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46 Cards in this Set
- Front
- Back
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2 parts nervous system |
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impulses transmitted by
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cerebrum and 4 lobes
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o Largest part of the brain
o Composed of 2 hemispheres o 4 lobes § Frontal – conceptualization, motor ability and judgment, thought process, emotions § Parietal – interpretation of sensory information, ability to recognize body parts § Temporal – memory storage, integration of auditory stimuli § Occipital – visual center |
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cerebellum
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keeps person oriented in space, balance. Doesn’t initiate movement but coordinates it
o Controls skeletal muscles o Controls voluntary movements |
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diencephalon
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area between cerebral hemispheres and the brainstem |
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brain stem 4 parts
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· Brain stem – central core of the brain, contains midbrain, pons and medulla · Midbrain – contains many neurons and tracts · Pons – controls rhythmicity of respiration, contains motor and sensory pathways · Medulla – cardiac, respiratory, vasomotor control. Swallow, gag and cough reflex. Motor and sensory fibers cross here · Spinal cord – continues with the brain stem |
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cerebral circulation
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functional division CNS |
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functional division ANS |
Autonomic nervous system – regulates autonomic body functions, ex heart rate -Sympathetic – maintains homeostasis and defense against stressors. Fight/flight -Parasympathetic – restorative and vegetative functions; decrease heart rate, dilates blood vessels constricts pupils. S= stress and P = peace |
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syncope |
sudden loss of strength, a temporary loss of consciousness (a faint) due to lack of cerebral blood flow - post inter period = sleepy, headache |
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seizures and aura
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occur with epilepsy, a paroxysmal disease characterized by altered or loss of consciousness, involuntary muscle movements and sensory disturbances
o Aura – subjective sensation that precedes a seizure; it could be auditory, visual, or motor |
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tremors
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o Intentional – worst with voluntary movement (reaching to get something) o At rest – occurs when muscles are quiet and supported against gravity (when hand on lap) |
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vertigo
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(rotational spinning) – caused by neurologic disease in the vestibular apparatus In the ear or in the vestibular nuclei in brainstem
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paresthesia
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abnormal sensation of burning/numbness/tingling
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paresis
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partial or incomplete paralysis
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paralysis
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loss of motor function due to a lesion in the neurologic or muscular system or loss of sensory innervation
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dysmetria
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inability to control the distance, power and speed of a muscular action
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dysphagia
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difficulty swallowing
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dysphasia
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difficulty with language comprehension or expression
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dysarthia
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difficulty forming words
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CN 1
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olfactory (sensory) – smell
o Have pt smell using each nostril o Smell normally decreased bilaterally with aging o Anosmia – decrease or loss of smell occurs bilaterally with tobacco smoking, allergic rhinitis and cocaine use |
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CN 2
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optic (sensory) – sight
o Test visual acuity and test visual fields by confrontation o Determine size, color, shape of optic disc o Papilledema with increased intracranial pressure; optic atrophy |
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CN 3
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oculomotor (motor) – eye movements
o Oculomotor, Trochlear and Abducens nerve get examined together o Nystagmus – back and forth oscillation of eyes. Occurs with disease of the vestibular system, cerebellum or brainstem § Presence unilateral or bilateral § Pendular movement (move equally left to right) § Jerk (a quick phase in one direction and then a slow phase in the other) § Amplitude – judge whether degree of movement is fine, medium, coarse § Frequency – constant or does it phade § Plane of movement – horizontal, vertical, rotary, or a combination o Ptosis (drooping) occurs with myasthenia gravis, dysfunction of cranial nerve III or Horner syndrome o Increasing intracranial pressure causes a sudden, unilateral, dilated nonreactive pupil |
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CN 4
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trochlear (motor) – eye movements
o PERRLA – pupils equally round, react to light accommodation (distance) o Extra ocular muscles |
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CN 5
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trigeminal (motor and sensory) chewing and pain sensations of face
o Palpate muscles – temporal and mascular o Sensory – close eyes and test for light sensation (cotton swab across forehead, cheek and chin) o Decreased or unequal sensation. With a stoke, sensation of face and body is lost on opposite side of lesion |
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CN 6
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abducens (motor) eye movements
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CN 7
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facial (motor) – facial expressions
o Also includes sensory function of taste |
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CN 8
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vestibulocochlear (acoustic) – hearing and whispered voice test
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CN 9
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glossopharyngeal – swallowing
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CN 10
