Health Assessment - Neuro

Front 1

Mental status can be inferred through individual behaviors, elaborate on the following: Consciousness, Language, Mood and affect, orientation, attention, memory, abstract reasoning, thought process, thought content, perceptions

Back 1

-aware of one’s existence, feelings, and thoughts(most elementary) –using voice to cx thoughts/feelings – mood=durable prolonged display of feelings affect=temporary expression of feelings –aware of objective world in relation to self – focus on one thing, concentrate –store experiences, remote memory =lifelong –deeper meaning beyond concrete – the way a person thinks –what the person thinks (specific ideas) –aware of objects via 5 senses

Front 2

Regarding Mental status assessment, what might a family member bring to the nurse’s attention?

Back 2

-behavioral changes, memory loss, inappropriate social interaction

Front 3

Regarding mental status assessment, name 3 abnormalities, and briefly explain each

Back 3

-brain lesions(trauma, tumor, CVA, stroke), assess pt for emotional/cognitive associations with lesion
-aphasia(impairment of language abilbility), assess language dysfunction and emotional problems(depress, agitation)
-psychiatric mental illness(esp. fast onset)

Front 4

What factors in the health history might affect your interpretation of mental assessment findings (4)

Back 4

-any known illness or health prob (eTOH, renal disease) –Rx known to affect mood or cognition –baseline educational and behavioral level, -Hx of stress, social/sleep habits, drugs/ETOH

Front 5

What are the four main components(headings) of the mental status assessment?

Back 5

-A(appearance) B(behavior) C(cognition) T(Thought process)

Front 6

Explain normal and abnormal results of the following types of objective data: Appearance(Posture, body movements, dress, groom/hygiene)

Back 6

-erect relaxed, restless/tense/curled/slouched –smooth & even/deliberate/coordinated, anxiety= fidgety, restless / brain disease & depression= apathy and psychomotor slowing, schizo=abnormal posture/bizarre gestures, facial grimaces –appropriate for setting/age,organic brain syndrome= inappropriate, schizo & manic= eccentric dress/bizarre makeup –clean & well groomed(shaved, neat), CVA=unilateral neglect (one side)/Alzheimers/depression =bad dress/hygiene/lack of concern of appearance

Front 7

Explain normal and abnormal results of the following types of objective data: Behaviors( LOC, Facial expression, Speech, Mood & Affect)

Back 7

-alert & oriented, lethargic(drifts to sleep)/obtunded(sleep most of time)/stupor(responds only to shake or pain), coma(light=some reflex, deep=none) –look appropriate with situation/eye contact, depression&Parkinson = flat masklike expression -Clear & Articulate, Dysphoria=abnormal volume/pitch/Dep&Park=slow, monotone/Dysarthia=distorted speech/Aphasia=misuse of words, -cooperative /responds appropriately, manic=mood swings, schizo= bizarre mood(see page 110)

Front 8

Explain normal and abnormal results of the following types of objective data: Cognitive Functions(Orientation, attention span, recent memory, remote memory, new learning, judgement

Back 8

-correct time/place/day, delirium(in order)=lost in time, place,rarely person –completes thought without wandering, diverts from initial thought/ irrelevant response/easily disctracted/confusion – 24 hour diet recall, delirium&Dementia&amnestic &korsakoff(alchohol)=memory deficit –verify past events, alzheimers&cerebral cortex dmg= memory lost -4 unrelated word test successful, alzheimers/dementia = zero/one/anxiety& depression = poor d/t lack effort -compare & eval alternatives in situation, emotional dysfunction&shizo &brain disease&mental retard=impaired judgement

Front 9

Explain normal and abnormal results of the following types of objective data: Thought Processes (thought process, thought content, perceptions, suicidal thoughts)

Back 9

-logical/coherent/relevant, illogical/unrealisitic / blocking(stops in midthought)/ideas merge – words are consistent/logical, obsessions /compulsions – perception congruent with nurse, illusions/hallucinations=brain disease, drugs, alcohol withdrawal –none, hyper or insomnia/ slowed activity,etc.

Front 10

Depression assessment(8 symptoms), how to diagnosis major depressive disorder, dysthmia depressive neurosis diagnosis?

