Neurological System- NUR203

Central nervous system

Brain and spinal cord

Each lobe of the brain

Has its own job

Sections of the spinal cord

-Cervical

-Thoracic

-Lumbar

-Sacral

How many cervical vertebrae are there?

7

How many thoracic vertebrae are there?

12

How many lumbar vertebrae are there?

5

How many sacral vertebrae are there?

5 fused

Is the nerve root of the spine anterior or posterior?

Anterior

Is the cord segment of the spine anterior or posterior?

Posterior

Are the spinous processes anterior or posterior?

Posterior

Peripheral nervous system

Consists of cranial and peripheral nerves

Peripheral nervous system controls

-Somatic nervous system

-Autonomic nervous system

Somatic nervous system

Regulates muscle movements and response to sensations of touch and pain

Autonomic nervous system is made of

-Sympathetic

-Parasympathetic

Sympathetic

Fight or flight

Parasympathetic

Calm and relaxed

How many cranial nerves are there?

12

Spinal nerves are a type of

Peripheral nerve

Spinal nerves

Carry impulses to and from the spinal cord

How many pairs of spinal nerves are there?

31 pairs

Each pair of spinal nerves attach

To the spinal cord

Dermatomes

Band of skin innervated by the sensory route of spinal column

Dermatomes for cervical spine are on

Head, shoulders, arms, and hands

Dermatomes for thoracic spine are on

Chest, abdomen, and back

Dermatomes for lumbar spine are on

Front of legs, lateral and medial thighs, bottom of posterior legs, and top of feet

Dermatomes for sacral spine are on

Butt, center of posterior thighs, calves, bottom of feet, and toes

Common or concerning symptoms

-Headache

-Head injury

-Dizziness or vertigo

-Weakness

-Numbness

-Loss of sensation

-Syncope

-Seizures

-Tremors or involuntary movements

-Ataxia

Dizziness

Lightheaded

Vertigo

Environment feels like it is spinning

Vertigo is usually

Inner ear issue

Vertigo can cause

Nausea

Syncope

Fainting, loss of consciousness

Ataxia

Lack of steadiness when getting up

Past history

-CVA

-Seizures

-Headache

Lifestyle (risk factors)

-Smoking

-Obesity

-HBP

Types of neurological assessments

-Complete

-Screening (focused)

-Neuro check

Complete neuro assessment is performed

When the patient has demonstrated a neurological deficit (brand new problem)

Complete neuro assessment consists of

-Cerebral function

-Cranial nerves I-XII

-Motor system and cerebellar functions

-Sensory system

-Reflexes

Cerebral functions (complete neuro assessment) is assessed with

-Level of consciousness (LOC)

-Mental status

-Language

Level of consciousness (complete neuro assessment) is assessed with

-Degree of wakefulness

-Response to stimuli

-Orientation to person, place, and time

Screening (focused) neuro assessment is performed

For every patient seen for a complete physical exam or admission to a facility

Level of consciousness (screening neuro assessment) is assessed with

-Brief mental status exam

-Selected cranial nerve assessment

-Motor screening

-Sensory screening

-Patellar reflexes

Brief mental status exam (screening neuro assessment)

-Orientation x3

-Evaluation of verbal responsiveness

-Level of alertness

-Appropriateness of responses

Selected cranial nerve assessment (screening neuro assessment)

-CN II, III, IV, VI

-Vision (visual fields, funduscopic exam)

-Pupillary light reflex

-Eye movements

-Hearing

-Facial strength (smile, eye closure)

Motor screening (screening neuro assessment)

-Muscle strength

-Movement

-Gait

-Muscle bulk and tone

-Coordination

Muscle strength (screening neuro assessment)

-Shoulder abduction

-Elbow extension

-Wrist extension

-Finger abduction

-Hip flexion

-Knee flexion

-Ankle dorsiflexion

Gait (screening neuro assessment)

-Casual

-Heel walk

-Toe walk

-Tandem walk

Coordination (screening neuro assessment)

-FIne finger movements

-Finger-to-nose

-Heel to shin

Sensory screening (screening neuro assessment)

-Tactile sensations in extremities

-Pain sensations in extremities

-Light touch

-Pain/temperature

-Proprioception

Reflexes (screening neuro assessment)

-Muscle stretch response/deep tendon reflexes

-Plantar responses

Neuro check is performed

As a quick check after a neurological event or surgery

Neuro check is used to make

Rapid, repeated evaluations of several key indications of nervous system status

After a fall, what type of neurological assessment is performed?

