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How do you test CN II? What is CN II?
Test visual acuity with Snellen eye chart, inspect fund, test visual fields with confrontation
CN II is optic nerve.
How do you test CN II and III? What nerves are they?
Test reactions to light and near response, inspect size and shape of pupils
- CNII- Optic
- CN III- Oculomotor
How do you test CN III, IV, and VI? What nerves are they?
Test extraocular movements in 6 cardinal directions, lid elevation, convergence
- CN III- Oculomotor
- CN IV- Trochlear
- CN VI- Abducens
How do you test CN V? What nerve is it?
Palpate temporal and masseter muscles while patient clenches teeth. Corneal Reflex. Test forehead, cheeks, and jaw bilaterally for sharp and dull sensation.
- CN V- Trigeminal
- Corneal reflex important for us when we put someone to sleep.
Where does the spinal cord end?
Approximately L1, gives rise to caudal equine
Which is more dangerous, thoracic or lumbar epidural?
What are the 5 components of the neuro physical exam?
Mental status, cranial nerves, motor system, sensory system, deep tendon reflexes
Describe a lethargic pt.
Responds to a loud voice. Drowsy, but can open eyes and look at you. Responds to questions then falls asleep.
Describe an obtunded pt.
Responds to physical (non painful stimuli). Able to open eyes and look at you. Responds slowly, somewhat confused. Decreased alertness and interest in the environment.
Describe a stuporous pt.
Responds to painful stimuli. Slow or absent verbal response. Lapses into unresponsiveness when stimulus ceases.
Describe a comatose pt.
Unarousable. No response to inner need or external stimuli.
How do you assess CN VII? What is CN VII?
Assess for symmetry, tics. Ask pt to squeeze eyes shut, puff out cheeks, smile, frown, raise eyebrows.
CN VII- Facial
How do you assess CN VIII? What is CN VIII?
Test hearing, lateralization, air and bone conduction.
CN VIII- Acoustic
How do you assess CN IV and X? What nerves are they?
Assess voice for hoarseness or nasal quality. Assess swallowing. Test gag reflex. Inspect palate when pt says "ahh"
- CN IV- Glossopharyngeal
- CN X- Vagus
How do you assess CN XI? What nerve is it?
Assess strength as pt shrugs shoulders up against your hands. Assess force as pt turns head against your hands.
CN XI- Spinal accessory
How do you assess CN XII? What nerve is it?
Ask pt to protrude tongue and move it from side to side, assess symmetry.
CN XII- Hypoglossal.
What does the motor exam involve?
Assess body position and symmetry. Note abnormal movements. Inspect muscle bulk and assess for atrophy. Assess muscle tone- should have slight resistance to passive stretch. Rapid alternating movements. Point to point movements, gait.
How is normal muscle strength graded?
5- pt moves against resistance.
What does muscle strength of 3 mean?
Pt can move against gravity only.
How is stance coordination assessed?
Romberg test and pronator drift.
How is the Romberg test performed?
Have pt close eyes and stand without support for 30-60 secs. Loss of balance = + Romberg Test
How is pronator drift assessed?
Pt stands with arms stretched forward, palms up, eyes closed. CRNA tries to push down on arms. Positive test occurs when pronation and downward drift occurs.
What is a normal DTR response?
What does a DTR response of 0 mean? Of 4?
- 0- No response.
- 4+ very brisk, hyperactive, clonus.
What DTR involve the pointy end of the reflex hammer?
Bicep, tricep, brachioradialis
What is Brudzinski's sign?
Can indicate meningeal irritation. When pt's neck is flexed legs bend up.
What is Kernig's sign?
Can indicate meningeal irritation. Pt experiences pain or spasm when attempting to straighten leg with pt supine.
What is an absence sz?
- sudden, brief lapse in consciousness, no falling
- Petit Mal lasts < 10 secs
What is a simple partial sz?
tonic and then clonic movements that start unilaterally in the hand, foot, or face, NO LOC
What is a complex partial sz?
same as simple partial sz, but there is impaired consciousness.
What is a tonic-clonic sz?
AKA Grand Mal, body stiffens, muscular contractions occur, LOC occurs.
What symptoms would lead us to cancel surgery for a kid?
Fever or purulent drainage
T or F, murmurs are extremely worrisome in children?
F, some are ok, especially if kid is asymptomatic. Don't alarm the parents but tell them to follow up with pediatrician.
What if a kid has a murmur AND is symptomatic?
This is more concerning, get a cards consult.
What's considered a neonate? An infant?
- Neonate- birth to 1 mo
- Infant 1 mo to 1 year
Most pedi pts do not require routine labs, but what kids should?
- Infants less than 6 mo should have a Hgb level.
- Premies may need additional testing.
- Kids vomiting for excessive diarrhea
What is the narrowest part of a the infant airway?
What characteristics of the infant airway could lead to a challenging intubation?
Narrow nares, large tongue (for head size), large occiput (when supine neck is flexed which obstructs trachea), larynx and glottis are funnel shaped (gets narrower after VC), they are obligate nose breathers.
Why is bradycardia especially concerning in infants?
They are unable to increase contractility so CO decreases.
What is Madeleine Leininger's theory about diversity and cultural care?
- Cultural and care knowledge is essential to the nurse's understanding of the many variations required in pt care to support compliance, healing, and wellness.
- Started phenomenon Transcultural Nursing, goal to provide cultural congruent holistic care
What changes in pulmonary function are seen in the geriatric pt?
Decrease in TLC, VC, FEV1
Increase in RV, FRC, dead space, CC
What are possible difficulties to anticipate with a geriatric pt?
- -Difficulty placing a spinal or epidural (intervertebral spaces narrowed)
- -More prone to renal failure
- -BP lability
- -Poor response to stress, trauma, heavy surgery
What life threatening causes should be ruled out if a pt c/o HA?
Meningitis, SDH, ICH, mass lesion
What are red flags in assessing headaches?
- -acute onset, "thunderclap," "worst HA of my life"
- -rash or signs of infection
- -ca (mets)
- -pregnancy (pre-eclampsia)
- -head trauma
Why does a post dural puncture headache occur?
Loss of CSF thru needle hole in dura, this results in loss of buoyant support of brain in cranial vault, puts traction on meninges.
What are symptoms of a post dural puncture HA?
HA absent or mild when supine. When head is elevated get front-occipital HA. Get can CN involvement- diplopia or tinnitus.
What CN involves the corneal reflex?
CN V, trigeminal nerve