CN ___ is frequently not tested, but if the client mentions altered taste, this may indicate a need to test for ______
CN I
smell
If client is able to move around the environment and see the chair to sit down, this indicates function of CN ____
CN II (optic nerve)
Observe the clients eye movements during an interview. If the eyes move equally side to side, up and down, and obliquely, this indicates function of CN ___, CN _____ & CN ____
CN III (occular)
CN IV (trochlear)
CN VI (abducens)
If pt. eyes blink, this indicates function of the ophthalmic branch of CN ____
CN V (trigeminal)
If the client's face is symmetric when he or she talks, this indicates function of CN ______
CN VII (facial)
If the client can hear you, this indicates function of CN _____
CN VIII (acoustic)
If you observe client swallowing their saliva, this indicates function of CN____ and CN ______
CN IX (glossopharyngeal)
CN X (vagus)
Hearing the client's gutteral speech sounds (K, G) indicates function of CN __
CN X (vagus)
If the pt shrug their shoulders or turn their head during the interview, this indicates function of CN _____
CN XI (spinal accessory nerve)
If client can enunciate words, this indicates function of the tongue and CN _____
CN XII (hypoglossal nerve)
Observing equilibrium is a test of CN ___
CN VIII (acoustic nerve)
This word is used for an unsteady gait
ataxia
_________ gait (stooped posture, flexion at hips, elbows, and knees)
kinsonian gait
A ______is a localized uncontrollable twitching of a single muscle group innervated by a single motor nerve fiber that may be observed or palpated.
fasciculation
What are four causes of fasciculation
1.) side effects to meds
2.) cerebral palsy
3.) neuraliga
4.) poliomyelitis
______ is lack of voluntary movment that is spastic or flaccid.
paralysis
____________is the involuntary contraction of muscles and occurs with upper motor neuron damage such as the pyramidal tract injury that occurs after a spinal cord injury or CVA.
spastic paralysis
_________is the lack of muscle tone and deep tendon reflexes that occurs after a lower motor neuron damage such as injury to the cauda equina from spina bifida
flaccid paralysis
_______is the term used for loss of or impaired sense of smell
anosmia
The confrontation test is testing what CN?
CN II - confrontation test is testing for peripheral vision - tester & pt same eye covered while tester brings wiggley fingers from side, hoping both ppl will see it at same time
These three CN are tested together because they control muscles that provide eye movement
CN III, CN IV, CN VI
______is involuntary movement of the eyeball in a horizontal, vertical, rotary or mixed direction
nystagmus
Testing for facial movement & sensation is testing CN ______.
CN V (trigeminal nerve) - clenching teeth
Name (6) facial movements to test CN VII.
1.) raise eyebrows
2.) purse the lips
3.) close eyes tightly
4.) show teeth
5.) smile
6.) puff the cheeks
The Rinne & Webber's test would be used to access what CN ?
CN VIII (acoustic)
Salty & sweet tastes are tested where? AND are testing what CN?
Anterior two thirds
CN VII (facial)
Bitter & sour tastes are tested where?
AND are testing what CN?
posterior one third of tongue
CN IX glossopharyngeal
You are evaluating CN ____ & CN ____ together when you test for movement of the soft palate and gag reflex
CN IX (glossopharyngeal) gag reflex
CN X (vagus) "ahhh" soft palate rising
Asymmetry of the soft palate or tonsillar pillar movement, any lateral deviation of the uvula, or absence of the gag reflex may indicate disorders of the ________ _________ (my my my momma says...)
medulla oblongata
What could you ask the client to do to test CN XII?
Protrude tongue
move tongue towared nose, chin and side to side
When accessing CN XI - you are also observing the contractions of the ____ & ______ muscles
sternocleidomastoid muscle (for of movement against hand as pt tries to turn head against pressure)
trapezius muscles (shoulder shrugs)
To test cerebellar function, use at least ______ techniques for each area assessed.
C. 2
Have the pt stand with feet together, arms resting at sides, eyes open, then eyes closed. Stand close to pt w/arms ready to "catch" client if he or she begins to fall off balance. There will be a slight swaying, but the upright posture & foot position should be maintained. **this describes what test?**
Rhomberg test
Testing for balance:
Have pt to close eyes & stand one one foot, then the other. He should be able to maintain position for at least ____seconds
5 seconds
Testing for balance:
1. Close eyes and stand on one foot
2. walk in tandem
3. hop on one foot
4. shallow knee bends
5. walk on toes, walk on heels
:)
Ways to test upper extremities for neurologic dysfunctions (4)
1. close eyes, touch nose rapidly w/index fingers
2. touch each finger to thumb in rapid sequence
3. move index finger back & forth between nose & your index finger
4. tap thighs w/hands using pronation & supination movements
Checking for lower extremity neurological dysfunction pt could be asked to :
place heel of one foot to the knee of the other leg, sliding it all the way down the shin (while lying supine)
*a person w/cerebellar disease may overshoot the knee & oscillate back & forth
Areas routinly assessed for sensory function are:
hands
lower arms
abdomen
lower legs
feet
Test kinesthetic sensation by:
grasping the client's finger or toe and moving its position 1 cm up or down (with client's eyes closed) Should be able to describe how the position changed
(pariental lobe)
Test stereognosis by:
asking pt to close eyes, place small familiar object in client's hand & ask him to identify it (parietal lobe)
Test two-point descrimination by:
touching selected parts of the body simultaneously while the client's eyes are closed using 2 prongs (points) asking how many points he detects
Using a blunt instrument to draw a number or letter or letter on the client's hand, back or other area is evaluating _________
graphesthesia
*if the pt can't distinguish the number or letter, it may indicate a parietal lobe lesion
Dorsiflexion of the great toe with fanning of the other toes is a ___________ response when checking for the plantar reflex.
