HA Neurological Quiz 4

Functional Assessment

A type of behavioral assessment used to determine functional relations between challenging behavior and environmental events

Hyporeflexia

Absence of reflex seen with LMN lesions (SC injury)

A person opens eyes to painful stimuli, withdraws hand from painful stimuli, and gives no verbal response

GCS: 7 Yes she has a coma

Spasticity

continuous resistance to stretching by a muscle due to abnormally increased tension, with increased deep tendon reflexes

Paralysis

decreased or loss of motor function due to problem with motor nerve or muscle fibers

Cerebellum

balance control and equilibrium

Senile tremors

benign and include head nodding (as if saying yes or no) and tongue protrusion

Athetosis

bizarre, slow, twisting, writhing movement, resembling a snake or worm

syncope

fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum ex: someone seeing blood and passing out

Biceps reflex

Normal response is the contraction of the biceps muscle and flexion of the forearm.

upper motor neurons

nerve located entirely within the central nervous system

motor function

The neuromuscular response to the sensory information Lift eyebrows, frown, bare teeth (CN VII facial nerve) Upper arm strength - bilateral hand grasps Cross your fingers Lower extremities Straight leg raises up to 900 Plantar flexion against resistance

pupillary response

changes in dilation of the pupils of the eyes associated with arousal the involuntary changing of size of the pupil

Concussion

collision or trauma causes violent shaking of brain, yielding behavioral changes but no changes on radiologic imaging

Glasgow Coma Scale: Motor Response

1 - no response 2- abnormal extension 3 - abnormal flexion 4 - flexion to pain 5 - moves to pain 6 - obeys commands

Glasgow Coma Scale: Eye Opening Response

4 spontaneously 3 to speech 2 to pain 1 no response

You are testing the DTRs of a 30-year-old woman. When striking the quadriceps reflex, you are unable to elicit a response. What is your next most appropriate action?

Ask the woman to lock her fingers and "pull."

The nurse is assessing a patient's neurologic status and finds that the patient is aware of his name but does not know the date or time of the day or where he is. How would the nurse best document this finding?

Awake, alert, and oriented times one

level of consciousness

Awake, alert, aware of stimuli, responds appropriately

Abdominal reflexes

Cause contraction of abdominal muscles and movement of the umbilicus in response to stroking of the skin Vary in intensity from one person to another Absent when corticospinal tract lesions are present

During an outpatient examination, you ask the person to stand with feet together, arms at sides, eyes closed, and hold position about 20 seconds. This text demonstrates intactness of:

Cerebellum

The nurse observes that a patient's gait is unsteady and assesses a positive Romberg sign. Which area of the brain is most likely affected?

Cerebellum

olfactory

Cranial nerve I, Sensory, Smell

Optic

Cranial nerve II, Sensory, Vision

Oculomotor

Cranial nerve III, Motor, Eye movement

Extiniction

Disappearance of the conditioned response.

A person opens his eyes spontaneously, obeys verbal commands, and has incomprehensible speech. What is his GCS? Is he in a coma?

GCS: 12 No he is not in a coma

An unconscious client with multiple injuries arrives in the emergency department. Which nursing intervention receives the highest priority?

Establishing an airway

Hyperreflexia

Exaggerated reflex seen with UMN lesions (stroke)

quadriceps reflex

Extension of the lower leg is the expected response

Romberg's sign

Falling to one side when standing with feet together and eyes closed, indicating abnormal cerebellar function or inner ear dysfunction

Achilles reflex

Foot plantar flexing againist your hand is the normal response

basal ganglia

Initiate and coordinate movement and control of automatic movement (ie. arm swinging with walking

Which of the following are correct examination techniques when testing the biceps reflex? Select all that apply.

Locate and place your thumb on the person's biceps tendon. With the reflex hammer, strike over the target in person's antecubital fossa.

Spinal cord

Long cylindrical structure of nervous tissue in upper two thirds of vertebral canal from medulla to lumbar vertebrae L1 to L2 Functions: ▪Connects brain to spinal nerves ▪Mediates reflexes of ▪Posture control ▪Urination ▪Pain response

Thalamus

Main relay station - sensory pathway where different areas of nervous system come together

Hypothalamus

Major respiratory center. Other basic functions: temperature, appetite, sex drive, heart rate, BP control, sleep center

Brainstem

Midbrain, pons, medulla Central core of brain vital functioning of respiration, heart, GI. Site of CN III-XII origination

During the assessment of a 4 week old infant, you note the response in this photo as you move your finger up lateral side of foot. What is your next action?

Move on with the examination; this is an expected response

pathologic reflexes

Only seen when there is a problem. 1. Babinski reflex: corticospinal problem. toes fan out 2. Suck: sucking motion when lips are touched 3. Snout: lips pursing 4. Palmar: grasp when Palm is stroked 5. Palmomental: face contracts when Palm is stroked *signifies progressive nervous system degeneration.

A fully alert normal person has a Glasgow Coma Scale of 15. Which assessments listed below contribute to the total score of the GCS? Check all that apply.

Person's eyes open spontaneously during the assessment. Person wiggles the fingers when asked to do so. Person is oriented to self, place, and time.

A patient has a tumor in the frontal lobe. What changes might be observed in this patient?

Personality changes

You test superficial reflexes on a 36-year-old woman. When you stroke up the lateral side of the sole and across the ball of the foot, you notice plantar flexion of the toes. How would you document this finding?

Plantar reflex present

In assessing a patient for increased intracranial pressure, what is the single most important factor to consider?

Pupillary response

A 21-year-old woman has a head injury secondary to a blow on the head and is unconscious. During your assessment, what are the expected findings when you test her deep tendon reflexes?

Reflexes will be normal.

