nervous system assessment

Health History Assessment Qs

Pt hx of current problem:

-onset

-any injuries at birth, neurological problems (TBI, stroke, degenerative diseases)

-medications with neuro side effect

-surgeries to head, spine, eye surgeries

6 categories of functionality for neurologic system

1. Mental status

2. Cranial nerve function

3. Motor function

4. Cerebellar function

5. Sensory function

6. Reflexes

Mental Status

Determine how well pt is doing with high level functioning

LOC

GCS

Body posture and speech

Clean or disheveled

A&Ox4 Qs

Mood and affect

Glasgow Coma Scale

Eye opening:

4 spontaneously

3 to speech

2 to pain

1 no response

Verbal:

5 A&O time, place, person

4 confused

3 inappropriate words

2 incomprehensible sounds

1 no response

Motor:

6 obey commands

5 moves to localized pain

4 flexion withdraw from pain

3 abnormal flexion (Decorticate)

2 abnormal extension (decerebrate)

1 No response

Comatose 8 or <

Totally unresponsive 3

PERRLA

Pupils equal round reactive to light and accommodating

Tests CN III (oculomotor) IV (trochlear) VI (abducens)

Motor function

Strength, tone, coordination, symmetry

Push/pull

Pronator drift

mm tone- flaccid vs hypertonic

Hypotonia

Flaccidity

Hypertonia

Spasticity

Myoclonus

Spasm of mm

Athetosis

Slow, writhing, involuntary movements of extremities

Chorea

Involuntary, purposeless, rapid motions

Dystonia

Impairment of mm tone

Sensory function

Assess touch pain temp

Heard of hearing

Proprioception

Cerebellar function

Balance and coordination

Observe pt gait and posture

Symmetry of movement

Reflexes

A mm response

Tap tendon with reflex hammer

0:absent 1:weak 2:normal 3:brisk 4:hyperreflexia 5:hyperreflexia with sustained clonus

Efffect of aging on NS

Less neurons in parts of brain, brain weight decreases, cerebral blood flow decreases

Changes in myelin sheath decreases nerve conduction

Orthostatic hypotension

Trouble maintaining body temp

Decreased memory, vision, smell, strength, reaction time

NS diagnostic studies

CSF from lumbar puncture

-specific gravity: 1.007

-ph: 7.35

-appearance- colorless and clear

-RBC: 0

WBC: 0-5cell

Glucose: 40-70 mg/dL

Microorganisms: none

Pressure: 60-150

LP teaching

Pt lying on side

Monitor for spinal headache- keep pt reclined or flat for 1 hour

Assess numbness, tingling, pain at. Injection site, inability to void

LP contra for increased ICP or possible herniation

Cerebral angiography

X-ray of the blood vessels in brain to detect lesions, aneurysms, hematomas, brain tumors

CT Scan

Computer assisted X-ray to detect hemorrhage, cysts, tumors, edema, infarction, atrophy

-can use contrast

MRI

Magnetic resonance imaging

Detect strokes, MS, tumors, trauma, herniation

-greater detail than CT

MRA-detects blood flow

PET Scan

Positron Emission

Metabolic activity to assess cell death or damage to detect stroke, Alzheimer’s disease, sz, tumors

EEG

Electroencephalography

Evaluates electrical activity in the brain

Electromyelography & nerve conduction studies: evaluates innervation of mm