Transcript articles for neurological examination

Health
examination
Ms christine
Mn prev
DEFINITION
• Health examination
• Health examination is the systematic
assessment of human body which involves the
use of one’s senses to determine the general
physical and mental conditions of the body
Physical examination
• Physical examination is defined as a complete
assessment of a patient’s physical and mental
status.
• A physical assessment is the systematic
collection of objective information that is
directly observed or is elicited through
examination techniques
Indication of health examination
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On admission
On discharge
On follow up
Health camps
Before and after diagnostic and therapeutic
procedure.
TECHNIQUE OF PHYSICAL
ASSESSMENT
INSPECTION
GENERAL INSPECTION OF A CLIENT
FOCUSES ON
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Overall appearance of health or illness
Signs of distress
Facial expression and mood
Body size
Grooming and personal hygiene
PALPATION
PRINCIPLES OF PALPATION
• You should have short fingernails.
• You should warm your hands prior to placing them
on the patient.
• Encourage the patient to continue to breathe
normally throughout the palpation.
• If pain is experienced during the palpation.
discontinue the palpation immediately.
• Inform the patient where, when, and how the
touch will occur, especially when the patient cannot
see what you are doing.
LIGHT PALPATION
DEEP PALPATION
PERCUSSION
TYPE OF PERCUSSION
• DIRECT PERCUSSION
INDIRECT PERCUSSION
AUSCULTATION
FOUR CHARACTERISTICS OF SOUND
• 1.Pitch (ranging from high and low):frequency or
number of oscillations generated per second by
vibrating object
• 2. Loudness (ranging from soft to loud): amplitude
of sound
• 3. Quality (gurgling or swishing)
• 4. Duration (short, medium or long)
OLFACTION
• STETHOSCOPE
EQUIPMENTS
OPHTHALMOSCOPE
OTOSCOPE
SNELLEN CHART
NASAL SPECULUM
VAGINAL SPECULUM
TUNING FORK
PERCUSSION HARMER
SPHYGMOMANOMETER
POSITIONING
• Sitting/fowler’s
STANDING
SUPINE AND PRONE
DORSAL RECUMBENT
Sim’s
LITHOTOMY
KNEE-CHEST
PREPARING THE ENVIRONMENT
PREPARING THE PATIENT
• PSYCHOLOGICAL PREPERATION
PHYSICAL PREPERATION
ARTICLES REQUIRED
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Screen to provide privacy
Bowl for antiseptic lotion
Kidney tray and paper bag
Weighing machine and height scale
Patient gown
ARTICLES REQUIRED
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Bath blanket to cover the patient
Pair of leggings
Draw sheet to cover patient’s chest
Square drum containing test tube, gauze
piece, cotton swab, specimen bottle,
swabsticks
• Gloves
• lubricant
ARTICLES REQUIRED
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Torch
Ophthalmoscope
Snellen’s chart
Book for colour blindness
Pen
Flash card
Autoscope with speculum of different sizes
Percussion Hammer
Tuning fork
ARTICLES REQUIRED
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Nasal speculum
Mouth gag
Laryngeal mirror
Tongue depressor
Stethoscope
Inch tape
ARTICLES REQUIRED
• Sterile tray for vaginal examination
• Proctoscope
• VITALS TRAY
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ARTICLES FOR NEUROLOGICAL
EXAMINATION
Powder, soap
Snellan’s chart
Pencil or pen
Cotton wicks
Torch
Tuning fork
Salt, sugar
ARTICLES FOR NEUROLOGICAL
EXAMINATION
• Tongue depressor
• 2 test tubes one with hot water and other with
cold water
• Safety pins
• Some thing solid for grasping
• Sharp object like key
• Reading material to assess eyes and language of
person
• Knee harmer
GENERAL SURVEY
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Identification data
Gender and race
Age
Signs of distress
Body type
Posture
Gait
GENERAL SURVEY
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Body movements
Hygiene and grooming
Body odour
Affect and mood
Speech
Substance abuse:
VITALS SIGNS
HEIGHT AND WEIGHT:
ASSESSING INTEGUMENT SYSTEM
• Assessing skin
• Skin color
 Erythema
CYANOSIS
Jaundice
Pallor
Vitiligo
Inspect skin vascularity
• Ecchymosis
Petechiae
C Inspect skin lesion
Palpate skin temperature, texture,
moisture and turgor
EDEMA
PITTING EDEMA
PITTING EDEMA
• Grades of pitting edema
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Grade 0 : (none)
Grade +1 :( trace , 2 mm)
Disappear rapidly
Grade +2 ( moderate , 4 mm)
10-15 sec
Grade +3 (deep, 6 mm)
≥ 1min
Grade +4 (very deep, 8 mm)
2-5min
ASSESSING NAILS
• Shape; convex
• Angle : between nail and its base is 160 degrees
• Texture: smooth, nail base should be firm and
non tender
• Color: pinkish nail bed with translucent white
tips
• Capillary refill
ABNORMALITIES OF NAIL
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Koilonychias (spoon nail)
clubbing
Paranychia
indentations called (beau’s line)
ASSESSING HAIR AND SCALP
• color,
• texture and distribution.
