wlk chapter 006 neurologicassess

7/25/2019 WLK Chapter 006 NeurologicAssess

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Chapter 6Nerolo!ic "ssessment


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#earnin! $b%ectives

After reading this chapter you will be able to: &efine 'ey terms related to nerolo!ic

assessment

&escribe fnctional anatomy of thenervos system

E(plain the cortical fnction of different

lobes of the brain &escribe common techni)es sed to

assess the mental stats


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#earnin! $b%ectives +contd-

&escribe fnctions of the brainstem, the

cerebellm, and 12 pairs of cranial nerves Identify the parameters necessary to

obtain a las!o/ Coma cale and be ableto interpret the reslts

&escribe common techni)es to assess

the cranial nerves, the sensory system, the

motor system, coordination, and !ait


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&escribe the importance of assessin!

sedation and delirim in the IC &escribe techni)es sed to assess deep,

sperficial, and brainstem refle(es E(plain the relationship bet/een vital si!ns

and nerolo!ic stats Identify the importance of IC3 monitorin!

and the vale of assessin! cerebral

perfsion pressre

#earnin! $b%ectives +contd-


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$vervie/

In%ries of the nervos system May affect respiratory system May affect patient cooperation /ith respiratory

procedres 5istory may indicate natre of dysfnction E(am localies and )antifies severity of

dysfnction

Initial interaction /ith patient is first step innerolo!ic assessment


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$vervie/ +contd-

Nerolo!ic assessment evalates7 Mental stats Cranial nerve fnction

Motor system Coordination ensory system 8efle(es

Meanin!fl nerolo!ic assessment

re)ires ade)ate stimlation


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:nctional Neroanatomy

Nerolo!ic system Central nervos system

;


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:nctional Neroanatomy +contd-

:nctional division ensory system +afferent- Motor system +efferent-

Cerebrm :nctions7 movement, #$C, ability to spea'and /rite, emotions, memory


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Cerebellm 3osterior part of the brain 8esponsible for e)ilibrim, mscle tone, and

coordination Cerebellar lesions case7; #oss of coordination +ata(ia-; ?remors; &istrbances in !ait and balance



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pinal cord :rom base of the brain do/n to #1 +4 cm- Connects brain to the body for motor and

sensory fnction *1 spinal nerves; C1@C=, ?1@?12, #1@#4, 1@4, one coccy!eal; 3osterior +dorsal- roots A sensory; "nterior +ventral- roots A motor



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pinal cord 5erniated vertebral dis' is the most common

spinal nerve root patholo!y

Involvement of mltiple nerve roots; illain@


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Mental tats and #$C

#$C and mentation7 most important parts

of the nerolo!ic e(am Chan!es de to CN dysfnction

Initial !oal of e(am is to determinepatients a/areness tarts /ith patient enconter

Compromise of #$C may be de to7

eneralied dysfnction +e.!., overdose-"bnormality in specific area


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las!o/ Coma cale +C-

Most /idely sed instrment to )antify

nerolo!ic impairment ?est

Motor response erbal response

; 3oorly sited for patients /ith impaired verbalresponse +e.!., aphasia, hearin! loss, tracheal

intbation-

Eye openin!


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las!o/ Coma cale +contd-

cale !oes from * +deep coma- to 14 +flly

a/a'e- C of 12@14 A non@IC observation

C of >@12 A si!nificant inslt C D> A severe coma A re)ires

endotracheal intbation


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Mini@Mental tate E(amination

MME or :olstein test *0@point )estionnaire to assess co!nition amples varios fnctions

; "rithmetic, memory, orientation core interpretation

; 29F*0 A normal; 20@26 A mild dementia; 10@1> A moderate dementia; D10 A severe dementia


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edation and &elirim in the IC

&elirim occrs in 60G to =0G of

mechanically ventilated patients "ssociated /ith7

#on!er hospital stay 5i!her mortality 3oor lon!@term co!nitive fnction


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edation and &elirim in the IC

+contd-

8ichmond "!itation edation cale

+8"- ?itrate sedation

Confsion "ssessment Method for the IC+C"M@IC- Evalates delirim


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Cranial Nerve E(am

12 cranial nerves A sensory and motor

fnction Midbrain +CN III, I-

3ons +CN III- Medlla +CN IH to HII-


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Cranial Nerve E(am +contd-

Ipsilateral findin!s e(cept on CN "costic problem +CN II, III- 3pillary response +CN II, III- Corneal refle( +CN , II- a! refle( +CN IH, H-


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ensory E(am

omatosensory path/ays pinothalamic +?- A pain, temperatre &orsal colmn@medial lemniscs +&CM#- A

vibration, position sense +proprioception- Evalates ability to perceive sensations

/ith eyes closed "ssessment of li!ht toch, pinpric', and

temperatre


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Motor E(am

3atients ability to move on command Motor stren!th and ran!e of motion cale from 0 +no movement- to 4 +fll

ran!e of motion and fll stren!th- If nconscios A response to pain


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Motor E(am +contd-

pper motor neron +MN-


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&eep ?endon 8efle(es

Evalate spinal nerves ?riceps, biceps, brachioradialis, patellar,

"chilles tendon Jestphals si!n A absence of patellar refle(

cale from 0 +no refle(-, 2 +normal-, 4

+hyperrefle(ia- Myasthenia !ravisand botlism have

abnormal deep tendon refle(es


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perficial 8efle(es

3lantar refle( ?ested /hen sspected #@#4 or 1@2

in%ry


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Coordination,


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ital i!ns and Nerolo!ic ystem


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ital i!ns and Nerolo!ic ystem

+contd-

"ta(ic breathin!7 mar'er of brainstem

dysfnction Increased IC3 A Cshin!s triad

5ypertension, /idenin! plse pressre,bradycardia, bradypnea


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Intracranial 3ressre Monitorin!

Indications Monitor patients at ris' for life@threatenin!

intracranial hypertension Monitor evidence of infection"ssess effects of therapy for redcin! IC3

"ltho!h hyperventilation decreases IC3,

cerebral perfsion pressre +C33- is the

most critical element to monitor

wlk chapter 006 neurologicassess

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