Aspects of

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Aspects of

• NEUROLOGICAL ASSESSMENT

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What comes to MIND when you think about
performing neurological checks?

• Does it scare you because you dont feel
  comfortable about it or trained well enough to
  perform? Maybe this study can make it a LESS
  impossible hurdle to achieve...

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Would you think of these aspects?

• Loss of motor function (clumsiness)
• Inability to swallow or chew. Frequent drooling.
• Behavior changes
• Dizziness, nausea, and vomiting
• Unusual facial expression

Woe...I was perfectly fine a minute ago!
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Neurological functioning includes

• 1. Gait evaluation and muscle tone/strength
• 2. L.O.C., Speech, and Memory
• 3. Emotional response
• 4. Spatial perception and body awareness
• 5. The Senses
• 6. Observation for seizure/involuntary tremors
• 7. Headaches
• 8. Intellect/Cognitive performance
• 9. Assessment of potential head injury

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I. Evaluation for gait and...

• Smooth and coordinated movement
• Balance equilibrium
• Muscle tone
• Sustained posture What section of
  the brain is responsible for all of the above
  functioning?

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Muscle tone

• When performing passive range of motion, normal
  muscle tone would demonstrate by slight
  resistance. Flaccid would be a term to describe
  no tone.

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The neurotransmitter Dopamine

• Affects motor functioning
• A deficiency creates involuntary
  tremors/trembling in an individual with
  symptomatic Parkinsons Disease

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Romberg Testing

• A Quick Check for Normal Balance Stand still
  with your feet close together, hands at your
  side, eyes closed. A minimal amount
  of swaying is normal, but to lose your balance by
  stepping away is not.

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Ataxia - Whats that?

• So often this word is described as a side-effect
  of medications.
• Is it a sign of impairment?

With six legs, how could I NOT be the walking
impaired!
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Oh, yes!

• Ataxia - the impaired ability to coordinate
  movement such as being observed as a slowing in
  motion or drunken staggering gait.

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Cerebral Functioningcould it be responsible
for???

• States of awareness degree of consciousness
• Ability to think
• Memory short and long term

• Sensations
• Emotions
• Willed movement

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II. L.O.C., Speech, and Memories

• I dont recall being incoherent, delirious, and
  without a STATE of awareness! BUT if you say
  its so, Ill deal with it

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How will the disoriented act?

• Thats open for interpretation!
• Generally though, someone with poor memory
  recall, inability to think clearly, and impaired
  judgment and perception fits the description
  What have you observed in disoriented behavior of
  a patient?

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Becoming delirious from a high fever alters a
state of awareness

• and can be considered a MAJOR distortion of
  cerebral functioning!

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III. Emotional Status A persons state of mind!

• Affect - Described as the outward manifestation
  (appearance) of a persons feelings or emotions
  such as happy, sad, or flat.

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IV. Spatial Perception Body Awareness

• Could my proprioception be any
  sharper? Thanks to my cerebral parietal
  lobe!

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Abnormal Finding Unilateral Neglect

• A condition in which an individual is
  perceptually unaware of and/or inattentive to one
  side of their body.
• From a nursing aspect, keep in mind that one of
  their own extremities may frighten the client due
  to restrictions of their visual and perceptual
  fields!

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V. Evaluate my SPECIAL senses

• Im just a tactile kind of guy who can in- vision
  my sensory neuron pathways going CRAZY over your
  heart!

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Unique sensory choices

• D. DULL/SHARP sensations
• E. OLFACTORY (pleasant smells vs. you know!)

• A. EQUALITY
• B. ACOUSTIC VIBRATION
• C. BITTER or SWEET tastes

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Temporal lobe

• Memory storage and integration of auditory
  stimuli
• Occipital lobe contains the visual area for
  interpreting impulses from the retina
  and understanding of the written word.

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VI. Observation for seizures or involuntary
tremors
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VII. Severe reoccurring headaches

• Those that wake you from a sound sleep can be
  especially troubling OR
• Vascular-types Migraine Cluster

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VIII. Intellect Cognitive Performance
Components

• Visual perception
• Attention span/orientation
• Following directions
• Functional communication

• Problem solving
• Memory recall
• Judgment
• Sequencing Often evaluated by O.T.

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Question in point

• Which of the following would you guess NOT to be
  a sign of neurological deficit? A. Posturing
  (rigidity) B. Sleeping during lecture C.
  Low pulse, high systolic BP D. Ataxic
  behavior E. A positive Babinski sign

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From the specialists perspective

• What is the purpose of performing a neuro-logical
  examination?

