Neuro - Assessment/Dx

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tiffanydawnn
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29057
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Neuro - Assessment/Dx
Updated:
2010-08-06 13:32:37
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Neuro - Assessment
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  1. health history
    • family history
    • headaches (look for changes)
    • clumsiness
    • loss of function, numbness, tingling, pain in an extremity
    • visual acuity / double vision
    • seizures (new, different)
    • personality changes / mood swings
    • fatigue / tireness
    • trauma in last 6 months
    • speech, reasoning, movement, intellect changes
  2. mental status
    • orientation
    • mood / behavior
    • general knowledge of well known facts
    • short & long term memory
    • attention span / ability to concentrate
  3. eyes
    • PERRLA
    • accomodation: place finger 6" from nose, bring closer, eyes should coverge/pupils constrict
    • ptsosis: drooping lids
    • nystagmus: rapid back and forth motion
  4. LOC
    • irritibility
    • personality changes
    • restlessness
    • short term memory
    • disorientation to time > place > person
    • confusion
  5. Glasgow Coma Scale
    • assess eye opening, verbal response, motor response
    • Score 3 - 15
    • < 8 = coma
    • 9 - 12 = moderate
    • 13 - 14 = mild
  6. GCS - eye opening
    • spontaneously - 4
    • to speech - 3
    • to pain - 2
    • none - 1
  7. GCS - verbal response
    • oriented - 5
    • confused - 4
    • inappropriate - 3
    • incomprehensible - 2
    • none - 1
  8. GCS - motor response
    • obeys commands - 6
    • localizes to pain - 5
    • withdraws from pain - 4
    • flexion to pain - 3
    • extension to pain - 2
    • none - 1
  9. awake and alert
    responds appropriately to auditory, tactile, visual stimuli
  10. disoriented
    • unaware of time > place > person
    • unable to follow simple commands
    • slowed thinking
    • inattentive
    • flat affect
    • easily bewildered
    • agitated, restless, irritable
    • high risk for injury
  11. delirium
    • sudden severe confusion and rapid changes in brainfunction that occur with physical or mental illness
    • motor restlessness
    • agitated
    • irritible
    • combative
  12. somnolent / lethargic / obtunded
    • drowsy/sleepy
    • oriented but sluggish
    • delayed responses to questions
    • responds to painful stimuli
  13. stupor
    • aroused only with visual stimulation
    • response to pain
    • slow/sluggish speech, movement, thought processes
  14. coma
    • sleeplike state
    • does not respond to painful stimuli
    • no verbal sounds
    • no cough or gag reflex - aspiration risk - airway
    • incontinent
    • irregular respirations
  15. aphasia
    • defective/absent lanugage function
    • language is primarily left hemisphere
    • speech, reading, writing, understanding
  16. expressive aphasia
    • loss of the ability to produce language
    • caused by damage to Broca's area
  17. receptive aphasia
    • inability to comprehend language or speak with appropriately meaningful
    • words
    • caused by damage to Wernicke's area
  18. global aphasia
    both expressive and receptive
  19. anomia
    inability to recall words or names
  20. dysarthria
    difficult/poor articulated speech due to poor muscle control
  21. muscle function
    • most commonly encountered neuro symptom
    • assess gait, stance, muscle tone, coordination, involuntary movement, stretch reflexes, hand grasps, foot pushes, arm drift
    • compare one side to other, assess in pairs (symmetry)
  22. spasticity / flaccidity
    • spasticity: muscles have sudden movement
    • flaccidity: muscles are weak and flabby
  23. Babinski's reflex
    • normal: flexion of great toe (negative Babinski's)
    • abnormal: extension of the great toe (positive Babinski's)

    reversed for infants < 6 months
  24. Romberg's test
    • pt stands feet together / eyes closed
    • negative Romberg: minimal swaying
    • positive Romberg: leans/sways to one side
    • may indicate cerebellar dysfunction
  25. paralysis
    • paralysis: loss of function
    • paresis: weakness (anything less than total loss)
    • flaccid paralysis: weak, soft, flabby muscle tone
    • spastic paralyis: involuntary sudden movements or muscle contractions
    • fasiculations: small, involuntary, spontanous muscle contractions
    • clonus: alterating contraction/relaxation of muscle
  26. sensory / perceptual status
    • assess response to pain, touch, temp
    • proprioception: sensation pertaining spatial position, muscular activity
  27. unilateral neglect
    pt is perceptually unaware of and inattentive to one side of the body
  28. hemianopia
    blindness in half of visual field
  29. vital signs
    • temperature
    • BP - widening pulse pressure can indicate increased ICP
  30. blood and urine tests
    • urine - diabetes insipidus, rule out drug use
    • ABGs - O2 concentrations
    • routine blood tests
  31. CSF test
    • normal CSF - 10 lymphocytes/ml ( > indicates infection)
    • C&S
    • --TB or viral infections
    • --bacterial infections may decrease glucose/chloride levels
    • Elevated protein - degenerative disease, brain tumor
    • Blood - hemorrhage
  32. CT
    • detects pathologic conditions of brain / spinal cord
    • shows areas with increased densities (tumors/thrombi)
    • no radioisotopes
    • no special prep
    • 60 mins w/contrast medium - 30 mins without
  33. brain scan
    • uses radioisotopes - injected several hours before scan
    • shows concentrated areas
    • no special prep
    • 45 mins
  34. PET scan
    • radioactive glucose injected
    • color composite picture is obtained
    • shades of color indicate levels of glucose metabolism
    • used for stroke, alzheimer's, parkinson's, epilepsy
  35. lumbar puncture
    • used to obtain CSF sample, relieve pressure, inject dye/meds
    • contraindicated for ^ ICP (causes brain herniation)
    • lie flat after test
    • monitor dressing for bleeding/CSF leakage
  36. electroencephalography (EEG)
    • measures electrical activity of brain
    • dx epilepsy, lesions, brain injury
    • electrical patches attached to scalp
  37. myelogram
    • x-ray w/ contrast medium to visualize spine
    • dx lesions in spinal canal, herniated disks, bone deformities
    • measure baseline LE strength and sensation pre-test
    • similar to lumbar puncture
  38. cerebral arteriogram
    • x-ray w/ contrast medium of blood vessels in the brain
    • dx aneurysms, vessel anomalies, ruptured vessels, displacement of vessels by tumors/masses
    • pre-test - assess pedal pulses (femoral approach), neck circumfrence (carotid approach)
    • post-test - monitor site for hematomas, LOC, pedal pulses/neck circumfrence
    • ^ risk for ^ ICP, stroke
  39. carotid duplex
    • evaluates carotid occlusion
    • non-invasive
    • used for TIAs
  40. electromyogram (EMG)
    • measures contraction of muscles in response to electrical stimulation
    • clarifies muscle vs. neuro problems
    • post-test - rest and analgesics
  41. echoencephalogram

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