Transcript LPN-C
Neurological Assessment
Objective One
Assess the components of
the basic neurological
assessment
The brain is highly dependent on blood flow and a
consistent supply of oxygen and glucose to maintain
neuronal function. Any decrease can cause neuronal
malfunction. Older adults tend to be vulnerable to
cognitive dysfunction secondary to many causes,
ranging from decreased blood pressure to infections.
Thus, any acute change in cognitive functioning needs
to be assessed for an underlying cause.
Neurological System
Functions through transmission of chemical and
electrical signals between the body and the brain
Receives, processes, and sends out information
Controls and coordinates the functioning of all other
systems in response to environment/surroundings
Involves cognition, emotion, memory, sensation and
perception, and regulation of homeostasis
Comprised of the central nervous system (CNS) and
the peripheral nervous system (PNS)
CNS = Brain and spinal cord
PNS = Cranial and spinal nerves
Two neurons with synapse (from MyNursingLab)
The PNS
• includes nerves emerging from the brain
(cranial nerves) and nerves emerging from the
spinal cord (spinal nerves).
• These nerves are divided into sensory nerves
that conduct messages from various parts of
the body to the CNS, whilst motor nerves
conduct impulses from the CNS to muscles
and glands.
• is further divided into the Somatic System
(SNS) and Autonomic System (ANS),
depending on the area of the body these
messages are transmitted to and from.
The SNS
• consists of sensory neurons from the head, body wall,
extremities, and motor neurons to skeletal muscle.
• The motor responses are under conscious control and
therefore the SNS is voluntary.
• Certain peripheral nerves perform specialized functions and
form the autonomic nervous system; they control various
activities that occur automatically or involuntarily such as
the contraction of smooth muscle in the walls of the
digestive system.
– The autonomic system is further divided into the
sympathetic and parasympathetic systems. These two
systems provide nerve stimuli to the same organs
throughout the body, but bring about different effects.
• The balance between these two systems is
controlled to create a state of homeostasis that is
where the internal stability of the bodily systems are
maintained in response to the external environment
Parasympathetic Nervous System
• slows down the body
• helps prepare for a more relaxed state, ready
for digestion and sleep.
• It will therefore increase peristalsis of the
alimentary canal, slow down the heart rate,
and constrict the bronchioles in the lungs.
.
The Sympathetic Nervous System
• helps prepare the body for "fight or flight" and
create conditions in the tissues for physical
activity.
• is stimulated by strong emotions such as
anger and excitement and will therefore speed
up heart rate, increase the activity of sweat
glands, adrenal glands, and decrease those of
the digestive system.
• also produces rapid redistribution of blood
between the skin and skeletal muscles.
Brain and spinal cord (from MyNursingLab)
Age-Related Considerations
Birth reflexes include rooting, sucking, palmar grasp,
tonic neck reflex, and Moro
Disappear during infancy
May return w/stroke or trauma
Denver Developmental Screening Test II (DDST) used to
screen young children
Neurons decrease over lifetime, resulting in slowed
reaction time, problem-solving skills, and voluntary
movement
Decreases in intelligence and memory not normal in the
elderly, and indicate a neurological deficit
Medication effects, dehydration, Alzheimer’s dementia, etc
Cerebral Function
Level of consciousness (LOC)
Arousal (alert, lethargic, stuporous, comatose)
Verbal stimuli
Tactile stimuli
Painful stimuli
Orientation (person, place, time)
Mental status and cognitive function
Behavior, appearance, response to external stimuli, speech,
recent and remote memory, communication, judgment
Posture, gait, motor movements, dress, hygiene/grooming,
mood, affect, facial expression
Consider language/education/culture during neuro exam
