Ch20 - Neurological System

Common/concerning s/s

HA

Head Injury

Dizziness and vertigo

weakness (generalized, promimal, or distal weakness)

Numbness, abnormal/loss of sensations

Syncope (fainting)

near syncope (blacking out)

seizures

tremors/involuntary mov’t

Dizziness

sensation of lightheadedness, faintness, or unsteadyness

occur with Meniere’s disease, inner ear infection, neurologic disease, CAD

vertigo

Dizziness common causes

vertigo

orthostatic hypotension

vasovagal stimulation

arrhythmia

medication side effects

vertigo

sensation of spinning, either or self or surroundings

Seizures

suddent excessive electrical discharge in cerebral cortex

generalized and partial (focal or local)

Seizure causes

epilepsy

brain tumor

head trauma

fever

cocaine

withdrawal

electrolyte problems

brain infections

stroke

Changes in sensation causes

nerve entrapment

neuropathy

bone spurs and herniated discs

central lesions from MS or stroke

Weakness

determine if unilateral/bilateral, new/gradual onset, progressive

Unilateral weakness/paralysis

CVA

compression of spinal cold

nerve injury

Progressive weakness

Nervous system disease

loss of bowel/bladder control

spinal cold injury, compression, tumor

syncope

losing consciousness and postural tone

Near syncope

lightheaded/weak, no loss of consciousness

Tremors

involuntary mov’t

occur with or w/o other neurological manifestations

trembling, shakiness, uncontrollable body movement

leg restlessness

Past health history

head injury/concussion

acute/chronic neurologic disease, tx, current state of healthF

family hx

genetic conditions

HTN, stroke, Alzheimer’s, dementia, epilepsy, Huntington’s

Lifestyle and health practices

Rx or OTC drugs

tobacco products

safety

exposure to lead, pesticides, pollutants, chemicals

heavy lifting, repetitive motions

able to perform ADL

Physical Exam

Mental Status

Cranial Nerves

Motor and Cerebellar Systems

Sensory System

Reflexes

To assess balance and coordination…

Gait and balance

• Romberg Test

• Pronator Drift

Rapid alternating movements

Point to point movements

Assessing sensory system

Pain and light touch

temperature sensations

vibratory sensations

proprioception

Discriminative sensations

Discriminative sensations

more tests to determine ability of sensory cortex to correlate, analyze, and interpret sensations

stereognosis, graphesthesia, point localization, two point discrimination, extinction

Stereognosis

tactile discrimination

eyes closed, correctly identify an object placed in hand

Graphesthesia

number id

eyes closed, use blunt object to write a number on hands

Point localization

briefly touch client, ask them to id location

two point discrimination

ask pt to id number of points felt when touched

extinction

simultaneously touch pt in same area on both sides of body at the same point, id area touched

Deep tendon reflex

muscle stretch reflex

strike tendon, note speed, force, and amplitude of reflex response

Biceps, brachioradialis, triceps, patellar, achilles

Clonus

muscular spasm with repeated, rhythmic contraction

Cutaneous stimulation reflexes: superficial

Abdominal

plantar

• normal: flexion of toes

• abnormal: dorsiflexion of big toe and fanning of others

cremasteric

• normal: scrotum elevates on stimulated side

Tests for meningeal irritation

assess neck mobility

Brudzinski sign

Kernig sign

Brudzinski sign

flex neck and watch hips and knees in reaction to maneuver

normal: hips and knees remain relaxed

abnormal: pain and flexion of hips and knees

Kernig sign

flex leg at both hip and knee, then straighten knee

normal: no pain

abnormal: pain and resistance

Cerebrovascular Accident

Stroke

CVA risk factors

HTN

Smoking

Wt

DM

Hyperlipidemia

diet and nutrition

physical activity

alcohol abuse

A-fib

CAD

Obstructive sleep apnea

Stroke FAST

Face: look uneven?

Arm: one arm hanging down?

Speech: slurred?

Time: call 911 NOW!!