• Thickness and lubrication of hair
INSPECT THE SCALP
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Cleanliness, color, dryness,
Lump, lesions,
Lice (pediculus humanus capitus)
Dandruff etc
HEAD AND NECK
• ASSESSING THE SKULL
• for size, symmetry
• any nodules or masses
INSPECT THE FACE
ASSESS THE EYE
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Inspect external eye structure
Position and alignment
Exophthalmoses
strabismus
ASSESS THE EYE
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Eye brows
Eye lid :
ectropion(eversion ,lid margin turn out)
entropion(inversion, lid margin turns inwards)
ptosis( abnormal drooping of lid over pupil
ASSESS THE EYE
• Eye lashes : sty.
• Eye balls
• Conjunctiva and sclera{ Paleness, redness or
purulent,jaundice}
ASSESS THE EYE
• Cornea and iris :arcus senilis
• Pupil : PEERLA.
ACCOMMODATION
PUPILLARY REFLEX TO LIGHT
VISUAL ACUITY
INSPECT INTERNAL EYE STRUCTURES
EXTRA OCULAR MOVEMENTS
PERIPHERAL VISION
EARS
• AURICLES
• EAR CANAL AND TYMPANIC MEMBRANE
• WEBER’S TEST:
• RINNE, S TEST:
HEARING
NOSE AND SINUSES
INSPECT THE MOUTH PHARYNX
AND NECK
• LIPS: lesions ,pallor (anemia),
cyanosis(respiratory cardiovascular problems),
cherry colored
• BUCCAL MUCOSA , GUMS AND TEETH: teeth look
for alignment , dental caries.buccal mucosa is a
good site to visualize jaundice and
pallor.leukoplakia (thick white patches ) is a
precancerous lesion.
• TONGUE
• FLOOR OF MOUTH
• PHARYNX:
ABNORMAL FINDINGS
• pallor, cyanosis or redness
• lesions, swollen lips red tonsils, swollen red
bleeding gums,
• white coating of tongue fissured tongue from
dehydration.
• bright red tongue seen in deficiency of iron b12
or niacin,
• black tongue
ASSESS THE NECK
PALPATE TRACHEA AND LYMPH
NODES
PALPATE THE THYROID GLAND
ASSESS THE THORAX AND LUNGS
• INSPECT THE THORAX
• Abnormal findings :increase in chest size and
contour , abnormal breathing pattern with the
use of accessory muscles, unequal chest
expansion, and abnormal breath sounds, barrel
chest, pigeon chest
PALPATE THE THORAX
PERCUSS THE THORAX
AUSCULATE BREATH SOUND
• Bronchial sounds heard over the trachea are high –
pitched, harsh sounds with expiration longer than
inspiration .
• Bronchovesicular sounds: heard over the main
stem bronchus and is moderate (blowing) sound
with inspiration equal to expiration.
• Vesicular sounds are soft , low pitched and heard
best in base of lungs during inspiration longer than
expiration.
ABNORMAL BREATH SOUNDS
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WHEEZE
RHONCHI
CRAKLES
FRICTION RUB
CARDIO VASCULAR SYSTEM
• INSPECT NECK AND PRECORDIUM
• PALPATE THE PRECORDIUM
• AUSCULATATE HEART SOUND
AUSCULATATION
ASSESSING THE BREAST AND AXILLA
• INSPECT BREAST AND AXILLA
• PALPATION OF BREAST AND AXILLA
ASSESSING THE ABDOMEN
QUATRANTS OF ABDOMEN
INSPECT THE ABDOMEM
AUSCULTATE BOWEL SOUNDS
PERCUSS THE ABDOMEN
PALPATE THE ABDOMEN
ASSESS MUSCULO SKELTAL SYSTEM
• INSPECT AND PALPATE MUSCLE
MUSCULO SKELTAL SYSTEM
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PALPATE THE BONES
INSPECT AND PALPATE THE JOINTS
INSPECT SPINAL CURVES
kyphosis
Lordosis
Scoliosis
ASSESSING MALE AND FEMALE
GENITALIA
• INSPECT AND PALPATE FEMALE GENITALIA
INSPECT AND PALPATE RECTUM AND
ANUS
NEUROLOGICAL SYSTEM
MENTAL AND EMOTIONAL STATUS:
BEHAVIOR AND APPEARANCE
LANGUAGE
INTELLECTUAL FUNCTION
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Memory
Knowledge
Abstract thinking
Association
Judgment
CRANIAL NERVE FUNCTION
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Olfactory nerve(1):
Optic nerve(2)
Occulomotor(3)
Trochlear(4)
Trigeminal(5)
Abducens(6)
CRANIAL NERVE FUNCTION
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Facial(7)
Auditory(8).
Glossopharyngeal(9)
Vagus(10)
Spinal accessory(11
Hypoglossal(12)
MOTOR FUNCTION
• Balance and gait
• Romberg’s test
• Motor function and coordination
SENSORY FUNCTION
REFLEX FUNCTION
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Biceps reflex
Triceps reflex
Knee and patellar reflex
Ankle/ Achilles tendon reflex
Babinski reflex
Abdominal reflex
PERIPHERAL VASCULAR SYSTEM
ASSESSMENT
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ALLEN’S TEST
BUERGER’S TEST
CAPILLARY REFILL
HOMAN’S SIGN
PALPATE PERIPHERAL PULSES
DOCUMENTATION OF DATA
AFTER CARE OF THE PATIENT
AFTER CARE OF ARTICLES