Assessment3Neuro.txt

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vanwin
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210426
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Assessment3Neuro.txt
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2013-03-30 19:45:55
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Assessment
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Assess3
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  1. ´╗┐Full mental health exam is needed when
    • Behavioral changes: memory loss, inappropriate social behaviors
    • aphasia: language impairment due to brain injury
    • brain lesions: stroke/CVA, trauma, tumor
    • symptoms of mental illness
  2. Appearance
    • Posture
    • - normal: straight, erected, relaxed
    • -abnormal: pacing, tensed muscles= anxiety, hunched over = depressed
    • Body movement
    • - normal: coordinated, smooth & even
    • - abnormal: restless, fidgety = anxiety, or slow= depression
    • - cogwheel = parkinsons
    • dress/ grooming & hygiene
    • -norm: appropriate for season, clean, shaven
    • -abnormal: disheveled, dirty, not shaven-
    • unilateral neglect- depression/ mental status
  3. Behavior
    • Level of Consciousness
    • Speech: smooth, articulated, appropriate volume/ fast = anxiety, slow = depressed, distorted = stroke
    • Affect&mood: relaxed & cooperative " how do you feel today,
    • - flat, no expression = mental illness
    • - schizophrenia: mood swings, bizarre moods
  4. Cognition
    • Orientation: Person, place & time
    • Recent memory:
    • Remote memory:
    • New learning: 4 unrelated words & repeat them back
  5. Mini Cog Exam
    • tell them 3 random words
    • ask them to draw a clock at a certain time
    • then ask them to repeat the words again
    • 1-2 words = possible dementia
    • no words = dementia
    • abnormal clock = cognitive impairment
  6. Thought Process
    • normal: logical
    • abnormal: illogical
    • - obsession - repetitive thoughts
    • - compulsion - repetitive behavior
  7. Assess suicidal thoughts if _____
    • They exhibit:
    • sadness, grief, despair, hopelessness
    • Ask:
    • have you ever thought of harming yourself?
    • are you thinking about it right now?
    • do you have plans?
  8. Major Depressive Disorder
    • If pt. shows 5 or more symptoms for 2wks:
    • depressed
    • fatigued
    • wt loss
    • agitation
    • worthlessness
    • diminished interest
    • inability to think
    • insomnia/ hypersomnia
    • death
  9. Aging
    • response time = slower
    • recent memory may decrease
    • Same: intellect & remote memory
  10. Neurological Assessment Subjective Data
    • headache
    • headinjury
    • dizziness/vertigo
    • syncope (random fainting)
    • seizures
    • tremors
    • incoordination
    • stroke/ CVA
    • meningitis
    • dysphagia
    • dysphasia
    • dysarthria
    • aphasia
  11. Cranial Nerve I & II
    Olfactory: close eyes & test each nostril separately

    Optic: visual acuity, snellen chart
  12. Cranial Nerve III IV VI
    • muscles around the eye, tested together
    • PERRLA = III
    • Extraoccular movements/ cardinal field of gaze test
  13. Nystagmus & Ptosis
    Nystagmus: jerking of the eye

    Ptosis: droopy eyelid on one side
  14. Cranial Nerve V
    • Trigeminal nerve: opthalmic, maxillary, mandibular
    • sensory: light touch
    • corneal reflex: cotton swab ( involuntary blinking)
    • motor: masticatoin
  15. Cranial nerve VII
    • Facial:
    • motor: symmetry of movements & strength
    • sensory: taste sweet, salt & sour (uncommon test)
  16. Bells Palsy
    asymmetry of the face, cranial nerve VII impairment
  17. Cranial Nerve VIII
    • Acoustic: hearing acuity
    • Whisper test:
  18. Cranial Nerve IX, X
    • Glossopharyngeal & vagus
    • motor: tongue blade, test pharynx movement
    • uvula, soft palate, gag reflex
  19. Cranial nerve XI & XII
    • Spinal acessory nerve:
    • sternomastoid & trapezius muscle; turn head & shrug shoulder against resistance

    Hypoglossal: tongue stick out
  20. Cerebellar Function Coordination & Balance Tests
    • Tandem walking: heel to toe(soberity)
    • Romberg: stand stil, test balance (positive = fall)
    • shallow knee bed/ hop in place
    • rapid alternating movements
    • finger to finger
    • finger to nose
    • heel to shin
  21. Deep Tendon Reflexes
    • Graded 0-4: 0 = none 2= normal 4= clonus
    • ┬áReinforcement: raise hand up to relax other muscles
    • clonus: short, jerking motion on stimuli
  22. Glascow Coma Scale
    • Eyes: 4
    • Verbal: 5
    • Motor: 6
    • max score = 15
    • 7 or < = coma

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