Neuro

Cranial Nerve 1

Olfactory Nerve- smell

Cranial Nerve 2

Optic Nerve- vision

Cranial Nerve 3

occulomotor- eye movement

Cranial Nerve 4

trochlear- eye movement

Cranial Nerve 5

trigeminal- mastication and sensation

How to test for function of cranial nerve 5?

• touch jaw as they chew or clench their teeth

• touch light sensation to person’s face, cheeks, and chin to test for sensation

Cranial Nerve 6

abducens- eye movement

Cranial Nerve 7

facial- face movement and sensation

How do you test cranial nerve 7?

• note face symmetry

• have person puff cheeks

Cranial Nerve 8

Acoustic nerve (vestibulocochlear)- hearing

How to test for cranial nerve 8?

whisper voice test or move fingers by the ear

Cranial Nerve 9

Glossopharyngeal- uvula, soft palate, and tonsillar pillar movement, posterior 1/3 of taste buds (not tested for)

Cranial Nerve 10

Vagus- controls specific body functions such as digestion, HR, and immune system

Cranial Nerve 11

Accessory- shoulder movement

How do you test for cranial nerve 11?

• shrug shoulders up equally against resistance

• rotate head against resistance

Cranial Nerve 12

Hypoglossal- tounge novement

How to test for cranial nerve 12?

• ask patient to say “light tight dynamite”

• stick tongue out and see if it is midline

The four unrelated words test

• pick 4 words with semantic and phonetic diversity, ask person to remember the four words

• ask for the recall of all 4 words at 5, 10, 30 mins

Normal 4 word recall response under 60 years old

accuratly recall 3-4 words at each interval

4 word recall in aging adults

people older than 80 average two or four words recalled over 5 minutes and improves over 10 and 30 mins

What happens with Aphasia?

loss of ability to speak or write coherently or to understand speech or writing due to a cerebrovascular accident

A-B-C-T of mental exams

A- Appearance

B- Behavior

C- cognitive

T- thought process

Mini-Cog aging adult test

• consists of three item recall test and clock drawing test

• tests for cognitive impairment

• those with dementia or other impairments will not be able to complete

What happens to the neuro aspect of the body with an aging adult?

• atrophy with steady loss of neuron structure in the brain and spinal cord

• velocity of nerve conduction decreases making the reaction time slower in some older persons

• diminished sensation of touch, pain, taste, and smell

What 2 ethnic groups have higher rate for stroke?

African Americans and Hispanics

91% of strokes are due to what?

modifiable factors

ex. smoking, diet, high BP

Perform a ______ on well persons with no significant findings from history

screening neurologic examination

Perform a ______ on persons with neurologic concerns

Complete neurologic examination

Perform _______ on persons with demonstrated neurologic deficits who require periodic assessments

Neurologic recheck examination

What tests the person’s ability to recognize objects by feeling their forms, sizes, and weights?

Stereogenosis

What’s the ability to “read” a number by having it traced on skin?

Graphesthesia

What is it called when at the same time touch both sides of the body; both sides should feel sensation?

Extinction

What is it called when the skin is touched and withdraw stimulus promptly; ask the person to put finger where you touched?

Point Location

What is it called when testing the posterior dorsal column tract?

Spinal Dorsal nerve is intact

How are specific muscle groups palpated or tested?

Always bilaterally

Rapid Alternating Movements

• finger nose finger test

• heel to shin test

What is the Romberg Test?

A balance test where the person is asked to stand up with feet together and arms at their sides. Close eyes and hold position for 20 seconds maintaining posture.

What is a DTRs 4-point scale used for?

reflex response is graded this way

0= no response

4= very brisk and hyperactive, indicative of a disease

What is reinforcement when testing reflex?

alternate technique to help elicit reflexes by performing an isometric exercise in a different muscle group

What is the clonus test?

• test for when reflexes are hyperactive

• support lower leg in one hand with with the other, move foot up and down to relax the muscle; then stretch muscle by briskly dorsiflexing foot; hold the stretch. Note: normal response: you would feel no further movement

A patient presents with, rapid rhythmic contractions of calf muscle and movement of foot. The nurse knows this is a sign of?

