ASSESSING THE SENSORY-NEUROLOGICAL SYSTEM

Structures Cerebrum  Cortex Frontal lobe  Temporal lobe Limbic system  Parietal lobe Occipital lobe  RAS Thalamus  Hypothalamus Cerebellum  Brainstem Midbrain  Medulla Meninges  Ventricles

Functions What are the functions of… Cerebrum: Largest part of brain (2 hemispheres – each with 4 lobes) Cortex: Outer layer of cerebrum; controls most conscious processes Frontal Lobe: Emotional expression, Broca’s area (expressive language) (Continued)

Functions What are the functions of… Temporal lobe: Hearing, taste, smell, memory, Wernike’s Area (language comprehension) Limbic system: Emotions, sexual arousal, behavioral expression, recent memory (Continued)

Functions What are the functions of… Parietal: Sensory input Occipital lobe: Vision and spatial relationships RAS: Wakefulness; Screens & channels incoming sensory input (Continued)

Functions What are the functions of… Thalamus: Clusters multiple sensory stimuli Hypothalamus: Controls autonomic nervous system and pituitary gland Cerebellum: Coordination, equilibrium (Continued)

Functions What are the functions of… Brainstem: Involuntary survival behaviors; includes midbrain, medulla and pons Midbrain: Visual, auditory, pupils, and eye movements (Continued)

Functions What are the functions of… Medulla: Regulates heart, respiratory rates, B/P, and protective reflexes Pons: Helps with respiratory function, facial sensation and movement (Continued)

Functions What are the functions of… Meninges: 3 layers (pia, arachnoid, dura); protect brain and spinal cord Ventricles: 4 cavities; capillaries produce and reabsorb CSF (Continued)

Relationship to Other Systems Integumentary  Respiratory HEENT  Musculoskeletal Lymphatic  Genitourinary Cardiovascular  Endocrine Hematological  Gastrointestinal

Developmental Variations in Older Adults Fact Neurons are continually lost during our lives Neural impulses slow down Fiction Misconception that creative, critical and abstract thinking, or problem-solving ability slip with age Neurological Deficits Meds, Malnutrition, Dehydration, Cerebral perfusion, Diabetes, Trauma, CA, Alzheimer’s, Parkinson’s, ETOH/Drug abuse, Isolation (Abuse/Neglect), Psychiatric disorders

Cultural Variations African Americans Irish Native Americans HTN, CVA Neural tube defects Native Americans Unique Neuropathy that causes death by age 24

Case Study Leon Webster, 21-year-old, African American, college senior, plays football MVA not wearing seat belt; lost control of car; hit tree Alert & oriented; C/O headache and neck pain

History What can the history tell you about History What can the history tell you about the neurologic/sensory system? Biographical data Current health status Past health history Family history Review of systems Psychosocial history

Symptoms What symptoms would signal a problem with the neurologic/sensory system? Headache Mental status change Dizziness, vertigo, syncope Numbness or loss of sensation Deficits of the 5 senses

Pertinent History Findings Headache and neck pain from hitting head in MVA; dizzy, nauseated after MVA Had a few beers before accident Unsure if lost consciousness; a little confused at time Lives on campus; home 1 hour away from school (Continued)

Pertinent History Findings Concussion and fractured fibula in high school while playing football + family history of HTN

Physical Assessment Approach: inspection, palpation, and auscultation Position: sitting Tools: stethoscope, B/P cuff, penlight, gloves, cotton, sharp object, coin, fragrance, sweet and sour substance, tongue blade, test tubes, reflex hammer, ophthalmoscope General Survey and head-to-toe scan

Cerebral Function Behavior Level of consciousness: time, place, person Glasgow Coma Scale (pg 770 new- 668 old) Memory: immediate, recent, remote Mathematical ability Thought process  Judgement General knowledge  Communication

Cranial Nerves CN I - olfactory: sensory smell CN II - optic: sensory sight CN III - oculomotor: pupils, EOM CN IV - trochlear: EOM CN V - trigeminal: facial sensations & motor,muscles of mastication CN VI - abducen: EOM CN VII - facial: motor, facial muscles, sensory, taste anterior tongue (Continued)

Cranial Nerves CN VIII - acoustic: hearing CN IX - glossopharyngeal: swallowing, voice, gag, taste posterior tongue CN X - vagus: swallowing, voice, gag CN XI - accessory: motor, neck muscles CN XII - hypoglossal: motor, tongue muscle

Sensory Function Superficial sensations: Light touch Pain Temperature Deep sensations: Vibratory sensations Kinesthetics (Continued)

Sensory Function Discriminatory sensations: Stereognosis Graphesthesia Recognition of solid object by touch Graphesthesia Recognition of outlines, numbers, words, symbols when written on skin 2 point discrimination Point localization Extinction

Deep Tendon Reflexes Biceps Triceps Brachioradialis Patellar Achilles (pg 785 new 684 old)

Superficial Reflexes Plantar Abdominal Anal Cremasteric Bulbocavernosus

Protective Reflexes Gag Cough Swallow Blink Corneal

Primitive Reflexes Babinski Page 784 new, 684 old Sucking Grasp Rooting Snout Glabellar

Meningeal Signs Nuchal rigidity pg 784 new, 689 old Kernig’s Sign (+ if contraction or pain of hamstring present) Brudzinski’s Sign (+ if flexion of the hips occurs)

Pertinent Physical Findings AAO x 3, Glasgow Coma Scale 15 Memory: immediate and remote intact, doesn’t remember events of accident Cognitive function intact CN 1 through XII intact +2 DTR, + plantar 2” sutured laceration on forehead

Nursing Diagnosis What actual or potential problems can you identify for Leon Webster?