Back 10

-Sleep (increase/decrease), Interest (diminished), Guilty/Low Self-Esteem,Energy (poor/low), Concentration (poor), Appetite increase/decrease), Psychomotor (agitation/retardation), Suicidal ideation –depression + 4 symptoms >2wks, depression + 3 symptoms =>2year

Front 11

Give 8 characteristics of suicidal assessment, 9 for Substance abuse(use acronyms)

Back 11

-Feelings of hopelessness, Suicidal ideations, plan, possessions, Auditory hallucinations, lack of support, ETOH/SA, precipitating event, Media
-CAGE- Cut down ever felt need, Annoyed you criticizing use, Guilty felt,Eye opener ;CRAFT-Car someone was high, Relax, feel better, fit in, Alone, Forget things while using, Family/friends cut down, Trouble from using

Front 12

What does the Glascow coma scale measure? (5)

Back 12

-quality of consciousness in ageing persons with possible confusion(alertness, coma, lethargic, obtuneded/stupor)

Front 13

Denver II (DDST) is used for what age group? What is it for? Specifically(3)

Back 13

-birth to 6 years old –interact with child to assess mental status(fine gross motor, language, personal/social)

Front 14

What does the instrumental ADL measure? Specifically?(3)

Back 14

-dependent mental status & higher functioning –shop/cook/meals, manage finance/meds, problem solve

Front 15

Describe the SET test. Abnormal findings?

Back 15

-developed for aging population (name ten items in four categories(fruits, animals, colors, towns)25 to 40=normal score –score less than 15=dementia

Front 17

What are some various cognitive tests(brief)? (5)Explain each

Back 17

-Clock drawing(give blank paper, draw a clock to show a time/ analysis=circle-1pt, 12#=1pt, number position=1pt, clockhands=1pt),WORLD spell(backwards, alpha), Mini cog(3 word registration +clock draw + 3 word recall), MMSE (detects organ disease, dementia, delirium- orientation, registration, attn & calculation, recall, language) MoCA (?)

Front 18

Elaborate on the following abnormalities of mood and affect: flat affect, depression, depersonalization, elation, euphoria, anxiety, fear, irritation, rage, ambivalence, lability, inappropriate affect

Back 18

Flat Affect: Lack of emotional response, Depression: Sad, gloomy, dejected., Depersonalization: Loss of identity, feeling estranged., Elation: Extreme joy and optimism. Euphoria: Cheerfulness and optimism that is inappropriate to the situation. Anxiety: Worried, uneasy, apprehensive but without specific cause. Fear: Worried or uneasy but with a specific cause.Irritation: Annoyed, easily provoked.Rage: Furious, out-of-control anger.Ambivalence: Experiencing opposing emotions about a topic.Lability: Rapidly shifting emotions. Inappropriate Affect: Affect clearly not matched with the content of the person’s speech

Front 19

Which of the following is the most basic function and therefore should be tested first in an assessment of mental status?
A. Behavior
B. Consciousness
C. Judgment
D. Language

Back 19

B

Front 20

Which of the following is not a significant contributor to the assessment of
mental status?
A. Known illness or health problem
B. Current medications known to affect mood or cognition
C. Racial background
D. Personal history; current stress, social habits, sleep habits, drug and alcohol use

Back 20

C

Front 21

Name the functions of the following structures: Wernicke’s area, Broca’s area, Cerebrum, cortex, frontal lobe, temporal lobe, limbic system, parietal, occipital lobe, RAS, Thalamus, hypothalamus, cerebellum, brainstem, midbrain, medulla, pons, meninges, ventricls

