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Neurological Assessment PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "Neurological Assessment” by Jennifer Coleman.

This medical PowerPoint presentation is about neurological assessment, a process used by healthcare professionals to evaluate the functioning of the nervous system. This assessment typically includes an evaluation of the patients mental status, cranial nerves, motor and sensory systems, and reflexes.

The following are some common components of a neurological assessment:
Mental status: This includes an evaluation of the patients level of consciousness, orientation, memory, and mood.
Cranial nerves: There are 12 pairs of cranial nerves that are responsible for various functions such as vision, hearing, and facial movement. The assessment of these nerves may involve testing the patients visual acuity, hearing, and facial expressions.
Motor system: This includes an evaluation of the patients muscle strength, tone, and coordination. The healthcare professional may ask the patient to perform specific movements such as walking or picking up an object to assess their motor function.
Sensory system: This involves an evaluation of the patients ability to feel touch, temperature, and pain. The healthcare professional may use different stimuli such as a soft brush or a pin to test the patients sensory function.
Reflexes: This involves an evaluation of the patients reflexes, such as the knee-jerk reflex. The healthcare professional may use a small rubber hammer to test the patients reflexes.

In addition to these components, a neurological assessment may also include a review of the patients medical history, medications, and any recent trauma or illness that may have affected their nervous system. The results of the assessment can help healthcare professionals diagnose and treat a wide range of neurological conditions.

Tags : neurological assessment, functioning of the nervous system, mental status, cranial nerves, motor and sensory systems, reflexes, Neurology, Neurology PowerPoint presentation

Published on : Jun 20, 2023 | Views : 805 | Downloads : 1

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Slide 1-

Neurological Assessment Health Assessment Jennifer Coleman
Slide 2-

Nervous System Divided into two regions Central Nervous System (CNS) Peripheral Nervous System (PNS)
Slide 3-

CNS - Brain Control center of body Covered and protected by scalp, skull, and meninges Blood brain barrier Cerebrum – right and left hemispheres, frontal, parietal, occipital & temporal lobes Diencephalon – (thalamus and hypothalamus) body temp, sleep Cerebellum – position sense, posture & equilibrium/balance Brain Stem – (medulla oblongata, pons & midbrain) resp. & cardiac regulation, sneezing, LOC
Slide 4-

Lobes of the Cerebrum Parietal – somatic sensory center Frontal – higher intellect, speech production, personality, behavior, emotions, voluntary movement Temporal – hearing, memory, speech perception and translation Occipital – vision Limbic - emotion
Slide 5-

CNS – Spinal Cord Extends from medulla to the level of the first lumbar vertebra Cord protected by vertebra, meninges and cerebral spinal fluid Gray matter is on the inside and white matter on the outside Mediates deep tendon reflexes
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Spinal Roots Cervical, thoracic, lumbar nerves Posterior (sensory) roots Anterior (motor) roots Damage to posterior – loss of sensation Damage to anterior – flaccid paralysis
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Peripheral Nervous System (PNS) The PNS links CNS with the rest of the body External environmental information received and transmitted via PNS Cold, wet, hot, pain
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Spinal Nerves Cervical 8 pairs C1-C8 Thoracic 12 pairs T1-T12 Lumbar 5 pairs L1-L5 Sacral 5 pairs S1-S5 Coccygeal 1 pair Coccyx
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Reflex Rapid involuntary predictable motor response to a stimulus. Reflex arc, is not dependent on the brain. Somatic Skeletal muscle contraction Autonomic Cardiac, smooth muscle and glands
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Dermatome Area of skin that is innervated by cutaneous branches of a single spinal nerve. Useful in identifying neurological lesions.
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Autonomic Nervous System (ANS) Division of PNS that regulates the internal environment of the body. Temperature, hormone levels, digestion…
Slide 13-

Assessment Three basic types of neurologic examination Screening neurologic exam Complete neurologic exam – neurologic concerns Neurologic recheck exam Assess mental status first Equipment Eye charts, tuning fork, pen light, reflex hammer, key, buttons, coin, big safety pin, cotton, Q-tip
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Mental Status Level of consciousness (LOC)/orientated X3/X4, intact recent and remote memory Confusion/disorientation Lethargy Delirium Coma Glasgow Coma Scale – eye opening, verbal response, motor response Cognitive abilities and mentation Mini Mental State Examination Mental Status Exam
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Mental Status Physical appearance, dress, grooming, hygiene Appropriate for age, sex, culture, season, setting Behavior and affect, facial expression Depressed, hostile, euphoric, fearful, flat/dull Assess thought content/process Give 3 part command
Slide 17-

