Neurological Sys HA Exam #4

did they have a loss of consciousness

room spinning

course
duration
motor activity/where is it / begins
color change with face or lips
incontinence
postictal phase = sleepy after seizure
strobe lights can cause

can have underlying neuro issues
can be benign

falling
difficulty walking
clumsy
trip walking up stairs

difficulty swallowing

difficulty speaking
unable to speak

stroke
meningitis
alcohol use problems

paralysis on ONE side
unilateral paralysis -> unable to move a portion of your face

neurologic examination - no significant findings in history
mental status, CN 2, 3, 4, 6, 7, 8 and motor function, sensation and reflexes

neurologic examination - neuro concerns or cues of neuro dysfunction
need neuro rechecks

5 components of neuro recheck:
Level of Consciousness
Motor Function
Upper and Lower Motor Strength
Pupillary Response
Vital Signs

Mental Status (cerebral functions)
Cranial Nerves (cranial nerve slides at bottom)
Motor System
Sensory System
Reflexes

Muscle size
Muscles strength (MS)
Involuntary movements (tics)
tone = normal degree of retention in voluntary relaxed muscles
cerebellum = balance

gait
walk heel-to-toe; tandem walking
normal: walk straight, stay balanced

stand, feet together, arms at side
then close eyes, hold position (stand close to patient)
does not test cerebellar function
normal: can maintain posture and. balance, slight swaying possible

shallow knee bend OR
hop in place, first on one leg, then other
some individuals cannot hop (agining, obesity)

rapid alternating movements
pat legs and alternate with the back of hands
touch thumb to each finger on same hand, then reverse the direction

finger-to-finger test
finger-to-nose test
heel-to-shin test (stroke pt won't be able to do)

Alert, Cooperative, Comfortable, Adequate attention Span
Explain what will be happening and exactly how you expect patient to response
use unbiased directions
compare symmetric parts of body and pt eyes should be closed

break tongue blade (sharp point and rounded end for dull)
ask "sharp" or "dull"
random order, irregular intervals
at least 2 seconds

use wisp of cotton
random order of site, irregular intervals
ask patient to say "now" or "yes" when touch is felt

tuning fork over bony prominences
fingers and toes
ask person to tell you when vibration starts and stops
if felt distal, can assume can feel more proximal and proceed no further

move finger or big toe up and down
ask patient which way it is moved
do a few trials before you ask patient to close eyes

stereognosis
ability to recognize objects by feeling it
put familiar object in hand, ask patient to identify it
test different object in each hand
key commonly used

ability to "read" a number by having it traced on hand
ask person to identify numbers (3, 1, 5)

maintain balance and muscle tone
deep tendon reflexes (DTRs)
superficial

No
SPINAL INJURY AFFECTS DTR

limb must be relaxed
muscle partially stretched
short, snappy blow of reflex hammer onto muscle's insertion tendon
relaxed hold of hammer
action is wrist (like percussion)
compare left and right sides

equal bilaterally

4+ very brisk, hyperactive with clonus, indicative of disease
3+ brisker than average, may indicate disease
2+ average, normal
1+ diminished, very low
0 no response

4+ and 3+

1+

relax muscle and enhance response
isometric exercise in muscle group away from one being tested
patellar: lock fingers together and "pull"
biceps: clench teeth or grasp thigh with opposite hand

supine, move from side to side of abdomen toward midline
normal: contraction of abdominal muscle, deviation of umbilicus toward stroke

with reflex hammer, draw a light stroke up lateral side at sole of foot and inward across ball of foot (upside down J)
normal: plantar flexion of all toes, inversion and flexion of forefoot (Negative Babinski)

dorsiflexion of big toe and fanning of all toes (Positive Babinski)
occurs with upper motor neuron disease

stroke your finger up the lateral edge and across the ball of an infant's foot
note fanning of toes (Positive Babinski)
present at birth, disappears (changes to adult response) by 24 months of age

eye opening, verbal response, best motor response
3/15 = bad shape
15/15 = best you can get