The Neurological System 2 Neurological Exam 5 Components
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Transcript of The Neurological System 2 Neurological Exam 5 Components
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The Neurological System
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Neurological Exam 5 Components
Mental status Cranial nerves Reflexes Motor- includes Cerebellar function Sensory
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Mental Status Examination
Examination - ABCTAppearanceBehaviorCognitionThought processes (thought content &
perceptions) Glasgow Coma Scale
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Assessing LOC:Glasgow Coma Scale
Eye opening
Verbal responsiveness
Motor responsiveness
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Glasgow Coma Scale
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Physical Examination
Levels of Consciousness Alert- awake or easily aroused Lethargic- not fully alert, drifts off when not
stimulated Obtunded- sleeps most times, difficult to
arouse (loud noise, vigorous shaking or pain) Stupor- need persistent loud noise or pain for
arousal; responds to stimuli Coma- no response
(Jarvis CH 2)
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Neurological: Physical Examination
Sensory System Function
With eyes closedInterpret sensationsDiscriminate side to side
Examine in detail if:Reduced sensationNumbness or painMotor or reflex abnormalSkin changes
Be specific: “tell me where I touch”
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Physical Examination
Sensory Function Tests:
Touch Light touch 1st then Pain & Temperature
Vibration Kinesthesia/Proprioception: Position sense Stereognosis Graphesthesia 2-point discrimination
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Sensory Function Tests:
Sensory Exam: Light Touch
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Sensory Function Tests:
Sensory Exam: Vibration
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Sensory Function Tests:
Proprioception: Position sense
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Sensory Function Tests:
Stereognosis
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Sensory Function Tests:
Graphesthesia
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Sensory Function Tests:
Two-point discrimination
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Motor Examination
Symmetry, size, and presence of involuntary movements
Full ROM of joints Check strength against resistance
Neuro patients: Assess hand grips and foot pushes if bedridden
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Cerebellar Function
1. Gait and posture
2. More specific tests Heel to toe in straight
line Walking on toes and
heels Hop on one foot
Note width of gait
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Cerebellar Function, con’tCoordination of hands
Rapid Alternating Movements
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Cerebellar Function, con’t Coordination of hands
Nose –to - Finger Test
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Cerebellar Function, con’t Coordination of legs
Heel to Shin Test
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Cerebellar con’t
3. Romberg:
Stand upright, place feet together, then close eyes
loss of balance means + Romberg test
Be prepared to protect client from falling!
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Reflexes Superficial
(abdominal reflex, Cremasteric reflex)
Abdominal Reflex
Cremastic Reflex
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Reflexes-Cont: Visceral (pupillary response to light)
PERRL/PERRLA
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Reflexes-Cont: Pathologic + Babinski in adults
Babinski’s Reflex (Adult)
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Reflexes-Cont: Reflex Arc – Deep Tendon Reflexes
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Reflexes-Cont: Deep Tendon Reflexes
Technique
Position limb so muscle is slightly stretched
Reflex hammer should strike tendon briskly to stretch tendon
Get patient to relax
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BRACHIORADIALIS BICEPS
TRICEPS
PATELLAR
ACHILLES/PLANTAR
DEEP TENDON REFLEXES
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Grading of DTRs
4+ very brisk 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 no response