a neurological exam attempts to answer the following questions: 1. are the findings symmetrical or...
TRANSCRIPT
A neurological exam attempts to answer the following questions:1.Are the findings symmetrical or unilateral?2.If unilateral, where do they originate?
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Five areas of nervous system exam:Mental status and
speechCranial nervesMotor systemSensory systemReflexes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Appearance and behavior
Speech and language
Mood
Memory and attention
Thoughts and perceptions
Insight and judgment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Mental Status and Speech
The Cranial NervesOriginate from the
base of the brain and provide sensory and motor innervation
Conduct parts of the cranial nerve exam when you assess other areas such as the eyes, ears, throat, and musculoskeletal system
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessing Cranial NervesTest the olfactory nerve by having your
patient identify common odors.Test the oculomotor, trochlear, and
abducens nerves by evaluating your patient's extraocular movements.
Test motor function of the trigeminal nerve by palpating the temporal and masseter muscles.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessing Cranial Nerves (cont.)Test sensory function of the trigeminal nerve
with sharp and dull objects.Test the glossopharyngeal and vagus nerves
with a tongue blade.Test the spinal accessory nerve by having
your patient shrug her shoulders against resistance.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Thirty-one pairs of nerves arise from the spinal foramina. Efferent or motor
tracts arise from the anterior root of the peripheral nerve.
If system is damaged:Function is lost below
the level of the injury Movements become
weak or paralyzed Bledsoe et al., Paramedic Care: Principles & Practice,
Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle
River, NJ
Assessing the motor system Inspect your patient’s general body
structure, muscle development, positioning, and coordination. Observe the size and contour of his muscles.
Assess muscle tone.Assess muscle strength.
Grip strength
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assessing the motor system (cont.)Assess your patient’s
position sense and coordination. Gait Perform the Romberg
test Pronator drift To assess your patient’s
coordination, test for rapid alternating movements.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The posterior root of the peripheral nerves carries the sensory, or afferent, nerve fibers to the spinal cord and brain.
A dermatome chart is a road map depicting bands of skin innervated by sensory nerve fibers.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
To assess the sensory system, test for pain, light touch, temperature, position, vibration, and discriminative sensations.
Ask your patient to close his eyes for each of these tests.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Assess pain. Dull or sharp?
Test for temperature sensation. Warm or cold?
Test for position sense. Up or down?
Test vibration sense. Tuning fork
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The reflex arc connects some sensory impulses directly to motor neurons.Triggers immediate
responses Test your patient’s
superficial and deep tendon reflexes.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Biceps Triceps Brachioradialis Quadriceps
Achilles reflex Plantar reflex Abdominal
reflexes
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Physical Examinationof Infants and Children
Specific techniques same as adult Inspection, palpation, percussion, and
auscultationYou must be familiar with the anatomical
differences between children and adults. You must understand the physical and
psychological developmental stages of the different age groups.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Building patient and family rapportRemain calm and confident. Be direct and honest about what you are
doing. Do not separate the child from his/her
parents. Provide continuous reassurance and
feedback.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
General appearance and behaviorAsk the parents if his/her behavior seems
normal. Two questions:
Does your patient look and act like a normal child in the same age group?
Do actions appear normal to you and to his parents?
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Infants (newborn to 1 year)The arms and legs will
flex slightly and move equally.
Recognize their parents’ faces and voices
Frightened by loud noises and bright lights
Four to six months, they begin to sit up
Very distressed by separation from their parents
Toe-to-head examBledsoe et al., Paramedic Care: Principles & Practice,
Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle
River, NJ
Toddler (1–3 years)Able to walk by
their 18th monthTrust no one but
their parentsMost difficult age
group to examine Assess vital areas
first.Like to be distracted
with toysBledsoe et al., Paramedic Care: Principles & Practice,
Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle
River, NJ
Pre-schooler (3–6 years)Distrusting of strangers
Speak with them to gain trust
Have a great fear of being hurt and of the sight of their own blood
Often feel guilty about their problem
Approach slowly and reassure
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
School Age (6–12 years)Will cooperate with
you if you gain their trust
Want to participate Still fear
separation, pain, and punishment
Modesty becomes more important
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Adolescent (13–18 years)Can be treated
much the same as adults
Modesty is extremely important. Have person of the
same sex conduct exam, if possible.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
© Index Stock Imagery, Inc.
General AppearanceNote whether your patient looks toxic or
sick. A toxic child appears not to recognize or
respond to his parents. These children usually require rapid
transport. Provide aggressive support of vital functions.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Head and Neck The fontanelles Smaller airway
Greater risk of obstruction
Observe facial expression for signs of pain or discomfort.
Check for neck stiffness.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chest and LungsObserve both the chest
and abdomen for movement. A child in severe
respiratory distress may exhibit a “see-saw” pattern.
Assess the rate, quality, and depth of respirations.
Auscultate for breath sounds with the bell of your stethoscope at the midaxillary line.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
CardiovascularHeart rate generally decreases with age.Measure pulse rate by listening to the heart.
Tachycardia or bradycardia can be a response to hypoxia
Blood pressure generally will rise as they grow older.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Normal Vital Signs for Various Pediatric Age Groups
AbdomenLiver and spleen
are proportionally larger and more vascular than an adult’s.
Inspect the abdomen for movement.
Palpate lightly first, then deeply.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
MusculoskeletalEvaluate pulses,
sensation, movement, and warmth in all four extremities.
Check for capillary refill. Accurately reflects
perfusion status Palpate the upper and
lower extremities.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Nervous SystemAssess the child’s general behavior, level of
consciousness, and orientation.Test specific functions such as language and
recall. Much of the nervous system exam is
conducted during other aspects of the physical exam.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Record the findings on your patient’s chart or permanent medical record.
The patient record is only as good as the accuracy, depth, and detail you provide.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The patient’s chart is a legal document.Present the data legibly, accurately, and
truthfully. Follow a standard format when charting
patient information. The SOAP format
Universally accepted organization for patient charts.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Physical Examination Approach and Overview
Overview of a Comprehensive Examination
Anatomical Regions Physical Examination of Infants and
Children Recording Examination Findings
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.
© 2009 by Pearson Education, Inc. Upper Saddle River, NJ