20G- Unit 2- 6- Neurological Assessment

Normal newborn baby's reflexes

• rooting

• palmar grasp

• tonic neck

• babinski ⭐️ (toes should flare up)

When assessing a pt's health history, what do you assess for? (Mnemonic)

Allergies Meds Past med history Last oral intake Events prior

AMPLE

What are things you can ask the pt when assessing health status

• changes in vision, hearing, smell, taste

• headache/head injuries

• dizziness, vertigo

• seizures

• tremors

• weakness

• coordination

• numbness or tingling

• nutritional problems

• cognition problems

• difficulty swallowing, speaking

• bowel/bladder problems

What objective data are you assessing during a neuro test

• mental status

• cranial nerves

• motor assessment

• sensory assessment

• reflex assessment

What are the 5 main components of a mental status exam

• Appearance and behavior

• Level of consciousness

• Cognition

• Thoughts and perceptions

• Mood and affect

In a mental status exam what do you assess when assessing appearance and behaviour?

• posture

• body movements

• dress

• grooming, hygiene

• facial expression

• speech

In a mental status exam what do you assess when assessing LOC?

(This is the most sensitive indicator of changes in neurological status)

• awake, alert, aware

In a mental status exam what do you assess when assessing cognition?

• orientation (A&Ox3)

• attention span

• immediate, recent and remote memory

• word comprehension

• calculations

• higher level intellect

In a mental status exam what do you assess when assessing thought processes, content, perception?

• relevance, coherance, consistent, are they aware of reality (hallucinations, delusions), signs of dementia

In a mental status exam what do you assess when assessing mood and affect?

Restlessness, agitation, euphoria

Recite all cranial nerves

Oh Oh Oh To Touch And Feel A Glossy Vagina And Hymen

How do you assess the cranial nerves

• intact smell

• visual acuity

• intact extra-ocular movements

• pupillary reaction (PERRLA)

• sensation and movement of face intact

• baseline hearing and balance

• intact gag reflex

• coordinated swallow

• able to turn head and shrug shoulders

What to assess when conducting a motor assessment?

• always compare one side to another

• assess: size, strength, tone, balance, coordination

How do you assess muscle size (motor assessment)

Size, symmetry

• if >1 cm différence between both muscles, document findings

How do you measure strength when conducting a motor assessment

• use a 5 point scale; 0 is no strength and 5 is normal strength or strong

• push and pull against resistance

• grip strength

• pronator/palmer drift

• straight leg raises

How do you measure tone when conducting a motor assessment

Degree of tension in relaxed muscles:

• flaccidity: no done

• spasticity: too much tone

How do you measure balance when conducting a motor assessment

Tests:

• gait

• tandem walking

• Romberg test

• knee bend or hop on one foot

What is the Romberg test? (Motor assessment)

Tests the client's equilibrium, client stands with feet together and arms at sides eyes open and then closed. Client should be able to maintain the position for 20 secs with minimal or no swaying

How do you measure coordination of movement when conducting a motor assessment

• rapid alternating movements

• finger to finger test

• finger to nose test

• heel to shin test

What do you assess for in a sensory assessment

ALWAYS COMPARE SIDES

• fine touch

• lower extremity sensations

• assess pain

• temp sensation

• vibrations

• position changes

What is stereognosis? (Sensory assessment )

ability to identify an object by feeling it

what is graphaesthesia? (Sensory assessment )

ability to "read" a number by having it traced on the skin

What is two-point discrimination?(Sensory assessment )

The smallest distance between two points that can be differentiated by the somatic sensory system

What does a widening BP indicate

Increasing intercranial pressure

What is the neurological scale to assess head trauma

Glasgow coma scale

GCS eye opening

Spontaneous = 4 Responds to voice = 3 Responds to pain = 2 None = 1

GSC Best verbal response

• orientation A&Ox3

• test memory and judgement

GSC Best Motor Response

• test motor strength by asking to do things

• localizes to pain

• withdraw to pain

• flexes to pain

• extends to pain

What is decorticate posturing?

when brain-injured patient responds to a painful stimuli with FLEXION OF THE ELBOWS, plantar flexion, feet with extension, internal rotation of the legs

• lesions of the CORTICOSPINAL TRACT

What is the term

lesions of the CORTICOSPINAL TRACT, when brain-injured patient responds to a painful stimuli with internal rotation, adduction, and FLEXION OF THE ELBOWS

Decorticate posturing

What is the term

Lesions of the brainstem, when brain-injured patient responds to a painful stimuli with EXTENSION OF THE ARMS, flexion of the wrists, jaw clenching, plantar flexion, neck extension

Decerebrate posturing

What is decerebrate posturing?

Lesions of the brainstem, when brain-injured patient responds to a painful stimuli with EXTENSION OF THE ARMS, flexion of the wrists, jaw clenching, plantar flexion, neck extension

What is the Canadian neurological scale

Asks the client more complex commands, requiring more complex neuro processing (than GCS)

• alert vs drowsy

• oriented vs disoriented

• speech normal, expressive or receptive deficit

• weakness

Diagnostic studies for neurological assessment

X-rays CT scan MRI Lumbar puncture Carotid duplex Cerebral angiogram EEG EMG PET

What diagnostic test is used to test the CSF for blood, protein, infection

Lumbar puncture

When is a lumbar puncture contraindicated?

When an increase in intracranial pressure is suspected

Which diagnostic test checks the blood flow of the carotid arteries - the main vessels heading into the brain

Carotid duplex

Which diagnostic test

• procedure that uses contrast and X-rays to see blood flow in the brain

• catheter is inserted into femoral or brachial artery and carefully moved up to the vessels in the neck

• due injected, pictures are taken

• catheter is removed and pressure held for 10-15 minutes

• leg kept straight for 4-6 hours

Cerebral angiogram

Which diagnostic test needs extensive monitoring of V/S

Cerebral angiogram V/S:

• 15-30min for 2h

• then every 1h for 6h

• then every 4h for 24h

Which diagnostic test tests brain wave activity and is used in detection of seizures and brain death

EEG- electroencephalography

Which diagnostic test assesses muscle and the nerve cells that control them (motor neurons)

• a needle electrode is inserted directly into a muscle and it records the electrical activity in that muscle

EMG

Which diagnostic test

• uses small amount of radioactive materials during a scan

• metabolic activities of the brain regions are measured to assess cell death of damage

• used to diagnose AD, Parkinson's, tumors

PET