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Neuro Assessment

Neuro Assessment

amccallgru
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Neuro Assessment

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  1. Neurological Assessment Amber McCall, PhD, FNP-BC, RN This is the camera box for live lecture picture

  2. Objectives • Obtain neurological medical history • Perform neurological physical assessment • Recognize normalneurological findings • On an adult patient • On a pediatric patient • Identify abnormalneurological findings • On an adult patient • On a pediatric patient Smile, you’re on camera!

  3. Types of Data • Subjective • Objective • What patients say • What nurses Observe “I don’t know where I’m at…Who are You…Who am I?” Hummm…My patient is alert, but not oriented to place or person. Smile, you’re on camera! Review

  4. I’m a +sign Which is it? Subjective Symptom Objective Sign From clinician’s investigation Positive HCG (human chorionic gonadotropin) pregnancy blood test • From patient’s perspective • Missed menstrual cycle I’m a - sign A nurse can find a sign Smile, you’re on camera!

  5. Types of Neuro Exams Integrate the neuro assessment throughout the head-to-toe exam • Screening • Secondary prevention • Detect problems early • Complete • Known neurological dysfunction • Recheck • Re-assessments done periodically Integrate, don’t separate Smile, you’re on camera!

  6. Key Takeaway: Assessment findings vary according to area of brain damage I’m Lobin’ it Broca’sarea Motor speech Expressive aphasia • Sensation • Personality • Behavior • Emotions • Intellect • Visual Review Smile, you’re on camera! • Hearing • Taste • Smell • Voluntary movement • Equilibrium • Muscle tone Wernicke’s area Language comprehension Receptive aphasia

  7. Review Smile, you’re on camera! Used with permission. Memory Notebook of Nursing, CD Images, Nursing Education Consultants, Inc. For student study purposes only, cannot be re-distributed by student in any means of communication (written, electronic, etc.).

  8. “Stroke” CVA (CerebroVascularAccident) Risk Factors Modifiable Non-modifiable Age Gender (men) Race/ethnicity African Americans Why? Complex issue Genetics • CV (cardiovascular) disease • HTN (hypertension) • Cigarette smoking • Diabetes • Atrial fibrillation • Quiveringof atria • Dyslipidemia (high blood cholesterol) • Carotid stenosis (narrowing) • Hormone therapy (estrogen) • Physical inactivity • Obesity Smile, you’re on camera! CVA is a well-known neurological disease

  9. Get Your Gear Penlight Tongue blade Cotton swabs Tuning fork Percussion hammer Aromatic substances Smile, you’re on camera! • Peppermint • Coffee • Vanilla

  10. Subjective Data: Neuro • Headaches • Injury • Dizziness • Seizures • Tremors • Weakness • Loss of coordination • Vertigo (spinning sensation) • Numbness, tingling • Sensations (paresthesias) • Dysphagia • Syncope (fainting) • Any difficulties… • Mechanically forming words (dysarthria) • Understanding words (receptive aphasia) • Saying words (expressive aphasia) • History (stroke, spinal cord injury?) • Hazards • Environmental • Occupational Smile, you’re on camera!

  11. Subjective Data: Neuro Infants & Children Aging Adult ADLs- activities of daily living Bathroom, eating, etc. IADLs- instrumental activities of daily living Shopping, finances, etc. Vision changes Memory loss Tremors Dizziness • Mother’s health • Baby’s birth • C-section, vaginal • Trauma • NICU time? • Neonatal intensive care unit • Congenital (“born with it”) defects • Reflexes • Balance • Seizures • Milestones • Lead exposure • Attention problems • Cerebral palsy • Muscular dystrophy See next 2 slides Smile, you’re on camera!

  12. Smile, you’re on camera! Used with permission. Memory Notebook of Nursing, CD Images, Nursing Education Consultants, Inc. For student study purposes only, cannot be re-distributed by student in any means of communication (written, electronic, etc.).

  13. SCUM Smile, you’re on camera! Used with permission. Memory Notebook of Nursing, CD Images, Nursing Education Consultants, Inc. For student study purposes only, cannot be re-distributed by student in any means of communication (written, electronic, etc.).

  14. The Neuro Exam • Mental status • Cranial nerves • Motor system (movement) • Sensory system (feeling) • Reflexes Smile, you’re on camera!

  15. Mental Status Expected: A/O x 3 • Alert • Oriented • Person • What is your name? • Place • Where are you at? • Time • What day is it? or • Which season it is? • What time it is? Not every patient will be oriented x 3 – they can be alert, yet confused Will you please stop asking me so many questions! Smile, you’re on camera!

  16. Quiz It! The nurse is assessing a patient’s Neurologic status and finds that the patient is aware of his name but does not know what the date or time of the day. How would the nurse best document this finding? • Awake, alert, and oriented times three • Awake, alert, and oriented times two • Awake, alert, and oriented times one • Awake, alert, and oriented times one, to person only Smile, you’re on camera!

  17. Quiz It! The nurse is assessing a patient’s Neurologic status and finds that the patient is aware of his name but does not know what the date or time of the day. How would the nurse best document this finding? • Awake, alert, and oriented times three • Awake, alert, and oriented times two • Awake, alert, and oriented times one • Awake, alert, and oriented times one, to person only Smile, you’re on camera!

