Presentation on theme: "NURS2520 Health Assessment II"— Presentation transcript:
1 NURS2520 Health Assessment II Neurological Assessment
2 Objective One Assess the components of the basic neurological assessment
3 The brain is highly dependent on blood flow and a consistent supply of oxygen and glucose to maintain neuronal function. Any decrease can cause neuronal malfunction. Older adults tend to be vulnerable to cognitive dysfunction secondary to many causes, ranging from decreased blood pressure to infections. Thus, any acute change in cognitive functioning needs to be assessed for an underlying cause.
4 Neurological SystemFunctions through transmission of chemical and electrical signals between the body and the brainReceives, processes, and sends out informationControls and coordinates the functioning of all other systems in response to environment/surroundingsInvolves cognition, emotion, memory, sensation and perception, and regulation of homeostasisComprised of the central nervous system (CNS) and the peripheral nervous system (PNS)CNS = Brain and spinal cordPNS = Cranial and spinal nerves
7 The PNSincludes nerves emerging from the brain (cranial nerves) and nerves emerging from the spinal cord (spinal nerves).These nerves are divided into sensory nerves that conduct messages from various parts of the body to the CNS, whilst motor nerves conduct impulses from the CNS to muscles and glands.is further divided into the Somatic System (SNS) and Autonomic System (ANS), depending on the area of the body these messages are transmitted to and from.
8 The SNSconsists of sensory neurons from the head, body wall, extremities, and motor neurons to skeletal muscle.The motor responses are under conscious control and therefore the SNS is voluntary.Certain peripheral nerves perform specialized functions and form the autonomic nervous system; they control various activities that occur automatically or involuntarily such as the contraction of smooth muscle in the walls of the digestive system.The autonomic system is further divided into the sympathetic and parasympathetic systems. These two systems provide nerve stimuli to the same organs throughout the body, but bring about different effects.The balance between these two systems is controlled to create a state of homeostasis that is where the internal stability of the bodily systems are maintained in response to the external environment
9 Parasympathetic Nervous System slows down the bodyhelps prepare for a more relaxed state, ready for digestion and sleep.It will therefore increase peristalsis of the alimentary canal, slow down the heart rate, and constrict the bronchioles in the lungs..
10 The Sympathetic Nervous System helps prepare the body for "fight or flight" and create conditions in the tissues for physical activity.is stimulated by strong emotions such as anger and excitement and will therefore speed up heart rate, increase the activity of sweat glands, adrenal glands, and decrease those of the digestive system.also produces rapid redistribution of blood between the skin and skeletal muscles.
14 Age-Related Considerations Birth reflexes include rooting, sucking, palmar grasp, tonic neck reflex, and MoroDisappear during infancyMay return w/stroke or traumaDenver Developmental Screening Test II (DDST) used to screen young childrenNeurons decrease over lifetime, resulting in slowed reaction time, problem-solving skills, and voluntary movementDecreases in intelligence and memory not normal in the elderly, and indicate a neurological deficitMedication effects, dehydration, Alzheimer’s dementia, etc
15 Cerebral Function Level of consciousness (LOC) Arousal (alert, lethargic, stuporous, comatose)Verbal stimuliTactile stimuliPainful stimuliOrientation (person, place, time)Mental status and cognitive functionBehavior, appearance, response to external stimuli, speech, recent and remote memory, communication, judgmentPosture, gait, motor movements, dress, hygiene/grooming, mood, affect, facial expressionConsider language/education/culture during neuro exam
17 Objective Two Demonstrate the proper technique for the assessment of reflex activity
18 Reflex FunctionDeep tendon reflex is tested with a rubber percussion hammer to tap a slightly stretched muscleNormal response = muscle contractionResponse grading scale:0 = No response detected+1 = Diminished response+2 = Response normal+3 = Response somewhat stronger than normal+4 = Response hyperactive with clonusClonus refers to involuntary continuous contractions of a muscle or group of musclesSuperficial reflexes are tested by lightly touching the body with the base of a reflex hammer or tongue blade, beginning with the most peripheral part of the limbGraded as positive or negativeDetermine sensory loss area by testing every 1-2 inches
19 Testing Reflexes Biceps Reflex Triceps Brachioradialis Patellar Rest client’s elbow in nondominant hand with thumb over biceps tendon; strike percussion hammer to own thumbTricepsAbduct client’s arm at the shoulder, flexing at the elbow; support upper arm with nondominant hand, letting forearm hang loosely; strike the triceps tendon 2 inches above the olecranon processBrachioradialisRest client’s arm on his leg; strike with percussion hammer 1-2 inches above bony prominence of the wrist on the thumb sidePatellarPosition client in seated position with legs dangling; strike the tendon directly below the patella with a percussion hammerAchillesPosition client in the supine or seated position with legs dangling; hold client’s foot slightly dorsiflexed; strike the Achilles tendon about 2 inches above the heel with the percussion hammerPlantarSuperficialStroke the sole of the client’s foot in an arc from the lateral heel to medially across the ball of the footDeep Tendon Reflexes:
20 Objective Three Demonstrate the assessment techniques employed in the assessment of cranial nerves
21 Dorsal aspect of brain w/cranial nerves (from MyNursingLab)
23 Checking Cranial Nerves CN IIdentify the smell of common substancesCN IITest visual acuity and visual fieldsCN III, IV, & VITest extraocular movement by having client move eyes through the 6 cardinal fields of gaze with head held steady; test papillary reaction to light and accommodationCN V - Motor functionMove jaw from side to side, clenching jaw, and biting down on a tongue bladeCN V - Sensory functionHave client close eyes and identify when he is being touched on the forehead, cheeks, and chin; test corneal reflex by puffing air over the corneaCN VII - Motor functionHave client make faces (smile, frown, whistle)CN VII - TasteTest taste on anterior portion of tongue by placing something sweet, salty, or sour on the tip of the client’s tongueCN VIIITest client’s hearing using wristwatch; test air/bone conduction using Weber & Rinne test; test for balance using Romberg test
24 Checking Cranial Nerves CN IX & X - Motor functionObserve client’s ability to talk, swallow, and cough; have client say “ahhh” while depressing tongue with tongue blade and observing rise of soft palate and uvulaCN IX & X - Sensory functionInduce client’s gag reflex (do NOT perform in lab practice)CN IX & X - TasteTest taste on posterior portion of tongue by placing something sweet, salty, or sour at the back of the client’s tongueCN XIPlace hands on client’s shoulders, and have him shrug shoulders against resistance; have client turn head from side to side against resistanceCN XIIHave client say “d”, “l”, “n”, “t”; have client protrude tongue and move it from side to side