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vagus – swallowing, gag
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CN 11
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spinal accessory – trapezius, sternomastoid muscles
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CN 12
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hypoglossal – motor - tongue
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mental status assessment
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Level of consciousness (LOC)
o Alert o Comatose o obtundant - a greatly reduced level of consciousness. The patient is not yet comatose but is close, arousing only with very strong stimulus. · Orientation – person, place, time = A&O x 3 · Memory o Immediate, recent and remote (childhood) |
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cognitive status assessment
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· Thought process · Calculations · Current events · Judgment and problem solving ability · Communication abilities · Emotion – mood and affect (how you show it) · Response to proverbs |
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motor function assessment
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test motor strength and compare bilaterally. Assess ROM against resistance
· Scale used o 5 = full ROM full resistance o 4 = full ROM some resistance o 3 = Full AROM o 2 = Full PROM o 1= trace movement, flicker finger muscle size strength tone involuntary movements |
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muscle size
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o Atrophy – abnormally small muscle with a wasted appearance; occurs with disuse, injury, lower motor neuron disease such as polio, diabetic neuropathy o Hypertrophy – increased size and strength; occurs with isometric exercise |
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involuntary movements
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o Normally none occur. If they do note location, frequency, rate and amplitude |
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tone (ROM)
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o Flaccidity – decreased resistance, hypotonia occur with peripheral weakness o Spasticity and rigidity – types of increased resistance that occur with central weakness o Paresis or weakness is diminished strength vs paralysis or plegia is absence of strength |
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sensory assessment
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· Pain (sharp/dull) · Temperature · Light touch · Posterior Column Tract o Vibration o Position (kinesthesia) with fingers · Tactile discrimination (fine touch) o Graphesthesia – ability to read a number by having it traced on skin o Stereognosis – test person’s ability to recognize objects by feeling their forms, sizes and weightsDeep Tendon Reflexes Assessment o Two point discrimination o Extinction (touch both sides od body at same time and point – ask person to state how many sensations are felt and where) o Point location – “put your finger where I touched you” |
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cerebellar function assessment
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· Posture and gait – steady gait with arm swing, balance maintained o Abnormal findings – crooked line of walk, widens base to maintain balance, staggering, reeling loss of balance. An ataxia that didn’t appear with regular gait may appear now · Romberg test – have pt stand, feet together, arms side, eyes closed o Positive sign is loss of balance that occurs when closing the eyes. You eliminate the advantage of orientation with the eyes, which had compensated for sensory loss Occurs with cerebellar ataxia (multiple sclerosis, alcohol intoxication), loss of proprioception, and loss of vestibular function · Heel to toe gait – tandem walk |
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coordination and skilled movement
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· Rapid alternating movements o Abnormal findings – lack of coordination. Slow, sloppy response is termed dysdiadochokinesia and occurs with cerebellar disease o Dysmetria – clumsy movement with overshooting the mark and occurs with cerebellar disorders or acute alcohol intoxication o Past pointing is a constant deviation to one side o Intention tremor when reaching to a visually directed object o Hand movements – tap finger to thumb, rapidly. Tap each finger to thumb rapidly. Pronate and supinate hands rapidly o Finger to nose test. Eyes closed touch finger to nose alternating and increasing speed · Heel to shin test – while supine or sitting, have patient run heel of one foot over the shin of the opposite leg |
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DTR assessment
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· Scale 0-4+ · 0 = absent · 1+ = diminished, low normal, or occurs only with reinforcement · 2+ = average · 3+ = brisker than average, may indicate disease, probably normal · 4+ = very brisk, hyperactive with clonus, indicative of disease · Clonus – set of rapid, rhythmic contractions of the same muscle · Hyperreflexia – exaggerated reflex · Hyporeflexia |
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DTR body parts
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· Biceps – forearm flexes at elbow · Triceps – forearm extends at elbow · Brachioradialis – slight flexion of forearm at elbow and forearm pronation · Patella – leg extends at knee · Achilles – plantar flexion |
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superficial cutaneous reflex assessment
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· Abdominal – umbilicus shifts towards stimulus · Crenasteric – testicle on same side of stimulation rises · Babisnki (plantar) – toes flex |
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neurological assessment includes
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· Mental status · Cognitive assessment · Cranial nerves · Motor functions and muscle tone · Sensory function · Cerebellar function · DTR and superficial cutaneous reflexes |
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aging adult
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causes general atrophy with a steady loss of neuron structure in the brain and spinal cord. causes decrease in weight and volume with a thinning of the cerebral cortex, reduced subcortical brain structures and expansion of ventricles
general loss of muscle bulk loss of muscle tone in the face, neck, around the spine decreased muscle strength impaired fine coordination and agility loss of vibratory sense at the ankle decreased or absent achilles reflex loss of position sense at the big toe pupillary miosis irregular pupil shape decreased pupillary reflexes velocity of nerve condition decreases 5-10% with aging, making reaction time slower - touch and pain sensation, taste, smell may be diminished muscle tremors may occur in habds, head and jaw with possible repetitive grimacing (dyskinesias) decrease in cerebral blood flow and o2 consumption. may cause dizziness and loss of balance with position slow and deliberate walking, some show hesitation and slightly wayward path |