Back 21

-receptive aphasia(hears sound, but has no meaning) –expressive aphasia(understand language, but cannot speak) -Cerebrum: largest part of brain -Cortex: outer layer of cerebrum; controls most conscious processes-Frontal lobe: emotional expression, Broca’s area (expressive language) -Temporal lobe: hearing, taste, smell, memory, Wernike’s (language comprehension)-Limbic system: emotions, sexual arousal, behavioral expression, recent memory-Parietal: sensory input-Occipital lobe: vision and spatial relationships-RAS: wakefulness-Thalamus: clusters multiple sensory stimuli-Hypothalamus: controls autonomic nervous system and pituitary gland-Cerebellum: coordination, equilibrium-Brainstem: involuntary survival behaviors; includes midbrain, medulla and pons -Midbrain: visual, auditory, pupils, and eye movements-Medulla: regulates heart, respiratory rates, B/P, and protective reflexes-Pons: helps with respiratory function, facial sensation and movement-Meninges: three layers (pia, arachnoid, dura); protect brain and spinal cord-Ventricles: four cavities; capillaries produce and reabsorb CSF

Front 22

The spinothalamic tract is important for what? (3)Posterious column?(3)

Back 22

-pain, temperature, light touch –position, vibration,fine localized touch(sterognosis)

Front 23

Describe the functions of the following motor pathways: Corticospinal/pyramidal trac(3), extrapyramidal tracts primitive(3), cerebeller system(2)

Back 23

-voluntary movement, purposeful(writing) –maintain muscle tone, control body movement(walking) –maintain equilibrium, posture

Front 24

Where are upper motor neurons located? Name the two tracts for these neurons. Example disease in upper? (3)

Back 24

-in CNS –corticospinal, extrapyramidal –CVA, cerebral palsy, multiple sclerosis

Front 25

Where are lower motor neurons located? Which nerves are innervated by these? Lower motor neuron diseases? (3)

Back 25

-in PNS –cranial and spinal –spinal cord lesions, poliomyelitis, amyotrophic lateral sclerosis

Front 26

Where do the cranial nerves go? How many?

Back 26

-enter & exit the brain from body site -12

Front 27

How many spinal nerves are there? Subdivide each group(5)

Back 27

-31 -8 cervical, 12 thoracis, 5 lumbar, 5 sacral, 1 coccygeal

Front 28

Explain the autonomic nervous system & divide into two.

Back 28

-PNS composed of cranial & spinal nerves, which are divided into somatic(voluntary;skeletal) and autonomic(involuntary;smooth muscle, cardiac,glands)

Front 29

Explain the four types of reflex arcs: DTR, Superficial, visceral, pathologic

Back 29

-patellar or knee jerk –corneal reflex, abdominal reflex –pupil response to light /accommodation –abnormal babinski/extensor plantar reflex

Front 30

For subjective data on headache, what are the three types? Explain each

Back 30

-Migraine=pulsating pain, localized side front or back of head(accompanied by nausea, vertigo, tremors; lasts 4-6 hours –Cluster=begins at night w/excrutiating pain on one side spread upward behind one eye; lasts few minutes to hours(sudden onset, assoc w/ETOH, stress) –Tension=muscle contraction HA of head, neck, upper back(steady pain, gradual onset, assoc w/ stress, PMS, dental probs, sinus)

Front 31

For subjective data, explain what might occur with dizziness.

Back 31

-Syncope-sudden loss of strength, temporary LOC (faint) due to lack of cerebral blood flow.

Front 32

Objective vertigo vs subjective vertigo. What causes vertigo?

Back 32

-room spins, you are spinning -neruological disease in vestibular apparatus in ear, or in vestibular nuclei in brain stem.

Front 33

What four things can seizures occur with? What is Aura? An infant might have what symptom for seizure?

Back 33

-epilepsy, paroxysmal disease w/LOC, involuntary muscle movements, sensory disturbances –subjective sensation that precedes a seizure(auditory, visual, motor) –high fever /neurological disease

Front 34

How do you define a tremor?

Back 34

-involuntary shaking, vibrating or trembling.

Front 35

Explain two types of weakness.

Back 35

Paresis-partial or incomplete paralysis, -Paralysis-loss of motor function due to lesion in neuro / MS or loss of sensory innervations

Front 36

Dysphasia vs Dysarthria

Back 36

-difficulty forming words, difficulty with language comprehension/expression

Front 37

For history of coordination, what condition is abnormal? Numbness/tingling =?

Back 37

-dysmetria-inability to control ROM –Parathesia

Front 38

What are some important patient histories for neuro?(6)

Back 38

-stroke(CVA), spinal cord injury, meningitis, encephalitis, congenital defect, alcholism

Front 39

What are the three assessment techniques used for neuro? Position?

