nervous_assessment.txt

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Author:
dodgybarnet
ID:
127663
Filename:
nervous_assessment.txt
Updated:
2012-01-15 16:24:19
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EMT book1
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Nervous Assessment
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  1. ´╗┐Obtunded
    • refers to less than full mental capacity in a medical patient, typically as a result of a medical condition or trauma
    • Cowlike
  2. Stuporous
    Arousable for short periods but unaware of surroundings
  3. Dysarthria
    • [diss-arr-three-er]
    • Speech defects => of motor deficits
  4. Dysphonia
    Speech defects => of vocal cord problems
  5. Aphasia (expressive or receptive)
    Speech defects => of brain damage
  6. A nervous system exam covers 5 areas:
    • 1. Mentation and speech
    • 2. Cranial nerves
    • 3. Motor system
    • 4. Sensory system
    • 5. Reflexes
  7. Cranial nerve I
    • Olfactory
    • Sensory
    • Smell
    • Test: Get Pt to ID smells
  8. Mentation and speech - areas covered?
    • * Appearance and behaviour
    • * Speech and language
    • * Mood
    • * Thoughts and perceptions
    • * Insight and judgment
    • * Memory and attention
  9. Cranial nerve II
    • Optic
    • Sensory
    • Sight
    • Test: Use visual acuity/visual field tests
  10. Cranial nerve III
    • Oculomotor
    • Motor
    • Test: PERRRL? + EOM
  11. Direct reaction to light?
    pupillary constriction when light shone in eye
  12. Consensual reaction to light?
    pupillary constriction in the opposite eye
  13. Near response part of EOM
    ask pt to follow your finger as you move it towards the bridge of their nose
  14. Lateral rectus muscle?
    Look away from nose
  15. Medial rectus muscle?
    Look towards the nose
  16. Superior rectus muscle?
    Look up, when abducted (looking away from the nose)
  17. Inferior rectus
    Look down, when abducted (looking away from the nose)
  18. Superior oblique muscle?
    Look up, when eye adducted (looking towards the nose)
  19. Inferior oblique muscle?
    Look down, when eye adducted (looking towards the nose)
  20. Cranial nerve IV
    • Trochlear
    • Motor
    • controls Superior oblique muscles
    • test: EOM
  21. Cranial nerve V
    • Trigeminal
    • Sensory
    • controls: Ophthalmic (forehead)
    • controls: Maxillary (cheek)
    • controls: Mandibular (chin) regions
    • Test: Palpate Temporal & Masseter muscles
    • Test: Sharp and dull objects on face (e.g. paper clip)
  22. Cranial nerve VI
    • Abducens
    • Motor
    • Lateral rectus
    • Test: EOM
  23. Cranial nerve VII
    • Facial
    • Sensory: Tongue
    • Motor: Facial muscles
    • Test: Look for asymmetry, tics, ptosis, nystagmus while pt makes a variety of facial expressions and while neutral. Ask pt to shut their eyes tightly while you try to open them to test muscle strength.
  24. Cranial nerve VIII
    • Acoustic
    • Sensory
    • Hearing balance
    • Test: Pt blocks one ear while you whisper in the other. Check if they heard. Evaluate balance when they have their eyes shut.
  25. Cranial nerve IX
    • Glossopharyngeal
    • Sensory: Posterior pharynx, taste to anterior tongue
    • Motor: Posterior pharynx
    • Test: Same as Nerve X
    • --- Hoarse voice = vocal cord issues
    • --- Nasal = palate issues
    • --- Pt sticks out tongue and says "aaahhh" - visualize for weirdness
    • --- Check gag reflex with a tongue depressor
  26. Cranial nerve X
    • Vagus
    • Sensory: Taste to posterior tongue
    • Motor: Posterior palate and pharynx
    • Test: Same as Nerve IX
    • --- Hoarse voice = vocal cord issues
    • --- Nasal = palate issues
    • --- Pt sticks out tongue and says "aaahhh" - visualize for weirdness
    • --- Check gag reflex with a tongue depressor
  27. Cranial nerve XI
    • Accessory
    • Motor
    • Trapezius muscles
    • Test: Hold the pts shoulders and ask them to shrug.
    • Sternocleidomastoid muscles
    • Test: Hold pts head and get them to try to look left and right while you provide resistance.
  28. Cranial nerve XII
    • Hypoglossal
    • Motor
    • Tongue
    • Test: Check speech - get pt to stick out their tongue - look for any deviation
  29. Strabismus
    • [sta-bizz-muss]
    • deviation
  30. Nystagmus
    • [niss-stag-muss]
    • involuntary movements
  31. Fasciculations
    • [fa-sick-you-lay-tions]
    • twitches
  32. Ptosis
    • [toe-sis]
    • droopy eyelid
  33. Motor system assessment areas?
    • General body structure,
    • Muscle development, Shape/bulk, Tone, Strength
    • Positioning,
    • Coordination
  34. Muscle Tone assessment?
    • Get Pt to relax and move their affected extremities through all of their range of motions.
    • Assess muscle tone: Spastic versus Rigid tone
  35. Spastic tone is?
    • increased muscle tone, especially at range of motion.
    • Common in stroke
  36. Rigid tone is 4 things?
    • Lead pipe rigidity
    • Cog wheel rigidity
    • Flaccidity
    • Paratonia
  37. Lead pipe rigidity?
    Increased muscle rigidity throughout movement. E.g. Parkinson's
  38. Cog wheel rigidity?
    Ratchet like jerkiness => pt resistance or fakery
  39. Flaccidity?
    Loss of muscle tone, common in stroke, spinal injury, etc
  40. Paratonia?
    • Sudden changes in tone (increase or decrease) during passive movement.
    • Common in dementia.
  41. Muscle Strength Assessment?
    • Assess, and compare bilaterally on a 0 - 5 scale:
    • --- Grip
    • --- Flexion / Extension of muscles
    • --- Abduction / Adduction
  42. Romberg test?
    • Stand feet together with eyes open.
    • Then they close their eyes for 20 to 30 seconds - observe any swaying.
    • Losing balance indicates a positive Romberg test.
  43. Tandem walking?
    Walk heal to toe in a straight line.
  44. Babinski response?
    Big toe curling up: brain dammage in adult

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