neurological
Terms
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- changes in level of consciousness (LOC)
- blacking out (unaware of your surroundings)
- pupillary constriction and accommodation
- PERRLA - CN III
- abstract reasoning
- difficult because of cultural, developmental, and generational differences - give them a proverb or situation and have them tell you what it means to them (interpretation) - "The early bird gets the worm"
- assess mouth for taste
- anterior (front) of tongue, facial nerve - posterior tongue, glossopharyngeal
- kinesthetic sensation
- have pt close their eyes, grasp their finger and ask them to tell you if you are moving it up, down, or holding it in the normal position
- dizziness
- feel like you can't keep your balance, faint, presyncope - if it progresses you will pass out (syncope)
- assess gag reflex
- CN IX - soft palate will rise on "ah" - swab to posterior pharynx, pt will gag - assess swallow before gag reflex
- remote memory
- over 24 hrs ago - where married - what high school
- coordination
- repeatative movement - run heel down shin, finger to thumb or finger to nose rapidly
- altered sensation
- numbness or tingling that comes and goes - common in MS, strokes, diabetes (peripheral neuropathy)
- orientation
- time, place, and person (x3) - normal for person in hospital/nursing home to lose track of time
- cognitive abilities
- ability to think
- dysphagia
- problems swallowing or gulping (gastric) - solids or liquids - sometimes drooling
- assess mouth and tongue movement
- CN XII - stick out tongue, side to side, touch to cheek
- shoulder and neck muscles
- CN XI - shrug shoulders against resistance - chin to the left and right
- glasgow coma scale
- level of conciousness with 15 point scale assessing 3 areas - graded by assessing best response
- tremors at rest
- Parkinsons disease
- face sensation and movement
- CN V - splits into different branches - opthalmic, maxillary, and mandibular - controls ability to detect sensation
- corneal reflex
- CN V and VII - cotton to cornea - causes pt to blink
- vibration with tuning fork
- place over a boney prominance - pt to say when they felt vibration and when it stops
- recent memory
- 24 hrs or less - eat for breakfast - do yesterday
- graphesthesia
- distinguishing between feeling and interpruting - with eyes closedtrace a letter or number on pt palm or back - pt should be able to tell you what it is you traced
- rhomberg test
- assesses balance - have pt stand with feet together, then close their eyes - should be able to maintain their balance - be there to catch them in case they fall
- reflexes
- can strike directly or indirectly - muscle will contract and move in response to sensation - graded 0-4 - 2=N
- dyshpasia
- problems speaking - either problem understanding what is being said to you or others having trouble understanding you - usually a difficulty with finding (forming) the word
- vertigo
- the room is spinning around you or you are spinning
- assess nose for smell
- have pt close their eyes and place a familiar scent for them to identify - unable to smell or identify, could be congested - assess patency first - also may be due to cocaine abuse, chronic smoker, age, or hyposensitivity
- visual acuity and peripheral vision
- eye chart (visual acuity) and peripheral vision test - problems indicate lesions in the spinal cord
- aura
- warning sign that a seizure is about to happen - helps to figure out where in the brain it is occuring - can be auditory (ringing, buzzing), olfactory (sweet or sour smell), visual (flashing lights, colors), motor (twitching)
- sharp and dull sensation
- paper clip and cotton ball with eyes closed - tell where and if it is soft or sharp
- extraocular movement
- CN III, IV, and VI - control the muscles that move the eye in the 6 cardinal fields
- stereogenosis
- with eyes closed, give the pt a familiar object - should be able to tell you what it is
- babinski reflex
- should be -, if + (toes fan) could indicate neuro disease
- assess hearing
- CN VIII - cover one ear and whisper something, should be able to repeat 50% - can also use watch or rub fingers together
- trigeminal neuralgia
- nerve irritated - pain radiating down nerve - nerve may never come back
- judgement
- determine safety and pt competence - give a hypothetical situation - if you smelled gas in your house, what would you do?