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Lesion here: Personality changes
- Interpretation of distance, size shape, texture
Lesion here: spatial disorientation
- Lesion here: Hallucinations
- controls receptive and expressive speech
- self preservation
motor control and fine body movements
- temp control
- water metabolism
- appetite control
- hormone control
Reticular Activating System
controls sleep and wake cycle....if the patient is arousable the RAS is functioning
- controls coordination of muscle movement
respiratory and vasomotor control center
Where do the cranial nerves arise from?
What assessment will tell you the mid brain is functioning?
How can you tell the pons is functioning?
controls respiration and BP
How do you know the medulla is functioning?
spontaneous respirations and BP maintained without mechanical support
What does the brain count on for metabolism?
What is necessary for the oxidation of glucose for energy in the brain?
How long does it take for brain damage to occur from no O2
- colorless and odorless
fills ventricles and subarachnoid space and spinal cord
made of water, protein, O2, CO2, electrolytes and glucose
Normal CSF pressure
80-180mm H20 pressure in recumbent position
Neuro assessment consists of
- Pupillary light reflexes
- Motor ability
- Sensory Ability
- Breathing pattern
Assessment of mental status includes
- persons memory
What's the most sensitive indicator of a patients neuro condition?
- Alert and Oriented....
Glasgow Coma Scale Categories
- Eye Opening Response
- Motor Response
- Verbal Response
Assessing motor function on an unconscious patient
Upper extremities...apply painful stimulus and observe for withdrawl
Lower extremities....flex legs so heels on bed and release knees-weak or paralyzed limb will extend and externally rotate. Observe for gross abnormalities by looking at position of arms and legs noting flaccidity, contractures, spasticity and posturing
Assessing motor strength with numbers
- 5/5 normal movement against gravity and resistance
- 4/5 full ROM against mod. resistance/gravity
- 3/5 full ROM against gravity only
- 2/5 extremity can move but not against gravity (can roll but not lift)
- 1/5 muscle contracts, extremity cant move
- 0/5 no muscle contraction or movement
Tests for coordination and fine motor skills
Tests for Balance and Equilibrium
- Push patient
- Stand on one foot, eyes closed, arms at side...maintain for 5 seconds
Stand erect with feet together and eyes closed
mild sway is normal, but a loss of balance is abnormal
- heel toe tandem
- smooth and symmetrical with a regular rhythm
- arm swing
Where's Broca's area located and what is it's function?
- language processing and comprehension
Where's Wernicke's area located and what's its function?
involved in the understanding of written and spoken language
If you have a problem in the brain stem, how will it show up in speech?
- defect in articulation, enunciation and rhythm
- breaks in rhythm, slow, slurred speech
If you have a problem with Broca's area you will....
- understand others
- recognize your own errors in speech
- have poor articulation
- speech will be labored/garbled
If you have a problem in Wernicke's area you will....
- have normal speech
- voices are heard and recognized, but words are meaningless
- mispronounce words
How do you assess peripheral nerve sensory function?
- temperature or deep pressure
How do you assess cortical sensory function?
Stereogenesis-ID familiar objects by touch and manipulation
Graphesthesia-draw a number on the palm with a q tip, have person ID it
How do you grade a deep tendon response?
- 0=no response
- 4=brisk, hyperactive
2=active or expected response
What will happen to your temp with head trauma?
elevates to high levels from damage to the hypothalamus
What will signify an increase in ICP?
- increased systolic BP
- widened pulse pressure
Assessment of cranial nerves....initially, subsequently
- initially all
- subsequently II-VI and IX and X
- cuz they regulate pupil response, eye movement and protective mechanisms
What does Doll's Eyes assess?
cervical spine injury....DR. do!!
when the head is rotated to the right, the eyes should move in the opposite direction, like a dolls eyes
if they don't do this it is an indication of a lesion at the brain stem
Oculovestibular Reflex test
- Dr. does
- HOB at 30
- Ice water, syringe, IV cannula-squire water in to ear
- Intact brain stem and cerebrum-profound nausea/nystagmus
- Intact brain stem only-eyes move toward irrigated ear
- Neither brain stem or cerebrum in tact-asymmetric eye movements or no eye movements