Term
| What are the subunits of the nervous system? |
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Definition
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Term
| What is included in the CNS? |
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Definition
| includes the brain and spinal cord. These two structures collect and interpret voluntary and involuntary sensory and motor signals |
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Term
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Definition
| collects, integrates, and interprets all stimuli. It also initiates voluntary and involuntary motor activity. |
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Term
| What are the 3 areas of the brain? |
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Definition
| cerebrum, brain stem, and cerebellum. |
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Term
| What is the cerebrum's fxn? |
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Definition
| control complex problem-solving; value judgements; language; emotions; interpretation of visual images; and interpretation of touch, pressure, temperature, and position sense. |
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Term
| What are the 4 lobes of the cerebrum? |
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Definition
| : parietal, occipital, temporal, and frontal |
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Term
| What are the divisions of the brain stem? |
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Definition
| the midbrain, pons, and medulla |
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Term
| What is the fxn of the brain stem? |
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Definition
| Is a major sensory and motor pathway for impulses running to and from the cerebrum. Regulates body functions such as respiration, auditory and visual reflexes, swallowing, and coughing. |
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Term
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Definition
| Lies in the posterior portion of the skull and contains the major motor and sensory pathways. |
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Term
| What is the fxn of the cerebellum? |
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Definition
| controls smooth, coordinated muscle movements and helps to maintain equilibrium |
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Term
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Definition
| the primary pathway for messages traveling between the peripheral areas of the body and the brain. It also houses the reflex arc for actions such as the knee-jerk reflex. |
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Term
| What questions should be asked when doing a neuro assessment? |
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Definition
| previous history of seizures, loss of consciousness, anesthesia (an absence of normal sensation – especially to pain), paresthesia (numbness and tingling; a “pins and needles” feeling), neuralgia, twitches, tremors, personality changes, memory deficits, mental deterioration, nervousness, anxiety, history of psychiatric problems, vertigo, sensory disturbance, phobias, hallucinations, delusions, illusions, nightmares, insomnia, and/or grandiose ideas. |
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Term
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Definition
| A sensory perception not resulting from external stimuli. An example would be someone who is hearing voices. |
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Term
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Definition
| A persistent belief even though illogical. An example would be someone who is feeling controlled by external sources. |
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Term
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Definition
| A false interpretation of external stimuli. Examples of illusions inlcude seeing mirages or hearing the ocean in a sea shell. |
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Term
| What does a mental status exam assess? |
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Definition
| assesses the patient’s cerebral function. Remember that the cerebrum controls sophisticated mental functions such as speech, problem solving, and memory |
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Term
| How do you assess intellect? |
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Definition
| Memory, Orientation, Recognition, Calculations |
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Term
| How do you assess orientation? |
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Definition
| Assess time, place, person. Organic brain disorders lose time first, then place, rarely person. |
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Term
| How do you assess attention span? |
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Definition
| Should be able to focus on examiner’s questions and respond. Impaired in anxiety, fatigue, intoxication. |
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Term
| How do you assess recent memory? |
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Definition
| Ask for 24 hour diet recall and other easily verifiable information. Impaired in organic brain syndromes and Alzheimer’s. |
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Term
| How do you assess remote memory? |
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Definition
| Ask for past health, birthdays, anniversary, relevant history. Lost in Alzheimer’s, cortical injury, but not in normal aging or most organic brain syndromes. |
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Term
| How do you assess new learning? |
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Definition
| Assess 4-word recall (should be able to recall all four at 10 minutes and three words at 30 minutes). Use the word groups “brown, honesty, tulip, eyedropper” or “fun, carrot, ankle, loyalty”. Four-word recall is impaired in Alzheimer’s, anxiety, and depression |
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Term
| How do you assess judgement? |
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Definition
| Ask questions such as “What would you do if your house caught fire?” or “What are your plans for the future?”. Judgement is impaired in mental retardation, emotional dysfunction, schizophrenia, and organic brain disease. |