Glasgow Coma Scale

Reliable & valid quantitative tool to measure to assess brain function ▪Gives LOC a numeric value (> objective) ▪Total score reflects brain's functional level §Scale divided into 3 areas: ▪Eye opening, verbal response, motor response ▪Each area rated separately # given for best response

vertigo

Rotational spinning caused by neuro disease in inner ear or brainstem

Mr. G. is a 54-year-old man with parkinsonism. Which description of his speech would contribute to the expected findings?

Slow, monotonous

During the neurologic exam, you place a key in the person's hand with their eyes closed and ask them to identify the object. This measures the ability of:

Stereognosis

sensory function

The ability of the nervous system to sense changes in either the internal or external environment

You are supervising a student caring for a 46-year-old man admitted to hospital with hypothermia following a boating accident. He was in the water 6 hours before rescue, wearing a floating device keeping his head out of water. You expect the student to know control of body temperature is located in:

The hypothalamus

nystagmus

back and forth oscillation of the eyes

During the examination of a 91-year-old woman, you note that the hands have a tremor as she reaches for her purse, and her head has a small yes-no nodding. There is no associated rigidity with movement. Which is your most accurate assessment?

These are expected findings due to aging.

cerebral cortex

Thought, reasoning, memory, sensation, voluntary movement

seizure

a sudden surge of electrical activity in the brain that affects how a person feels or acts for a short time time limited event caused by excessive hypersynchronus discharge or brian neurons

point localization

ability of the person to discriminate exactly where on the body the skin has been touched

Graphesthesia

ability to "read" a number by having it traced on the skin

two point discrimination

ability to distinguish the separation of two simultaneous pinpricks on the skin

Stereognosis

ability to recognize objects by feeling their form, size, and weight while the eyes are closed

paresthesia

abnormal sensation (burning, numbness, tingling, prickling, crawling skin sensation)

dizziness

altered sensation of orientation in space

decorticate rigidity

arms adducted and flexed, wrists and fingers flexed; legs extended, internally rotated, plantar-flexed

decerebrate rigidity

arms stiffly extended, adducted, internally rotated; legs stiffly extended, plantar-flexed

dysphasia

impairment in speech consisting of lack of coordination and inability to arrange words in their proper order

paraplegia

impairment or loss of motor and/or sensory function in the lower half of the body

Dysarthria

imperfect articulation of speech due to problems of muscular control resulting from central or peripheral nervous system damage

Ataxia

inability to perform coordinated movements

astereognosis

inability to recognize objects correctly

Tremor

involuntary contraction of opposing muscle groups resulting in rhythmic movement of one or more joints

triceps reflex

let the arm just go dead as you suspend it by holding the upper arm. Strike the triceps tendon directly just above the elbow. Forearm should extend

Agraphia

loss of ability to express thoughts in writing

Apraxia

loss of ability to perform purposeful movements in the absence of sensory or motor damage (ex: inability to use objects correctly)

Agnosia

loss of ability to recognize importance of sensory impressions

Dysphasia/Aphasia

loss of ability to understand or express speech, writing, or signs, or loss of comprehension of spoken or written language

Amnesia

loss of memory

hemiplegia

loss of motor power (paralysis) on one side of the body, usually caused by a stroke; paralysis occurs on side opposite the lesion

Flaccidity

loss of muscle tone, limp

Analgesia

loss of pain sensation

anesthesia

loss of touch sensation

Neurological Assessment

mental status, cranial nerves, motor system, cerebellar (balances/coordination), sensory system, reflexes

lower motor neurons

motor neuron in the peripheral nervous system with its nerve fiber extending out to the muscle and only its cell body in the central nervous system

deep tendon reflexes

muscle contraction in response to a stretch caused by striking the muscle tendon with a reflex hammer. test used to determine if muscles are responding properly ex: knee jerk Grade on 4-Point Scale §4+ Very brisk §3+ Brisker than average ▪May indicate disease §2+ Average, normal §1+ Diminished, normal §0 No response

Glasgow Coma Scale: Verbal Response

oriented x3 5 confused 4 inappropriate words 3 incomprehensible sounds 2 none 1

Opisthotonos

prolonged arching of back, with head and heels bent backward, and meningeal irritation

Fasciculation

rapid continuous twitching of resting muscle without movement of limb

myoclonus

rapid sudden jerk of a muscle

Clonus

rapidly alternating involuntary contraction and relaxation of a muscle in response to sudden stretch

infantile automatisms

reflexes that have a predictable timetable of appearance and departure -moro reflexes (1-4 months) -Stepping reflexes (disappears before walking) -rooting reflexes -sucking reflexes -plantar reflexes/babinski sign

dyskinesia

repetitive stereotyped movements in the jaw, lips, or tongue that may accompany senile tremors

Tic

repetitive twitching of a muscle group at inappropriate times (winking and grimacing)

Proprioception

sensory information concerning body movements and position of the body in space

tremor

shaking; rhythmic muscular movement

Coma

state of profound unconsciousness from which person cannot be aroused

nuchal rigidity

stiffness in cervical neck area

Chorea

sudden, rapid, jerky, purposeless movement involving limbs, trunk, or face

intracranial pressure

the amount of pressure inside the skull Occurs during Stroke Head Injury Meningitis Hypertensive hemorrhage Brain tumor Signs/symptoms Change in LOC (most important) Headache, lethargy, vomiting, behavior change, eye movement, visual disturbances, unequal pupils.

Medulla

the base of the brainstem; controls heartbeat and breathing

atrophy

to waste away (gets smaller)

cremasteric reflex

upward pull of testicles and scrotum due to touch

Glasgow Coma Scale scores

§Score 15 → fully alert, normal person §Score 7 or < → coma