NURS2520 Health Assessment II

1. NURS2520Health Assessment II Neurological Assessment

2. Objective OneAssess the components of the basic neurological assessment

3. The brain is highly dependent on blood flow and a consistent supply of oxygen and glucose to maintain neuronal function. Any decrease can cause neuronal malfunction. Older adults tend to be vulnerable to cognitive dysfunction secondary to many causes, ranging from decreased blood pressure to infections. Thus, any acute change in cognitive functioning needs to be assessed for an underlying cause.

4. Neurological System • Functions through transmission of chemical and electrical signals between the body and the brain • Receives, processes, and sends out information • Controls and coordinates the functioning of all other systems in response to environment/surroundings • Involves cognition, emotion, memory, sensation and perception, and regulation of homeostasis • Comprised of the central nervous system (CNS) and the peripheral nervous system (PNS) • CNS = Brain and spinal cord • PNS = Cranial and spinal nerves

6. Two neurons with synapse (from MyNursingLab)

7. The PNS • includes nerves emerging from the brain (cranial nerves) and nerves emerging from the spinal cord (spinal nerves). • These nerves are divided into sensory nerves that conduct messages from various parts of the body to the CNS, whilst motor nerves conduct impulses from the CNS to muscles and glands. • is further divided into the Somatic System (SNS) and Autonomic System (ANS), depending on the area of the body these messages are transmitted to and from.

8. The SNS • consists of sensory neurons from the head, body wall, extremities, and motor neurons to skeletal muscle. • The motor responses are under conscious control and therefore the SNS is voluntary. • Certain peripheral nerves perform specialized functions and form the autonomic nervous system; they control various activities that occur automatically or involuntarily such as the contraction of smooth muscle in the walls of the digestive system. • The autonomic system is further divided into the sympathetic and parasympathetic systems. These two systems provide nerve stimuli to the same organs throughout the body, but bring about different effects. • The balance between these two systems is controlled to create a state of homeostasis that is where the internal stability of the bodily systems are maintained in response to the external environment

9. Parasympathetic Nervous System • slows down the body • helps prepare for a more relaxed state, ready for digestion and sleep. • It will therefore increase peristalsis of the alimentary canal, slow down the heart rate, and constrict the bronchioles in the lungs. .

10. The Sympathetic Nervous System • helps prepare the body for "fight or flight" and create conditions in the tissues for physical activity. • is stimulated by strong emotions such as anger and excitement and will therefore speed up heart rate, increase the activity of sweat glands, adrenal glands, and decrease those of the digestive system. • also produces rapid redistribution of blood between the skin and skeletal muscles.

12. Brain and spinal cord (from MyNursingLab)

14. Age-Related Considerations • Birth reflexes include rooting, sucking, palmar grasp, tonic neck reflex, and Moro • Disappear during infancy • May return w/stroke or trauma • Denver Developmental Screening Test II (DDST) used to screen young children • Neurons decrease over lifetime, resulting in slowed reaction time, problem-solving skills, and voluntary movement • Decreases in intelligence and memory not normal in the elderly, and indicate a neurological deficit • Medication effects, dehydration, Alzheimer’s dementia, etc

15. Cerebral Function • Level of consciousness (LOC) • Arousal (alert, lethargic, stuporous, comatose) • Verbal stimuli • Tactile stimuli • Painful stimuli • Orientation (person, place, time) • Mental status and cognitive function • Behavior, appearance, response to external stimuli, speech, recent and remote memory, communication, judgment • Posture, gait, motor movements, dress, hygiene/grooming, mood, affect, facial expression • Consider language/education/culture during neuro exam

16. Glasgow Coma Scale

17. Objective TwoDemonstrate the proper technique for the assessment of reflex activity

18. Reflex Function • Deep tendon reflex is tested with a rubber percussion hammer to tap a slightly stretched muscle • Normal response = muscle contraction • Response grading scale: • 0 = No response detected • +1 = Diminished response • +2 = Response normal • +3 = Response somewhat stronger than normal • +4 = Response hyperactive with clonus • Clonus refers to involuntary continuous contractions of a muscle or group of muscles • Superficial reflexes are tested by lightly touching the body with the base of a reflex hammer or tongue blade, beginning with the most peripheral part of the limb • Graded as positive or negative • Determine sensory loss area by testing every 1-2 inches

19. Deep Tendon Reflexes: • http://www.youtube.com/watch?v=fymDY2q0FtE&feature=related

20. Objective ThreeDemonstrate the assessment techniques employed in the assessment of cranial nerves

21. Dorsal aspect of brain w/cranial nerves (from MyNursingLab)

22. Cranial Nerves

25. Neuro exam • Part 1 http://www.youtube.com/watch?v=nABAdENIbXY&feature=related • Part 2 http://www.youtube.com/watch?v=_1Rd1wVeqU4&feature=related

26. Objective FourDemonstrate the complete assessment of the neurological system(*Lab Practice)