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what are some age-related changes associated w/ the neurological system?
- decline in mental fx may result from the decrease in mental stim. and increase in loneliness that occurs w/ loss of employment, relatives, friends
- brain vol. and brain cells decrease w/ aging
- motor response slow
- vibration, position, sense and some reflexes may be diminished or absent
- processing and leanin of new material occurs slowly
- delirium is more common characteristic of infection than elevated temp
- depressin becomes more prevalent
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what are the levels of conciousness?
- alert
- lethargy
- obtundation
- stupos
- coma
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defn lethargy
client is able to open eyes and respond, but is drowsy and falls asleep readily
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defn obtundation
client needs to be lightly shaken to respond, but may be confused and slow to respond
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defn stupor
client requires painful stimuli to achieve a brief response
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what are the 2 abnormal positions associated w/ coma pt's.
- decoricate rigidity- flexion and internal rotation of upper extremity joints and legs
- decerebrate rigidity- neck and elbow extension, writst and fingers flexed
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what is the Glasgow Coma Scale?
measures the levels of conciousness
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how do you assess cognitive processes?
- memory- recent (repeat series of numbers) and remote (state birth dates)
- knowledge- what do they know about current illness/hospitalization
- abstract thinking- interpert a cliche'
- association- how do various concepts are related
- judgement- ask client about solution
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what are the parts of the mini-mental exam?
- orientation to time and place
- attention and calculations (count backward by 7's)
- registration and recalling of obj
- language (name obj, follow commands, write)
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CN 1... name it give me the function and system.
- olfactory
- sensory-smell
- ears, nose, mouth and throat
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CN II.. name it, give me the function and system
- optic
- sensory- visual acuity, visual fields
- eyes
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CN III, IV, VI... name it, give me the function and system
- Oculomotor , trochlear, abducens
- sensory- PERRLA, six cardnial positions of gaze
- eyes
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CN VI... name it give me the function and the system
- facial
- sensory- tast (salt/sweet) on anterior 2/3's of tongue
- motor- facial movements
- head and neck
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VII... name it give me the function and the system
- auditory
- sensory- hearing and balance
- ears, nose, mouth and throat
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IX... name it give me the function and the system
- flossopharyngeal
- sensory- tast (sour/bitter) on posterior 1/3 of tongue
- motor- swallowing, speech sounds and gag reflex
- ears, nose, mouth, throat, neurological
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X... name it give me the function and the system
- vagus
- motor- swallowing, speech sounds and gag reflex
- ears, nose, mouth, and throat
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XI... name it give methe function and hte system
- motor- turn head, shrug shoulders
- head and neck
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XII... name it give me the function and the system
- hypoglossal
- motor- tongue movements
- ears, nose, mouth and throat
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how do you assess motor function?
- assess coordination- finger to nose rapidly
- gait
- balance
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what test are used to assess balance?
romberg and heel-to-toe-walk
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how do you est sensory function?
- pain
- temperature
- light touch
- vibration
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what are the 3 ways to assess discrimination and how does it work?
- two point discrimination- use paper clips to determine the distance at which the 2 points are felt at once
- stereognosis- familiar object placed in clients hand w/ eyes closed
- graphesthesia- identify what is being drawn on their palms
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what is the graing of deep tendon reflex (DTR)
- 4+: very brisk w/ clonus
- 3+: more brisk than average
- 2+: expected
- 1+: diminished
- 0: no response
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when the tricep tendon is hit w/ a reflex hammer, the expected response is for the elbow to?
extend
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when the patellar tendon is hit with a reflex hammer, the expected response is?
extension
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when the achilles tendon is hit with a reflex hammer, the expected response is?
platar flexion of the foot
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when the bicep tendon is hit with a reflex hammer what is the expected response?
flexion
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