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Term
| How do you assess perception? |
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Definition
| Visual hallucinations are often associated with medications and organic syndromes. Auditory hallucinations are associated more with psychiatric disorders. |
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Term
| How do you assess Cranial Nerve I (OLFACTORY)? |
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Definition
| After assessing patency of both nares, have client close eyes, obstruct one nare, and sniff using common substances. |
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Term
| When does bilateral decreased sense of smell occur? |
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Definition
| age, tobacco smoking, allergic rhinitis, cocaine use. |
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Term
| What does unilateral loss of smell indicate? |
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Definition
| can indicate a frontal lobe lesion. |
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Term
| How do you assess Cranial Nerve II (OPTIC)? |
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Definition
| Check visual acuity (have the patient read newspaper print) and visual fields for each eye. |
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Term
| What does unilateral blindness indicate? |
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Definition
| a lesion or pressure in the globe or optic nerve. |
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Term
| What does loss of the same half of the visual field in BOTH eyes indicate? |
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Definition
| can indicate a lesion of the opposite side optic tract as in a CVA. |
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Term
| How do you assess Cranial Motor III (OCULOMOTOR)? |
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Definition
| Assess pupil size and light reflex |
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Term
| What does a unilaterally dilated pupil with unilateral absent light reflex and/or if the eye will not turn upwards indicate? |
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Definition
| internal carotid aneurysm or uncal herniation with increased intracranial pressure. |
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Term
| How do you assess Cranial Nerve IV (TROCHLEAR) and Cranial Nerve VI (ABDUCENS)? |
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Definition
| Have patient turn eyes downward, temporally, and nasally. |
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Term
| What if the patient cannot move eyes? |
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Definition
| the patient may have a fracture of the eye orbit or a brain stem tumor. |
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Term
| Why are Cranial Nerves III, IV, and VI examined TOGETHER? |
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Definition
| they control eyelid elevation, eye movement, and pupillary constriction |
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Term
| How do you assess Cranial Nerve V (Trigeminal)? |
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Definition
Palpate jaws and temples while patient clenches teeth.
Have patient close eyes, touch cotton ball to all areas of face. |
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Term
| What is a unilateral deficit of Cranial Nerve 5 indicate? |
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Definition
| seen with trauma and tumors. |
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Term
| How do you assess Cranial Nerve VII (FACIAL)? |
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Definition
Check symmetry and mobility of face by having patient frown, close eyes, lift eyebrows, and puff cheeks.
Asses the patient’s ability to identify taste (sugar, salt, lemon juice) |
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Term
| What does an asymmetrical deficit of Cranial Nerve VII indicate? |
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Definition
| trauma, Bell’s palsy, CVA, tumor, and inflammation. |
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Term
| How do you assess Cranial Nerve VIII (ACOUSTIC/VESTIBULOCOCHLEAR)? |
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Definition
| This tests hearing acuity |
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Term
| What does an impairment in cranial nerve 8 indicate? |
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Definition
| inflammation or occlusion of the ear canal, drug toxicity, or a possible tumor. |
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Term
| How do you assess cranial nerve IX (GLOSSOPHARYNGEAL) and X (VAGUS)? |
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Definition
| Depress the tongue with a tongue blade and have the patient say “ahh” or yawn. Uvula and soft palate should rise. Gag reflex should be present and the voice should sound smooth. |
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Term
| What causes a deficit in IX and X? |
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Definition
| brain stem tumor or neck injury. |
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Term
| How do you assess Cranial Nerve XI (SPINAL ACCESSORY)? |
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Definition
| Have the patient rotate the head and shrug shoulders against resistance. If the patient is unable to do this it may indicate a neck injury. |
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Term
| How do you assess Cranial Nerve XII (HYPOGLOSSAL)? |
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Definition
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Term
| What indicates an lower/upper motor neuron damage of XII? |
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Definition
| Wasting of the tongue, deviation to one side, tremors, and an inability to distinctly say l,t,d,n sounds |
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Term
| How do you test for reflexes? |
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Definition
| When you strike a slightly stretched tendon with a reflex hammer, a simple muscle contraction occurs. |
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Term
