Denise Coffey MSN, RN. Central Nervous System (CNS) Cerebral cortex Frontal lobe Parietal lobe ...
-
Upload
iris-garrison -
Category
Documents
-
view
225 -
download
0
Transcript of Denise Coffey MSN, RN. Central Nervous System (CNS) Cerebral cortex Frontal lobe Parietal lobe ...
Central Nervous System (CNS) Cerebral cortex
Frontal lobe Parietal lobe Occipital lobe Wernicke’s area Broca’s area
Basal ganglia Thalamus
Hypothalamus Cerebellum Brainstem
Midbrain Pons Medulla
Spinal cord
Slide 23-2
Pathways of the CNS Crossed representation Sensory pathways
Spinothalamic tract Posterior (dorsal) column
Motor pathways Corticospinal or pyramidal tract Extrapyramidal tracts Cerebellar system
Upper motor neurons Lower motor neurons
Slide 23-3
Slide 23-5
[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]
© Pat Thomas, 2006.
Preparation Screening neurologic examination Complete neurologic examination Neurologic recheck
Equipment needed Penlight Tongue blade Cotton swab Cotton ball Tuning fork (128 or 256 Hz) Percussion hammer Occasionally need: familiar aromatic substance
Slide 23-8
Test Cranial Nerves I—Olfactory II—Optic III—Oculomotor,
IV—Trochlear, VI—Abducens
V—Trigeminal Motor function
Sensory function
Corneal reflex
VII—Facial Motor function Sensory function
VIII—Acoustic (vestibulocochlear)
IX—Glossopharyngeal, X—Vagus Motor function Sensory function
XI—Spinal accessory XII—Hypoglossal
Slide 23-9
Motor System—Inspect and palpate Muscles
Size Strength Tone Involuntary
movements
Cerebellar function Balance tests
Gait Tandem walking Romberg’s test Shallow knee bend
Coordination and skilled movements Rapid alternating movements Finger-to-finger test Finger-to-nose test Heel-to-shin test
Slide 23-11
Sensory System Person is alert,
cooperative, and comfortable
Guidelines for sensory testing
Spinothalamic tract Pain Temperature Light touch
Posterior column tract Vibration Position (kinesthesia) Tactile discrimination
(fine touch) Stereognosis Graphesthesia Two-point discrimination Extinction Point location
Slide 23-12
Test the stretch or deep tendon reflexes Technique Grading Reinforcement Biceps reflex Triceps reflex Brachioradialis reflex Quadriceps reflex Achilles reflex (“ankle
jerk”) Clonus
Test the superficial reflexes Abdominal reflex Cremasteric reflex Plantar reflex
Slide 23-13
Neurologic recheck Level of consciousness
Person Place Time
Motor function Pupillary response Vital signs Glasgow Coma Scale (GCS)
Slide 23-14
Oculomotor response (Cranial nerve III) Size, equality, and roundness of pupils
assessed Size measured in millimeters Evaluated for symmetry in size and
response to light stimulus Brisk, sluggish, non-reactive Consensual reaction of opposite pupil at
same time
Assess accommodation by holding finger 4-6 inches from client’s nose and then pull out to 18 inches.
As finger moves away pupil will accommodate by dilating, as finger moves closer, constricting
PEARLA- Pupils equal and reactive to light and accommodation
Ability to follow commands Muscle tone Muscle strength Coordination Balance (Romberg test) Posturing (Decorticate, Decerebrate)
Clear and appropriate Confused Inappropriate Garbled Aphasia (Expressive, Receptive) Limited hearing Use of hearing aids