  18. Alert as is • Alert to stimuli(verbal or pain) • Unresponsive(despite verbal or painful stimuli) Smile, you’re on camera! Used with permission. Memory Notebook of Nursing, CD Images, Nursing Education Consultants, Inc. For student study purposes only, cannot be re-distributed by student in any means of communication (written, electronic, etc.).

  19. Kruse Levels of Consciousness No need to memorize, just be aware Smile, you’re on camera!

  20. Causes of Altered Mental Status (AMS) • A: • Alcohol, ingested drugs & toxins • E: • Endocrine/exocrine, particularly liver; electrolytes • I: • Insulin; hyper or hypoglycemia • O: • Oxygen (lack of), opiates • U: • Uremia (extra urea waste in blood), renal (kidney) related causes including hypertensive problems • T: • Trauma, temperature changes • I: • Infections, both neurologic & systemic • P: • Psychiatric conditions • S: • Space occupying lesions, stoke, subarachnoid hemorrhage, shock Smile, you’re on camera! This is FYI only No need to memorize, just be aware

  21. Alterations in Memory Delirium Dementia Progressive worsening condition Slow onset VS. • Temporary condition • Rapid onset Smile, you’re on camera!

  22. Cranial Nerves

  23. Well, hope you have a good time learning those.

  24. AAAHHHHHH! Cranial Nerves!! Say it isn’t so! Smile, you’re on camera!

  25. Ditto. It helped us marry for  Hummm…It didn’t help me that much This helps some people (use it if so) Smile, you’re on camera! Used with permission. Nursing Made Insanely Easy! Educator Images on CD Edition, I CAN Publishing, Inc. For student study purposes only, cannot be re-distributed by student in any means of communication (written, electronic, etc.).

  26. On your mark…Get set… GO!!!!!

  27. You have 1 nose to smell with (olfactory) Smile, you’re on camera!

  28. You have 2 eyes to see with (optic) Smile, you’re on camera!

  29. 3, 4, 6 make your eyes do tricks!

  30. Let’s Review Smile, you’re on camera!

  31. I’m the great wizard of eyOz 3 mOves eyes, lids and pupils (OculOmOtOr) Smile, you’re on camera!

  32. 4 moves eyes downward towards nose (trochlear) Tro da’ nose (toward the nose) Smile, you’re on camera!

  33. 6 Pack of Abs 6 is lateral eye movement (abducens) Nice abs! Lateral to the: L = Left R = Right I second that!

  34. 6 Pack of Abs 6 is lateral eye movement (abducens) Nice abs! Lateral to the: L = Left R = Right I second that!

  35. Let’s Review Smile, you’re on camera!

  36. 5 is chewing and facial sensation (trigeminal) So soft!!! Smile, you’re on camera! Clenching jaw Tri- Five

  37. 7 is facial expression, saliva, tears (facial) 7 symmetric? 7 Smile, you’re on camera!

  38. Let’s Review Smile, you’re on camera!

  39. 8 is hearing (acoustic) 8 Smile, you’re on camera! 8 - Ear- Hear- Acoustic

  40. 9 is gag reflex, phonation (9lossopharyngeal) glossopharyngeal “ahhh… 9a9 me!” (gag me!) 9 Smile, you’re on camera!

  41. 10 is talking, swallowing (vagus) After dating for 10years, we went to Vegas, swallowed the good stuff and said, “I do!” Smile, you’re on camera!

  42. Let’s Review Smile, you’re on camera!

  43. 11 is shoulder shrug (spinal accessory) These accessories add (1+1) 2 my look Hey, balancing these ain’t as easy as it looks… 1 1 Smile, you’re on camera!

  44. 12 is tongue (hypoglossal) Smile, you’re on camera! 12- tongue

  45. Let’s Review Smile, you’re on camera!

  46. This picture may help! Smile, you’re on camera!

  47. We have 2 eyes to see with (optic) We have one nose (olfactory) 3 4 6 Yet another picture! 8- Ear- Hear Sensation Expression Smile, you’re on camera! 12 Tongue Used with permission. Nursing Made Insanely Easy! Educator Images on CD Edition, I CAN Publishing, Inc. For student study purposes only, cannot be re-distributed by student in any means of communication (written, electronic, etc.).

  48. Memory Tool 1- nose (to smell with), olfactory 2- eyes (to see with), optic 3- oculomotor pupil constriction 4- trochlear, downward towards nose (tro da nose) 6- lateral eye movement abducens (6 pack abs) 5- tri, facial sensation, clench jaw, trigeminal 7- expression, facial 8- ear, hear, acoustic 9- glossophayrngeal, taste 10- vagus, say ahhh (go to Vegas, 10th year) 11- shrug shoulders, spinal accessory 12- stick out tongue, hypoglossal Make my eyes do tricks Bolek, B. (2006). American Nurse Today Smile, you’re on camera! Even more pictures!

  49. Let’s Review You got some nerve tryin’ to learn all this at once… Cranial Nerves Smile, you’re on camera!

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