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To localize a pathological condition whether it be

• INFECTIOUS OR DEGENERATIVE DISORDER
• TRAUMA INDUCED

• CEREBRAL EDEMA
• INTRACRANIAL HEMORRHAGE
• TUMOR

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Then Identify and Treat...

• for the underlying cause which isnt always an
  easy task.
• The physician depends on the nurses ability to
  assess and record accurately any changes in the
  patients neuro status.

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Standardized tools of assessment

• What is the name of the neurological test that
  checks for best motor/speech/pupil response?

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Glasgow Coma Scale!

• Quizzing the mind??? What is a nurse
  documenting when staggering or shuffling
  is described? What evaluation is describing
  slurred or slowed response to questioning?
  Memory Recall What three beasts of the
  earth were shown in this slide presentation so
  far?

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Rate your own awareness

• A. State of stupor
• B. Semi-comatose
• C. Delirious
• D. Totally brilliant
• E. Agitated at this point of
  the presentation!

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Are you or someone you love acting sad with
feelings of hopelessness?

• Its important that the nurse is observant for
  symptoms of clinical depression. What signs
  should we be looking for?

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The neurotransmitter Serotonin

• Medications that treat depression inhibit (block)
  the uptake of serotonin altering the brain
  chemistry.
• Dopamine induces sleep patterns, affects sensory
  perceptions, and controls moods of an individual.

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Angiogram or MRI

• Used to diagnose the following 1. cerebral
  aneurysms 2. displacement of vessels by
  tumors or other masses 3. to visualize the
  cerebral arterial system

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Closed Head Injury (CHI)

• During track and field practice, Tom was
  traumatized by a blow to his frontal skull by a
  shot put coming in his direct path. He sustained
  a serious frontal fx. after being diagnosed in
  the ER. He will need to be observed very closely
  the next few days for signs of increased
  intracranial pressure. He was admitted to ICU.

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First, a look at frontal, cerebral lobe
functioning

• Written and Motor Speech affected
  
• Directs R L movements of the body, i.e. right
  brain function controls the left side of the body.

• The ability to form concepts, to think - your
  intellect Judgment formation -
  Does it make sense that you might not be able to
  joke with Tom or use abstracts like its raining
  cats dogs!

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Toms personality is strange, its like hes
someone else

• This statement was made by his dad within three
  hours of being admitted to the ICU unit. Often,
  because I.I.P. can occur suddenly and progress
  rapidly, a nurse must be trained to interpret and
  accurately recognize early signs of danger.
• Its not unusual for Tom to become suddenly
  irritable and restless! A subtle change of
  L.O.C. is being observed caused by cerebral
  swelling.

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Toms conscious, but has a throbbing headache

• Look for some of these early I.I.P. signs
  diplopia nausea headaches
  L.O.C. changes to disorientation,
  restlessness, or lethargy.
  Beginning pupillary changes

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Pupils are controlled by cranial nerve III
(oculomotor)

• Signs of impending brain herniation
  Inequality, of pupil size, and being incapable of
  constricting is another sign. Dilating
  pupils that respond slowly to light. A pupil
  that is fixed and fully dilated is sometimes
  called a blown pupil.

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I.I.P - Later developing signs

• Ischemia pressure build in the vasomotor center
  causing awidening pulse pressure (increased
  systolic BP and declining diastolic) PLUS
  bradycardia Cushings response

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And, more late-stage results

• Irregular and unpredictable breathing such as
  Cheyne-Stokes, snore-like, or ataxic.
• Hyperthermia, hyper-reflexia, rigidity
  (posturing), seizures, vomiting, singultus
  (hiccups), and a Babinski are also ominous
  signs of BRAINSTEM HERNIATION AND MOTOR NEURON
  DAMAGE.

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Diencephalon functioning...

• The thalamus relays sensory impulses of pain,
  temperature and touch to the cortex, and
  associates sensations with emotions whether
  pleasant or not.
• The hypothalamus controls temperature regulation,
  respiration, blood pressure, and emotional
  statesfears, anger, sexual arousal, and pain.

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The Brain Stem

• Consists of the midbrain, pons, and medulla
  oblongata. All three parts of the brain stem
  perform as a two way conduction path similar to
  how telephone wires send messages.
• The medulla oblongata contains the control
  functioning for vomiting, vasomotor (BP),
  respiratory, and cardiac centers.

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Given the opportunity, my brain could shut down
right now - Bye!
See you on the flip side!