Neuro check

Neuro check neuro assessment consists of

-Level of consciousness

-Pupil size and response

-Verbal responsiveness

-Extremity strength and movement

Level of consciousness (neuro check)

-Alertness (orientation x3)

-Ability to arouse

-Response to touch

Ability to arouse (neuro check)

Wakes quickly and is alert, difficult to arouse, unable to arouse

Pupil size and response (neuro check)

PERRLA, done with penlight

Verbal responsiveness (neuro check)

Clear coherent speech

Extremity strength and movement (neuro check)

Squeeze examiner's fingers simultaneously and check equality and level of strength, can they move fingers/arms/legs

Any neuro change at all means RN has to

Call provider

Equipment needed for physical exam

-Penlight

-Snellen chart

-Tongue blade

-Cotton swab

-Tuning fork

-Reflex hammer

-Familiar aromatic substance

Tongue blade is used to

See uvula

Aroma of foods stimulates appetite, so if the patient cannot smell it causes

Issues with eating (as well as other safety concerns such as not being able to smell smoke in case of a fire)

Exam components

-Mental status, speech, language

-Cranial nerves

-Motor and cerebellar systems

-Sensory systems

-Reflexes

Mental status components

-Appearance and behavior

-Speech and language

-Mood

-Thoughts and perceptions

-Cognitive function

Appearance and behavior is associated with

Level of consciousness

Level of consciousness

-Alert

-Lethargic

-Obtunded

-Stupor

-Comatose

-Posture and motor behavior

-Dress, grooming, hygiene

-Facial expression

-Manner, affect, relationship to people

Lethargic

Drowsy but responsive

Obtunded

Opens eyes but response is slow and is somewhat confused

Stupor

Arouses from sleep only after painful stimuli, verbal response slow or absent

Speech and language

-Is their speech garbled?

-Is their speech inappropriate?

Comatose

Unarousable with eyes closed

Mood

-Do they appear depressed?

-Poor eye contact?

-Do not initiate conversations?

-Are they pleasant and talkative?

Thoughts and perceptions

-Thought processes

-Thought content

-Perceptions

-Insight and judgement

Thought processes indicate mental status changes if

Flight of ideas

Thought content indicates mental status changes if

Meaning is unclear

Perceptions indicate mental status changes if

Patient has hallucinations

Insight and judgement indicate mental status changes if

Patient has unsafe impulsive behavior

Cognitive function

-Orientation (alert and oriented x3)

-Attention

-Memory

-Calculation

Attention

Ability to focus

Memory includes

Short and long-term

You can test a patients memory by asking

-DOB, SS#, address, phone number

-Ask them to explain a common phrase (ex. explain the meaning of "the apple doesn't fall far from the tree")

Calculation can be tested by asking the patient to

Subtract by 7s starting at 100

Glasgow coma scale is a

Hospital assessment tool

Glasgow coma scale consists of

-Eye opening response

-Verbal response

-Motor response

Glasgow coma scale pupil reaction

-B (brisk)

-S (sluggish)

-NR (no reaction)

-C (eye closed)

B

Brisk

S

Sluggish

NR

No reaction

C

Eye closed

Glasgow coma scale pupil gage (mm) ranges from

2-9mm

Coma scale in glasgow coma scale consists of

-Eyes open

-Best verbal response

-Best motor response

Eyes open scale (glasgow coma scale)

-4

-3

-2

-1

-C

Eyes open: 4

Spontaneously

Eyes open: 3

To speech

Eyes open: 2

To pain

Eyes open: 1

None

Eyes open: C

Eyes closed

Best verbal response scale (glasgow coma scale)

-5

-4

-3

-2

-1

-T

Best verbal response: 5

Oriented