Back 39

-Inspection, palpation, percussion –sitting

Front 40

Elaborate on the following cerebral function tests: Behaviors, LOC, Mental status/cognitive function, Abstract thinking, Communication

Back 40

-Facial expression, posture, grooming, affect – time,place, person - memory(immediate, recent, remote), math(calcs), thought(define familiar words) – judgement-respond to hypothetical situation – speech, auditory, visual comprehend

Front 41

Explain the following Cranial nerves, function, and abnormality: CNI, CNII, CNIII, CNIV &CNVI

Back 41

-olfactory, sensory smell, anosmia-loss of smell bilat d/t smoke, cocaine, rhinitis – optic nerve, sensor/acuity and field, papilledema w/ increased intracranial pressure – Oculomotor, pupils/EOM, Ptosis w/myasthenia gravis – Trochlear/Abducen, EOM, Strabismus(deviated gaze)/ Nystagmus occurs with brain disease)

Front 42

Explain the following Cranial nerves, function, and abnormality: CN V, CNVII, CNVIII

Back 42

-Trigeminal, facial sensation/mastication/corneal , asymmetry jaw/Less STR on one side/less sensation/no blink – Facial, facial expression/taste(anterior tongue), loss of symmetry with stroke/bells palsy –Acoustic, sensory hearing, nonbilat hearing

Front 43

Explain the following Cranial nerves, function, and abnormality: IX & X, XI, XII

Back 43

Glossopharyngeal/vagus, swallow/voice/ gag(uvula), vocal cord dysfunction(hoarse, brassy voice) –Accessory, motor/neck/muscle, atrophy/paralysis –hypoglossal, tongue muscle(say DLTN), atrophy

Front 44

Abnormal finding for Muscle strength(2).Tone(4) Involuntary movements(6)

Back 44

-paresis/weakness, paralysis/plegia(absence of strength) –limited ROM, pain w/motion, flaccidity(decreased resistance,hypotonic), spasticity and rigidity(increased resistance) –tic, tremor, fasciculation(small contraction), myoclonus(brief twitching), chorea(rapid complex body mvments), athetosis(slow twisting)

Front 45

What is ataxia? Inability to tandem walk is associated with?

Back 45

-uncordinated or unsteady gait –multiple sclerosis, alcohol intoxication

Front 46

What does a positive Romberg test indicate? Conditions?

Back 46

-loss of balance when you close your eyes –Multiple slcerosis, alcohol intox,

Front 47

What is RAM? Where is it tested?(3) Abnormality of RAM?

Back 47

-rapid alternating movements –knees palms and dorsal alternate, finger to finger, finger to nose, heel to shin –dysmetria=clumsy movement with overshooting mark, past pointing= constant deviation to 1 side, cerebellar disease (heel to shin prob)

Front 48

Hypoalgesia vs analgesia vs hyperalgesia
Hypoesthesia, anesthesia, hyperesthesia

Back 48

-decreased pain sensation, absent pain sensation, increased pain sensation –decreased touch sensation, absent touch sensation, increased touch sensation

Front 49

Testing a person’s vibration on the foot with a tuning fork looks for what abnormality?

Back 49

-Peripheral neuropaty(diabetes, alcoholism)

Front 50

What is sterognosis? Insterognosis?

Back 50

-Recognize objects by touch – inability “”

Front 51

What is the grading system for DTR?

Back 51

-0=absent, 1= hypoactive, 2=normal, 3=hyperactive, 4=hyperactive with clonus

Front 52

What condition might hyperreflexia occur with? Hyporeflexia?

Back 52

-upper motor neuron lesion(brain attack) – spinal cord injury

Front 53

For biceps reflex, what reflex do you expect for a normal response? Brachioradialis? Patellar? Achilles?

Back 53

-elbow flexion –elbow extension –forearm flexion & supination –knee extension –Plantar flexion

Front 54

Testing for clonus, what condition is present if the leg has a sustained reflex?