Glasgow Coma Scale
Objective Two
Demonstrate the proper
technique for the
assessment of reflex activity
Reflex Function
Deep tendon reflex is tested with a rubber percussion
hammer to tap a slightly stretched muscle
Normal response = muscle contraction
Response grading scale:
0 = No response detected
+1 = Diminished response
+2 = Response normal
+3 = Response somewhat stronger than normal
+4 = Response hyperactive with clonus
Clonus refers to involuntary continuous contractions of a
muscle or group of muscles
Superficial reflexes are tested by lightly touching the body
with the base of a reflex hammer or tongue blade,
beginning with the most peripheral part of the limb
Graded as positive or negative
Determine sensory loss area by testing every 1-2 inches
18
Testing Reflexes
Biceps
Reflex
Rest client’s elbow in nondominant hand with thumb over biceps tendon;
strike percussion hammer to own thumb
Triceps
Reflex
Abduct client’s arm at the shoulder, flexing at the elbow; support upper arm
with nondominant hand, letting forearm hang loosely; strike the triceps
tendon 2 inches above the olecranon process
Brachioradialis Rest client’s arm on his leg; strike with percussion hammer 1-2 inches above
bony prominence of the wrist on the thumb side
Reflex
Patellar
Reflex
Position client in seated position with legs dangling; strike the tendon directly
below the patella with a percussion hammer
Achilles
Reflex
Position client in the supine or seated position with legs dangling; hold
client’s foot slightly dorsiflexed; strike the Achilles tendon about 2 inches
above the heel with the percussion hammer
Plantar
Superficial
Reflex
Stroke the sole of the client’s foot in an arc from the lateral heel to medially
across the ball of the foot
http://www.youtube.com/watch?v=kOq5Np0eZ6A&feature=related
Deep Tendon Reflexes:
http://www.youtube.com/watch?v=fymDY2q0FtE&feature=related
Objective Three
Demonstrate the
assessment techniques
employed in the assessment
of cranial nerves
Dorsal aspect of brain w/cranial nerves (from MyNursingLab)
Cranial Nerves
Checking Cranial Nerves
CN I
Identify the smell of common substances
CN II
Test visual acuity and visual fields
CN III, IV, & VI
Test extraocular movement by having client move eyes through the 6 cardinal
fields of gaze with head held steady; test papillary reaction to light and
accommodation
http://www.youtube.com/watch?v=YntJiBCz3pA&feature=related
CN V - Motor
function
Move jaw from side to side, clenching jaw, and biting down on a tongue blade
CN V - Sensory
function
Have client close eyes and identify when he is being touched on the forehead,
cheeks, and chin; test corneal reflex by puffing air over the cornea
CN VII - Motor
function
Have client make faces (smile, frown, whistle)
CN VII - Taste
Test taste on anterior portion of tongue by placing something sweet, salty, or
sour on the tip of the client’s tongue
CN VIII
Test client’s hearing using wristwatch; test air/bone conduction using Weber
& Rinne test; test for balance using Romberg test
http://video.google.com/videoplay?docid=1911735836954444981#
http://www.youtube.com/watch?v=4hOSkmDYAR4&NR=1
Checking Cranial Nerves
CN IX & X Motor function
Observe client’s ability to talk, swallow, and cough; have client say “ahhh”
while depressing tongue with tongue blade and observing rise of soft palate
and uvula
CN IX & X Sensory
function
Induce client’s gag reflex (do NOT perform in lab practice)
CN IX & X Taste
Test taste on posterior portion of tongue by placing something sweet, salty, or
sour at the back of the client’s tongue
CN XI
Place hands on client’s shoulders, and have him shrug shoulders against
resistance; have client turn head from side to side against resistance
CN XII
Have client say “d”, “l”, “n”, “t”; have client protrude tongue and move it from
side to side
Neuro exam
Part 1
http://www.youtube.com/watch?v=nABAdENIbXY&fe
ature=related
Part 2
http://www.youtube.com/watch?v=_1Rd1wVeqU4&fea
ture=related
Objective Four
Demonstrate the complete
assessment of the
neurological system
(*Lab Practice)