Clonus present

What are the three things the Glasgow Coma scale tests for?

1. eye-opening response

2. motor response

3. verbal response

F.A.S.T. plan from American Stroke Association

F=Face drooping

A=Arm weakness

S= speech difficulty

T= Time to call 911

What are risk factors that can increase a Pt risk for stroke?

HTN

Cigarettes

Heart Disorders

An 80 year old women presents with memory loss, trouble seeing, changes in personality, and losing track of time. The nurse suspects she has what?

Alzheimers

Ischemic strokes can be defined to be a sudden interruption of blood flow. Which pt would be identified as having an ischemic stoke?

1. embolic

2. tumor

3. thrombotic

Both embolic and thrombotic

Hemorrhagic strokes involve acute rupture and bleeding. Which conditions can result in a hemorrhagic stroke?

1. congenital malformations

2. tumor

3. cocaine abuse

4. distributed coagulation cascade

ALL of the above

What is repetitive movement of the jaw, lips, or tongue?

Dyskinesias

RAMS in aging adult

rapid alternating movements, difficult to perform

Plantar reflex in aging adult

may be absent or difficult to interpret

Abnormality in Cranial Nerve 1

cant smell well (anosmia)

Abnormality in Cranial Nerve 2

• absent or defect in central vision

• bad peripheral vision

• absent light reflex

• papilledema

• optic atrophy

Abnormality in Cranial Nerve 3

• dilated pupil, pitosis, eye turns out and slightly down

• failure to move up, in, down

• absent light reflex

Abnormality in Cranial Nerve 4

failure to turn eye down or out

Abnormality in Cranial Nerve 5

• NO BLINKING

• absent touch and pain (parathesias)

• weakness of masseter or temporalis muscles

Abnormality in Cranial Nerve 6

failure to move laterally, diplopia on lateral gaze

Abnormality in Cranial Nerve 7

• absent or asymmetric facial movement

• loss of taste

Abnormality in Cranial Nerve 8

decrease or loss of hearing

Abnormality in Cranial Nerve 9

no gag reflex

Abnormality in Cranial Nerve 10

• uvula deviates to the side

• no gag reflex

• hoarse voice

• cant swallow and fluid goes up nose

Abnormality in Cranial Nerve 11

unable to shrug shoulders

Abnormality in Cranial Nerve 12

tongue deviate to the side and the tongue movement is slowed

Fasciculations

muscle twitches when a single peripheral nerve is overactive

Myoclonus

sudden, brief twitching

chorea

involuntary, irregular or unpredictable movements

athetosis

slow, writhing, and continuous worm-like movement of the limbs or trunk

Reasons for a ischemic stroke

• sudden interruption of blood flow

• thrombotic

• embolic

Reasons for a hemorrhagic stroke

• acute rupture and bleeding

• congenital malformations

• disturbed coagulation cascade

• tumor

• cocaine abuse

Examples of abnormal gaits

• spastic hemiparesis- one side of body contacted constantly

• cerebellar ataxia- poor muscle control causing clumsiness

• parkinsonian

• scissors- knees go together while walking

• steppage or footdrop

• waddling

• short leg

hemiplegia

paralysis of one side of the body

paraplegia

paralysis of the legs and lower body, typically caused by spinal injury or disease

peripheral neuropathy

common in diabetes patients, loss of sensation involves all modalities; loss most severe at feet and hands

Babinski reflex

plantar foot stimulates extension of upward movement. children under 2 have positive sign but if older, it could mean there is a disorder

oppenheim reflex

drawing two knuckles down the patients chin will cause the patient to have dorsiflexion of the big toe (bad)

gordon hoffmann reflex

An extensor plantar response when the calf muscle is squeezed

Kernig reflex

the appearance of resistance or pain during extension of the patient’s knees beyond 135 degrees

Brudzinski reflex

severe neck stiffness causes a patient’s hips and knees to flex when the neck is flexed

snout reflex

protrusion of the lips elicited by tapping the midline of the upper lip