Speech and Language Quality Rate Volume Fluency – Abnormal patterns Aphonia/dysphonia – difficulty/discomfort in talking (laryngeal disease) Cerebellar dysarthria – distorted speech sounds, may sound unintelligible, basic language intact
Slide 18-

Language Speech Abnormalities Aphasia (stroke) Broca’s (expressive) – Understands, but cannot speak Global – severe form, absent/reduced speech, absent/reduced understanding Wernicke’s (receptive) – Ability to express self, but cannot understand others Palatal paralysis Parkinsonism – slower, monotonous speech
Slide 19-

Thought Processes and Perception Perceptions Illusions/delusions Hallucinations Ability to make a decision/judgment Insight
Slide 20-

Cognitive Abilities and Mentation Immediate (sec-min) – Ask to repeat 3-4 unrelated words Recent memboy (min-hrs) – Ask who “I” am, last meal, last visitor, repeat 3-4 unrelated word (wait) Remote memory (days-yrs) – Ask BD, anniversary, last President, favorite President Abstract reasoning skills – Meaning of a proverb, simple math Interpretation of stimuli – Visual, auditory, tactile
Slide 21-

Cranial Nerves I-VI (p. 661) I(S) Olfactory smell II(S) Optic vision III(M) Oculomotor pupil constriction, EOM, lid elevation, light reflex IV(M) Trochlear EOM, uvula movement V(B) Trigeminal sensation of face, scalp & cornea (corneal reflex), mastication VI(M) Abducens lateral eye movement
Slide 22-

Cranial Nerves VII - XII VII(B) Facial lid closure, frown, smile, raise eyebrows, puff cheeks, taste VIII(S) Acoustic hearing IX(B) Glossopharyngeal swallow, gag, whistle X(B) Vagus swallow, gag, laryngeal sounds, say “ahh” XI(M) Spinal accessory shoulder & neck movement XII(M) Hypoglossal symmetrical tongue, ROM of tongue
Slide 23-

Motor System Comatose posturing (p. 710) Decorticate Rigidity (abnl. flexion) Decerebrate Rigidity (abnl. extension) Flaccid Quadriplegia (nonfunctional brain stem) Opisthotonos (meningeal irritation) Cerebellar function Coordination Gait Station/Position
Slide 24-

Motor System (Cerebellum) Coordination Ataxia – rapid alternating hand/foot tap (RAM), Romberg test, finger to nose, finger to finger Gait and Balance Heel-toe walk (Tandem test), rate size of steps, posture, fluid, feet clear floor, client will watch feet
Slide 25-

Gait Abnormalities (Table 23-5) Spastic hemiparesis – stroke, immobile arm against body, stiff/extended leg, toe drag Cerebellar ataxia – loss of position sense, staggering, MS, alcohol (barbiturate) Parkinsonian – basal ganglia defects, stooped posture, trunk forward, short/shuffling steps, rigid body Scissors – knees cross/in contact, CP Steppage/footdrop – lower motor neuron defect Waddling – MD, dislocation of hips, lordosis & protruding abdomen Short leg – >1inch
Slide 26-

Motor System Muscle size, strength, tone bilaterally Grip, palpate muscle size bil, push/pull arms and legs (0-5 scale), note tics, tremors or fasciculation Tremor differentiation “When does it occur?” Table 23-4 (p. 703-704)
Slide 27-

Tremors Fasciculation – Rapid, continuous twitching of resting muscle/part of muscle, fine (atrophy/weakness) or coarse (cold/fatigue) Tic – Repetitive twitching Myoclonus – Rapid, sudden jerk, hiccup, falling asleep, grand mal seizure Resting (static) – Coarse & slow, disappears with voluntary movement, “pill rolling” Intention – Worse with voluntary movement, MS, Essential (older adults), often with emotional stress, improves with sedative/alcohol – benign
Slide 28-

Tremors continued Chorea – Sudden, rapid, jerky, purposeless movement, disappears with sleep, Huntington’s Athetosis – Slow, twisting, writhing, continuous movement (snake/worm like), disappears with sleep, CP
Slide 29-

Sensory Assessment Exteroceptive sensation Light touch, superficial pain (sharp/dull), summation effect, temperature Proprioceptive sensation Motion, position, vibration Cortical sensation Sterognosis, graphesthesia, extinction, two-point discrimination (2-3 mm is normal), point location
Slide 30-