| What kind of information do deep tendon reflexes (DTRs) give the examiner? |
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Definition
| DTRs assist with evaluation of lower motor neurons and fibers. For example, if the patient’s biceps reflex is normal, you know that the lower motor neurons and fibers at levels C5 and C6 are intact. |
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Term
| How do you check the bicep reflex? |
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Definition
| With the patient sitting, flex his arm at the elbow and rest his forearm on his thigh with the palm up. Place your thumb firmly on the biceps tendon in the antecubital fossa. Strike your thumb with the hammer. The elbow and forearm should flex, and the biceps muscle should contract. |
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Term
| How do you check the triceps reflex? |
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Definition
| The triceps tendon is tested with the patient’s arm flexed at a 90° angle. Supporting the arm with your hand, strike the triceps tendon on the posterior arm just above the elbow. The tendon should contract and the elbow extend. |
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Term
| How do you check the brachioradialis reflex? |
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Definition
| Have the patient rest his slightly flexed arm on his lap with the palm facing downward. Strike the posterior arm about two inches above the wrist on the thumb side |
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Term
| How do you check the patellar reflex? |
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Definition
| Dangle the patient’s legs over the side of the bed. Place your hand on the patient’s thigh and strike the distal patellar tendon just below the kneecap. (If the patient must remain supine, flex each leg to a 45° angle and place your dominant hand behind his knee to support it.) The normal response is contraction of the quadriceps muscle with extension of the knee. |
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Term
| How do you check the achilles reflex? |
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Definition
| Have the patient dorsiflex (point downward) his foot slightly and lightly tap the Achilles’s tendon on the posterior ankle area. A slight jerking of the foot should be seen. |
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Term
| How do you assess for bicep strength? |
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Definition
| instruct the patient to bend the forearm up at the elbow (flexion) while you hold the patient’s wrist exerting a slight downward pressure |
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Term
| How do you assess for triceps strength? |
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Definition
| having the patient extend his arm while you push against his wrist |
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Term
| How do you assess for hand strength? |
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Definition
| Hand grasps should also be assessed. Ensure that the patient follows instructions to release the hand when assessing grip strength. In some cases, gripping the examiner’s hands is almost reflex while being able to release the hand grasp on command is more important. |
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Term
| How do you assess upper leg strength? |
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Definition
| flex his hip and knee so that the knee is about 8 inches off the bed. Tell the patient to maintain this position while you attempt to push down against the thigh |
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Term
| How do you assess lower leg strength? |
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Definition
| test lower leg and foot muscle strength by having the patient push his foot against your hand, then have him pull it up against your hand. |
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Term
| How do you assess coordination? |
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Definition
| by having the patient close the eyes and touch the finger to the nose. Coordination can also be assessed by having the patient perform rapid alternating movements (RAMs). The patient is instructed to pat his upper thigh with the same side hand, alternately patting with the palm and the back of the hand as quickly as possible. Repeat with both hands. These tests will help you evaluate coordination and detect intentional tremors. |
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Term
| How do you assess for coordination if bed ridden? |
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Definition
| . However, if he can stand beside the bed, you can perform the Romberg test for balance |
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Term
| What kind of disease can maintain balance w/ eyes open but not closed? |
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Definition
| If the patient has a cerebellar disease, he may be able to maintain his balance with the eyes open, but not with them closed. |
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Term
| How do you assess the sensory system? |
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Definition
Instruct the patient to keep his eyes closed during all the tests. o
Compare one side with the other, noting whether sensory perception is bilateral. o
If you detect an area of increase or decreased sensation, mark it with a water-soluble marker and note which peripheral nerves carry sensation to the area. |
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Term
| What cranial nerve are you assessing during the sensory system assessment? |
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Definition
| Cranial Nerve V (TRIGEMINAL) |
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Term
| If you have pain perception, do you need to test for temperature? |
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Definition
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Term
| How do you test for pain? |
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Definition
| have the patient close his eyes and let you know when you are touching a sterile needle to his skin. Lightly touch the proximal and distal aspects of the arms and legs with the needle. |
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