Health Assessment 2-24 Neurologic sys

CNS

brain

• cerebrum

• cerebellum

• brain stem

spinal cord

PNS

reflex arc

cranial nerves

spinal nerves

autonomic nervous system

parts of the cerebral cortex

part of the cns

frontal lobe

parietal lobe

temporal lobe

occipital lobe

frontal lobe

part of cerebral cortex

personality, behavior, emotions, intellectual function

Broca’s area (motor speech)

parietal lobe

part of cerebral cortex

primary sensation- touch, pain, temp, pressure

temporal lobe

cerebral cortex

auditory, taste, smell

Wernicke’s area (speech comprehension)

occipital lobe

part of cerebral cortex

visual receptor center

cerebellum

part of cns

controls motor coordination of voluntary movement, equilibrium, muscle tone

brain stem

part of cns

midbrain

pons

medulla

midbrain

aka mesencephalon

part of brainstem

relay center for processing visual/auditory info, controls motor movement, regulates arousal (sleep-wake), sleep and pain

pons

part of brainstem

relay station coordinates automatic functions and manages key sensory and motor pathways

breathing, REM sleep/sleep-wake, sensory processing, originates cranial nerves for eyes, chewing, swallowing, hearing, facial sensations

medulla

part of brainstem

essential involuntary life support processes

HR, breathing, bp, links cardiac and respiratory systems

crossed representation

nerve pathways connect to the opposite side of the brain

left cerebral cortex receives info and controls right side, etc

types of peripheral nerves

sensory

motor

mixed

nerve

bundle of fibers outside cns

carry input via sensory afferent fibers

delievers output from CNS via efferent fibers

reflex

basic defense of nerv sys

involuntary reflex operates below level of consciousness control to permit quick reaction to dangerous/damaging situation

types of reflexes

stretch on/deep tendon (myotactic) eg knee jerk

superficial (cutaneous) eg plantar reflex

visceral (organ) eg pupillary response to light/accomodation

reflex arc pathway

receptor

sensory neuron

integration center (interneuron)

motor neuron

effector

types of reflex pathways

monosynaptic (one synapse, direct connection w/o interneuron, eg knee jerk)

polysnynaptic (slower but broader response eg pulling away from hot surface)

spinal nerves

8 cervical

12 thoracic

5 lumbar

5 sacral

1 coccygeal

subjective data

patient health history

family history

lifestyle

history of current health concerns

patient health history

seizures

head injury

spinal cord injury

stroke

family history

stroke

seizures

alzheimers

lifestyle

smoking

drinking

BMI

history of current health concerns

headaches

dizziness/vertigo

tremors

weakness

alterations in coordination

numbness/tingling

difficulty swallowing or speaking

objective data: neuro screening exam sequence

mental status assessment

cranial nerves '

motor sys

snesory sys

reflexes

equipment needed for objective data collection / neuro exams

penlight

tounge blade

cotton swab

cotton ball

percussion hammer

mental status examination

level of conscioysness LOC

orientation: person place time situation

appropriatenss of responses

causes of altered mental status

A lcohol or drug abuse

E ndocrine/epilepsy/electrolyes

I nfection

O verdose/oxygen deficit

U remia

T rauma/tumor/temp

I nsulin (hypo/hyperglycemia)

P sychiatric/poisons

S troke/shock

LOC options

full consciousness- alert, attentive, follows commads

lethargic- drowsy, partially awakens to stimulation

obtunded- difficult to arouse, needs constant stim to follow a simple command

stuporous- vigorous and continous stim needed, typically painful stim req, deep sleep state

comatose- does not respond to continous or painful stimulus

glasgow coma scale

eye opening

• spontaneous 4

• to speech 3

• to pain 2

• no response 1

motor response

• obeys commands 6

• localizes pain 5

• flexion/withdrawal 4

• flexion abnormal 3

• extension abnormal 2

• nothing 1

verbal response

• orientated 3x as appropriate 5

• conversation confused 4

• speech inappropriate 3

• speech incomprehensible 2

• nothing 1

normal is 15

coma < 7

routine assessment of cranial nerves

II- visual acuity

III, IV, VI - eye movements, pupillary light reflex, accomodation

VII- facial strength (eyes closed, smile, lift brows)