Light Touch Client sitting Eyes closed “Say where you are touched.” Compare bilaterally, and distally to proximally.
Slide 31-

Vibratory Sensation Close eyes Strike fork & start on most distal bony prominence & work medially with neuropathy Ask when do you feel the vibration start and when do you feel the vibration stop.
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Stereognosis Close eyes Place object in hand “Identify object.” Test bilaterally with different objects. Note speed and accuracy Astereognosis – unable to identify object
Slide 33-

Graphesthesia (Parietal Lobe) Close eyes Draw letter or number on hand “Identify figure.” Test bilaterally Note speed and accuracy Agraphesthesia – inability to identify figure
Slide 34-

Reflexes Deep tendon Grading scale 0-4+ Compare bilaterally Biceps, brachioradialis, triceps, patellar, achilles Superficial Abdominal Plantar (Negative Babinski) Cremasteric
Slide 35-

Reflex Charting 4+ - Hyperactive, commonly with clonus Clonus – continued movement after stimulations removed
Slide 36-

DTR Testing Sometimes need a distraction to help with reflex production. Ask client to lock fingers and “pull” – Isometric contraction away from muscle group being tested Try further encouragement of relaxation. Not brain dependent – often present when unconscious, asleep
Slide 37-

Abnormal Reflexes 0 or 1+ - deep coma, sedation, narcosis, ICP, spinal shock, hypothyroidism, infectious diseases 3+ and 4+ - suggest upper motor neuron disease, hyperthyroidism, pre-eclampsia, Sustained clonus confirms severe neurological disease
Slide 38-

Biceps Reflex Support the client’s forearm Client’s arm flexed at 45-90 degree angle Hold arm loosely Strike tendon with a brisk wrist motion on top of your thumb
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Brachioradialis Reflex
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Triceps Reflex Relaxed arm required. extension of the forearm.
Slide 41-

Patellar Reflex Sit on edge of table with leg hanging free. Place hand over quadriceps muscle Strike patellar tendon just below the patella – blunt end of hammer
Slide 42-

Achilles Reflex Loosely support foot in hand. Briskly strike Achilles tendon. Plantar flexion of the foot.
Slide 43-

Abdominal Reflex
Slide 44-

Plantar Reflex Stroke up the lateral side of the sole & across the ball of the foot to just below the great toe. Plantar flexion of the toes, normal response. Negative Babinski sign.
Slide 45-

Meningeal Irritation Nuchal rigidity Severe pain, spasms and resistance with gentle neck flexion Kernig’s sign Thigh on abdomen, knee flexed to 90 degrees, resistance with pain Brudzinski’s sign Chin to chest – involuntary hip flexion and pain
Slide 46-

Neurosurgery Considerations Assess for increased intracranial pressure (ICP) Level of consciousness (LOC) Motor function Pupillary response Vital signs Following an ICU stay of several days, client will normally be confused about the date.
Slide 47-

Newborn Considerations Myelin is needed to conduct the impulses and the neurons of a newborn are not completely myelinated. Several unique reflexes that extinguish at different times during infancy. High-pitched, shrill cry (cat-like screech) occurs with CNS damage. Lethargy, hyporeactivity, hyperirritability and parent’s report of significant change in behavior – referral and further testing. Denver II – newborn to 6 yr (personal, fine motor, language, gross motor)
Slide 48-

Newborn Reflexes Rooting 3-4 months Sucking 10-12 months Palmar Grasp 3-4 months Plantar Grasp 8-10 months Moro 1-4 months Tonic neck appear 2-3 m, disappear 3-4 m Babinski 24 months Placing appears 4 days Stepping disappears before walking
Slide 49-

Plantar
Slide 50-

Moro Reflex
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Tonic Neck
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Babinski Positive Babinski reflex – normal with infant Abduction of the toes with dorsiflexion of the great toe
Slide 53-

Placing & Stepping Reflex
Slide 54-

Gerontological Variations Inc. risk for ischemic brain injuries Dec rate of nerve conduction Dec number of neurons (dec. total brain weight) Dec neurotransmitter amt. & production Sensory alterations (dec. vision/hearing) Cognitive changes (dec. memory, esp. short-term memory)
Slide 55-

Normal Findings after 65 General knowledge and abilities should be intact. Decreased ability to identify vibrations at ankle level. Decreased muscle tone in face and neck. Irregular shaped pupils. General loss of muscle bulk.