?

Decreased sensation and increased sensation

To test the anterolateral tract, how would you test for temperature?

Test temperature sensation only when pain sensation is abnormal.

To test the anterolateral tract, how would you test for light touch?

Apply light pressure using a cotton in random order of sights and at irregular intervals. Have the patient say now or yes when touch is felt. 

To test the posterior column tract, how would you test for vibration?

Test the persons ability to feel vibrations of tuning fork over bony prominences. Assess on both sides for sensation. 

To test the posterior column tract, how would you test for position (kinesthesia)?

Test the persons ability to perceive passive movements of extremities. Do they know the position the extremity is at?

To test the posterior column tract, how would you test for tactile discrimination?

Means fine touch and can also measure discrimination ability of sensory cortex.

What is stereognosis?

Test the patients ability to recognize objects by feeling their form while their eyes are closed. They should know the object in their hand. 

What is graphesthesia?

Ability to “read” a number by having it traced on skin. The patients eyes will be closed and they should be able to tell you what the number is. Can indicate neurological problems.

What is two-point discrimination?

Tests ability to distinguish separation of two simultaneous pin points on the skin.

What is extinction?

Simultaneously touch both sides of body at the same point. Both sensations are normally felt.

What is point location?

Touch the skin and withdraw promptly. Ask the person to put the finger where you touched.

What is deep tendon reflexes (DTR)?

Measurement of stretched reflexes reveals intactness of reflex arch at specific spinal levels. Limb should be relaxed and you will stimulate reflex by directing short, snappy blow of reflex hammer onto the muscles insertion tendon. Also called the mininsky reflex.

What is the reflex response scale and what does it mean?

4 - very brisk, hyperactive with clonus, indicative of disease

3 - brisker than average, may indicate disease

2 - average, normal

1 - diminished, low normal, or occurs with reinforcement

0 - no response

What is reinforcement?

Alternate technique to help elicit reflexes by performing an isometric exercise in a different muscle group. Must document that this technique was used on the patient.

What is clonus?

Hyperactive movements in the patient. The normal response would be no movement

What is sustained clonus associated with?

UMN disease

What will you see if clonus is present?

You will note rapid rhythmic contractions of calf muscle and movement of the foot.

How would you assess the plantar reflex?

Position thigh with slight external rotation. With reflex hammer, draw a light stroke up the lateral side of the foot and inward across the ball of the foot. Normal response is the plantar flexion of the toes and inversion and flexion of forefoot. 

What happens if you have a positive Bibinsky reflex?

If the toes fan out, this is abnormal. It is only normal in infancy.

What is the highest and lowest score can you get on the Glasgow coma scale?

Highest is 15 and lowest is 3.

What happens if the Glasgow coma scale score goes below 7?

You will need assistance to keep their airway open as it means a stroke or coma will happen.

What does dyskinesias mean in the aging adult?

Repetitive movements in the jaw, lips, or tongue may accompany senile tremors.

What does RAM mean in the aging adult?

Will start to become more difficult to perform.

What does DTR mean in the aging adult?

Will become less brisk in the lower extremities like the ankles and knees. Aging people find it difficult to relax limbs, and always use reinforcement when eliciting DTR’s. 

What does the FAST plan mean?

F = face drooping

A = arm weakness

S = speech difficulty

T = time to call 911

This indicates a stroke

What does flaccidity mean?

The state of lacking firmness, being soft, limp, and flabby.

What does spasticity mean?

Decreased muscle tone and will hang like a rag doll with no control

What does rigidity mean?

The inability to be bent or be forced out of shape. (contracture)

What does cogwheel rigidity mean?

Seen in parkinson’s disease. Increased muscle tone and rigidity and will feel like jerks and stops in place.

What is a tic?

Involuntary compulsive movement o the extremity. Can be seen in neurological disorders and tourettes. 

What does myoclonus mean?

Rapid sudden jerks in the body.

What does fasciculation?

Rapid continuous twitching of a relaxed muscle. This can be a neurological issue.

What is chorea?

Rapid jerky movements in the limbs, trunk, or face. 

What is athetosis?

Make slow, snake-like, twisting movements.

What is a rest tremor?

When the patient has a tremor at rest but goes away when they start moving.

What does pin-rolling mean?

May be done hit a resting tremor. The patient will move their fingers like they are rolling something in their hand. 

What does intention tremor mean?

Become more increased when they move or when they are asked to do something.

What are some stroke symptoms?

Weakness or numbness in the face, arms, or legs, especially on one side of the body. Sudden change in vision, confusion or trouble speaking, and severe headache with no reason or explanation.

What is ataxia?

Staggering, wide gait. Seen with cerebellar issues and can be seen in MS.

What is parkinsonian?

Shuffling gait with their top half leaning forward.

What is scissoring?

Knees will be crossed and will have rigidity.

What is waddling?

Hip muscle weakness and can be seen in muscular atrophy.

What does decorticate mean?

When their posture is towards the middle of the body. Arms and hands will be clenched on their chest.

What does decerebrate mean?

When the posture extends outwards.This is the worse and shows issues from the brainstem. 

What does flaccid mean?

No movement and just hangs there. Can be even worse and can mean they have a nonfunctioning brainstem.

What does opisthotonos mean?

Arching the neck and the back. If they have bilateral meningitis, this can be seen.