VIII- hearing

I olfactory

sensory - smell

test nostrils independently with eyes closed

non noxious smells like coffee, toothpaste, alcohol swab

note asymmetry in sense of smell

anosmia- decreased/loss sense of smell occurs bilaterally w/ smoking, cocaine, allergic rhinitis, Covid

ii optic

sensory-

test visual acuity and confrontation (peripheral vision)

assess optic disc w ophthalmoscope to det color, size, shape

note defects in or absent central/peripheral vision

note absent light reflex, retinal lesions, optic disk atrophy

III oculomotor

IV trochlear

VI abducens

sensory and motor

check pupils for size, regularity, equality, light reaction

assess extraocular movements

note fixed dialated pupils (abnormal) or eyes turning out or down or failure to move eyes

V trigeminal

mixed function

assess motor function through muscles of mastication by palpating while teeth are clenched

assess sensory function by performing light touch sensation with cotton wisp to the forehead check chin with eyes closed

note lack of bliink reflex weakness of masseter or temporalis muscles

Vii facial

motor function

assess facial expressions

note absence or asymmetry

viii acoustic / vestibulocochlear

sensory function

normal convo and whispered voice test

weber and rinne test with tuning fork

cranial nerve ix (glossopharyngeal) and x (vagus)

mixed

gag reflex

does uvula deviate to one side

dysphagia

xi spinal accessory

motor function

examine sternomastoid and trapezium muscles for equal size

check for equal strength by turning head and shrug shoulders

xii hypoglossal

motor function

assess tounge for symmetry and strength

note atrophy or deviation to one side

cranial nerve tests

1. sniff test

2. visual acuity

3. 6 cardinal gazes, pupillary constriction, open and close eyes

4. 6 cardinal gazes, down and in movement of eyees

5. facial sensation- maxillary mandibular masseter strength and temporalis muscle strength

6. 6 cardinal gazes, lateral moement of the eyes

7. puffing out cheeks, smile and frown

8. whisper test, weber, rhine and rhomberg

9. gag reflex and swallow

10. coughing gag reflex

11. shrugging- trapezius, side to side movement- sternocleidmastoid

12. tounge movement and strength, light, tight or dynamite

assessment of motor systems

inspection and palpation

size, strength and tone

• look for paralysis tic chorea tremor myoclonus

assess cerebellar function

observe for coordination of movements

• rapid alternating movements RAM

• finger nose test

• heel to shin

• balance tests - romberg tests

sensory assessment

pain

light touch

vibration

position (kinesthesia)

sterognosis

graphesthesia

extinction

point location

assesing reflexes

4+ scale

signs of stroke

weakness/numbness esp on one half of body

confusion, trouble speaking

changes in visision

trouble walking or balancing, dizziness

severe headaches

stroke assessment

B alance

E eyes

F ace

A rms

S peech

T ime

most common cause of adult disability and fifth leading cause of death in US

stroke risk factors

80% preventable

advanced age

high bp

smoking

daibetes

heart disease

history of stroke or TIA

obesity

seizures

excessive, hypersynchronous discharge of neurons in the brain

can be provoked or unprovoked

epilespy = condition of unprovoked recurrent seizures

health history of seizures

how long have you had seizures

how frequently do they occur

do you have any warning signs

is there anything that seems to trigger the seizure

assessing infants and children

motor control of newborn is under spinal cord and medulla and need strong stimuli, respond with strong stimuli and whole body movements

tonic neck reflex

grasp reflex

step reflex

crawl reflex

aging adults

steady loss and atrophy of neuron structure causes thinning of cerebrum

• general loss of muscle bulk and tone and strength

• impaired fine coordination

• decreased achilles reflex

• pupillary miosis, irregular pupil shape, decreased pupillary reflexes

• nerve conduction decreases- forgetfulness

signs of alzheimers

1. memory loss that disrupts daily life

2. trouble planning or solving problems

3. difficulty completing familiar tasks

4. confusion with time or place

5. trouble with images or distance

6. new problems with speaking or writing

7. inability to retrace steps

8. decreased or poor judgements

9. social withdrawal

10. changes in mood or personality