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