Abnormal. This is termed a positive Babinski's sign & may indicated pyramidal motor tract disease
You check for the plantar reflex by:
using the end of the handle on the reflex hammer, stroke the lateral aspect of the sole of the foot from heel to ball, curving medially across the ball of the foot. Expected findings should be plantar flexion of all toes
You elicit abdominal reflexes by:
stroking each quadrant with the end of a tongue blade. For upper ab reflexes, stroke upward & away from umbilicus. For lower abdominal reflexes, stroke downward & away from umbilicus. Expected response to each stroke is contraction of the rectus abdominis muscle & movement of the umbilicus toward the side stroked
A __________is the earliest and most sensitive indicator of alterations in cerebral function
change in the level of consciousness (LOC)
_____ & ______ are the first orientation to disapear
date & time
healthy ppl often don't remember the day or time. after you reorient the pt, they should remember teh correct date & time
Orientation to _______is the second orientation to be lost
place
Orientation to _________ is the last to be lost
person
*This is the first to return. Orientation returns opposite to which it was lost
Oriented x2 means:
The client is oriented to person & place but not time
x1= oriented to person but not place or time
x3= oriented to time, place, person
When interacting w/an unconscious client ALWAYS assume that he can hear everything you say; thus telling the pt what action you are ging to do before you do it
True or false?
True
_________ breathing is periods of apnea alternating w/hyperventilation
Cheyne-Stokes
seen in pts w/brainstem compression or bilateral cerebral dysfunction
Pt. w/lesions of the midbrain and pons or those w/diabetes mellitus who are in ketacidosis.....assessment of respiratory pattern might reveal _______________
central neurogenic hyperventilation (sustained hyperventilation)
The pupillary response is controlled by CN ______, which originates from the ________
CN III (oculomotor)
originates from the midbrain
Bilaterally dilated pupils may indicate:
1. overdose of hallucinogenics
2. overdose of CNS stimulants
3. pressure in the brainstem that is compressing CN III
A unilateral fixed & dialated pupil is suggestive of pressure on teh CN III
Pt who are _______ can be aroused w/saying their name & touching them. Once aroused, they respond appropriately but return to "sleep" as soon as the stimuli ceases
Lethargic
Pt who are _____ require a louder verbal stimuli and vigorous shaking to prompt a response: they carry out requests while awake, but return to "sleep" when stimuli stops
obtunded
Pt who are _______ require painful stimuli to respond and the response usually is a withdrawal from the source of pain
stuporous
________ clients require painful stimuli and respond w/abnormal flexion or extension
semicomatose
________pt do not respond to any stimuli, even central pain
comatose
This is a 15 pt scale to assess consciousness
Glasgow Coma scale
Two tests assessed when meningitis is suspected:
Kernig's sign
Brudzinski's sign
MENINGEAL IRRITATION:
Flexing one of pt legs at hip and knee, then extending knee. No pain reported is a negative ________
Kernig's sign
if pt has inflammation of the meninges, he will report pain along the vertebral column when the leg is extended
MENINGEAL IRRITATION:
You flex pt. neck (while in supine position) No pain or resistance should be reported. A positive _______ sign occurs when the pt passively flexes the hip and knee in response to head flexion & reports pain along the vertebral column
Brudzinski's sign
Progressive demyelination of nerve fibers of the brain and spinal cord
INFO:
Meningitis = inflammation of meninges that surround the brain & spinal cord
*produces severe headache, fever & general malaise
SIGNS of meningeal irritation include: stiff neck, + Brudzinski's & Kernig's signs. Confusion, agitation & irritability may occur
INFO: Encephalitis
Inflammation of the brain tissue & meninges
MANIFESTATIONS: headache & nausea, signs of fever, nuchal rigidity, lethargy, irritabilty, & vomiting. Over several days may develop -consciousness, motor weakenss, tremors, seizures, aphasia, & +babinski's sign
Injury to the cervial spinal cord may result in _________
quadriplegia
Injury to the thoracic & lumbar spinal cord may result in _________
paraplegia
difficulty swallowing
dysphagia
difficulty speaking or understanding speech
aphasia
The ______ lobe contains the primary motor cortex and is responsible for functions related to voluntary motor activity
frontal lobe
Broca's area is located where? And is involved in _______
Left frontal lobe
formation of words
INFO: FRONTAL LOBE
-contains primary motor cortex
-contains Broca's area (word formation)
-controls intellectual function, awareness of self, personality & autonomic responses related to emotion
This lobe contains the primary somesthetic (sensory) cortex. One of its major functions is to receive sensory input such as position, sense, touch, shape and texture of objects
parietal lobe
This lobe contains the primary auditory cortex. Wernicke's area, located in the left lobe is responsible for comprehension of spoken & written language
temporal lobe
The ________ lobe contains the primary visual cortex and is responsible for receiving and interpreting visual information
occipital lobe
CN ____ & CN _____ originate in the midbrain
CN III oculomotor
CN IV trochlear
INFO:
Motor & sensory tracts from the frontal & parietal lobes cross from one side to the other in the MEDULLA, so that lesions on the right side of the brain create abnormal movement and sensation on the left side and vice versa
Functions of the _________ include coordinating movement, equilibrium, muscle tone and proprioception
cerebellum
each of the cerebellar hemispheres controls movement for the same (ipsilateral) side of the body
The _________ arises from the thoracolumbar segments of the spinal cord and is activated during stress (fight-or-flight response)
The _____ arises from craniosacral segments of the spinal cord & controls vegetative functions (breed & feed)
parasympathetic nervous system
The _______ actions are involved in functions associated w/
-concerving energy such as decreasing heart rate & force of myocardial contraction
-decreasing blood pressure & respiration
-stimulating gastrointestinal peristalsis