Back 54

-upper motor neuron disease (results in rapid strong, oscillating muscle contractions)

Front 55

SUPERFICIAL REFLEXES: For abdominal reflex, what do you expect to see for normal result?Cremasteric? Bulbocavernosus? Anal?

Back 55

-umbilicus moves toward stimulus –inner thigh, testes will rise –dorsal penis, muscle contracts –stroke skin around anus; puckers

Front 56

Name 8 newborn reflexes, with time elapsed

Back 56

-moro/startle,1-4 mos, tonic neck (b-6wk, disappears 4-6mos), grasp(birth, disappears 3-4mos), babinski (disappears 12 mos) –stepping(birth-diss 3-4wks) , rooting/suck (birth, disappear 3-6/10-12 mos) crawl (birth, disappears 6wk) Pull to sit(birth)

Front 57

If Moro reflex is absent or persistant after 5 months, what might be wrong? Tonic neck persistence? Persistant babinski reflex at 2-2.5 yo? Persistance of palmar grasp? Spasticity?

Back 57

-severe CNS injury, -brain damage -pyramidal tract disease –frontal lobe lesion –cerebral palsy

Front 58

Identify the dermatomes in the hand? Feet?

Back 58

-thumb=C6, index/middle=C7, ring/pinky=C8 –medial=L4, dorsal=L5, lateral=S1

Front 59

In testing the spinothalamic tract for superficial sensations, name & explain three tests for sensory function.

Back 59

-pain=ability to perceive pin prick(sharp/dull) –temperature=(only when pain abnormal) sensation of hot/cold tuning fork, -light touch-feel touch on skin when with cotton (esthesias)

Front 60

For posterior column tract test, what kind of tuning fork should be used to test vibrations? Condition sense is lost in? Kinesthesia=?

Back 60

-low pitch(128to256) -peripheral neuropathy(DM & ETOH) –position

Front 61

The monofilament test is important for detecting what?

Back 61

-peripheral neuropathy, diabetes

Front 62

Define graphesthesia. Extinction.

Back 62

-ability to read number on hand –touch bilat same point, ask how many sensations are felt & where

Front 63

In testing balance, shallow knee bend contraindicates what?

Back 63

-obese, elders

Front 64

If patient cannot place their chin on their chest, what is the meningeal sign? What about if you flex the neck and have involuntary hip flexion?(indicates) If you flex hip & knee to 90 degrees, and extend knee, you experience pain in hams and resistance to extend, this is known as?

Back 64

-Nuchal rigidity –brudzinski –irritated meningeal –Kernig sign (meningeal irritation)

Front 65

For an abnormal papillary response for the consual test, what abnormality may be present? What can vital signs indicate in neuro?

Back 65

-brain injury(dilated, non reactive from ICP, pressure on cranial nerve 3) –cushing reflex( increased ICP, increased BP, decreased pulse

Front 66

What is a decorticate response? Decerebate?

Back 66

-hemispheric lesion of cerebral cortex; UE= flex of arms, wrists & fingers with adduct, LE= extension, internal rotation, plantar flex –ominous lesion in brain stem @ midbrain/upper pons, all extremities are rigid extensors with hyperpronation of forearms

Front 67

Give the following pathological reflexes of infant: Grasp, Snout, Palmomental, Suck

Back 67

-examiners hand gently insterted into palm of pt hand – reflex pucking or protrusion of lips with percus, reflex stroke where chin is pushed upward –suck movements by lips when stroked/touched

Front 68

What is the normal result for Glascow Coma scale? Coma?

Back 68

Normal=15, 7=coma

Front 69

What are some focus areas for healthy ppl 2010? Key objectives?

Back 69

-alzhemiers, head trauma – increase mental health assessment, increase # mental health patients who receive treatment, reduce hospitalizations of nonfatal head injury, reduce deaths by vehicle accident, increase safety

Front 70

Which area of the brain is most likely affected if the patient is having trouble with the finger-to-nose test?
A. Cerebellum
B. Cerebrum
C. Hypothalmus
D. Brain stem

Back 70

A

Front 71

Vibratory sense is most frequently affected in cases of
A. Heart disease
B. Crohns’ disease
C. Lung Cancer
D. Diabetes

Back 71

D