Neuro checks and stroke

Memory

Immediate Past

Neurons

Individual cells in the nervous system that receive, integrate, and transmit information.

Cranial Nerve 2

Optic: Vision Test: check diagonal, vertical, and horizontal visual fields, Snellen test, ophthalmoscope, examine the ocular fundus to determine the color, size, and shape of the optic disk (Red Reflex).

Weber Test

Test done by placing the stem of a vibrating tuning fork on the midline of the head and having the patient indicate in which ear the tone can be heard.

Vertigo

a sense of whirling, dizziness, and the loss of balance, that is often combined with nausea and vomiting.

Syncope

fainting or sudden loss of consciousness caused by lack of blood supply to the cerebrum.

Homonymous hemianopsia

Hemianopsia is visual field loss on the left or right side of the vertical midline. It can affect one eye but usually affects both eyes. Homonymous hemianopsia is half visual field loss on the same side of both eyes. Homonymous hemianopsia occurs because the right half of the brain has visual pathways for the left hemifield of both eyes, and the left half of the brain has visual pathways for the right hemifield of both eyes. When one of these pathways is damaged, the corresponding visual field is lost.

Hemorragic: Subarachnoid

Higher in Women Warning: Headache (common) Onset: Activity (often), sudden onset, most commonly related to head trauma occurs when there is intracranial bleeding into the cerebrospinal fluid-filled space between the arachnoid and pia mater membranes on the surface of the brain. Subarachnoid hemorrhage is commonly caused by rupture of a cerebral aneurysm (congenital or acquired weakness and ballooning of vessels).

Cranial Nerve 12

Hypoglossal: Motor, moving tongue. Test: Request that the patient protrude their tongue and assess for midline protrusion. Ask the patient to say "light, tight, dynamite," and note that the sound of letters is clear and distinct. Also, place resistance on one side of the tongue with a tongue blade. Repeat this to the other side.

Babinski's Test

Normally, when the lateral aspect of the sole of the relaxed foot is stroked the great toe is flexed. If the toe extends instead of flexes and the other toes spread out the test is positive and would indicate upper motor (brain or spinal cord) involvement.

Cranial Nerve 3

Occulomotor: Eye movement, lifting lid, constricting pupil Test: nystagmis, Assess pupil response by testing constriction to direct and consensual light. Also test accommodation by moving a finger toward the eyes and observe pupil constriction and inward movement of the eyes.

Cranial Nerve 1

Olfactory: Smell Test: With the patient's eyes closed, check patency of both nostrils. Keep the eyes closed, assess for sense of smell in each nostril using coffee and/or cinnamon sticks.

Level of Awareness

Person Place Time and Situation

Stuporous

A state of impaired consciousness characterized by a marked diminution in the capacity to react to environmental stimuli.

Cranial Nerve 5

Trigeminal: Sensory, chewing, corneal refelex, ans sensation of jaw/lips Test: The nurse touches the face lightly with a cotton wisp, clench the jaw. The nurse palpates the muscles of the jaw and compares left to right in an awake patients.

Cranial Nerve 4

Troclear: Eye movement Occulomotor (3, 4 & 6)

Abstract Reasoning

Use proverb. A literal explanation or repeats the phrase means intellectual ability is impaired.

Cranial Nerve 6

Abducens: Moving Eyes Occulomotor (3, 4 & 6)

Cranial Nerve 8

Acoustic (Vestibulocochlear): Hearing and equilibrium Test: watch tick test or whisper test is used to assess the acoustic. Weber Test and Rinne test Vestibular: The caloric test is completed if the patient complains of vertigo or dizziness

Cranial Nerve 10

Vagus: Main Nerve of the Parasympathetic NS Works with C.N 9

Glasgow Coma Scale

Assessment tool used to determine consciousness in clients. The Score of 15 reveals a fully oriented person. Like to see better than 12, lowest score is 3. Consists of eye movement, motor and verbal response.

Language

Expressive and receptive aphasia

Cranial Nerve 7

Facial: Moving face and taste Test: Ask the patient to raise the eyebrows, close the eyes, purse the lips, smile and frown.

Cranial Nerve 9

Glossopharyngeal:Motor/sensory posterior oral (taste), pharyngeal cavities (uvula) Test: say "ah" and the nurse notes movement of the soft palate, test for sweet & sour tastes, gag reflex is tested in patients with a low level of consciousness.

Lethargy

a lowered level of consciousness marked by listlessness, drowsiness, and apathy.

Lacunar Stroke

a stroke resulting from occlusion of a small penetrating artery with development of a cavity in the place of the infarcted brain tissue.

Dysarthria

does not affect the meaning of communication or the comprehension of language, but it does affect the mechanics of speech.

The frontal lobe controls

higher cognitive function, memory retention, voluntary eye movements, voluntary motor movement, and speech in Broca's area. Broca's - nonfluent aphasia/understand but difficulty speaking

left brain damage

impaired speech/language aphasia aware of defects, depression impaired comprehension R/T language, math Respond well to nonverbal cues impaired right/left discrimination Slower in organization and performance of tasks cautious Impaired spatial discrimination Have fearful, anxious response to stroke

Comatose

in a state of deep and usually prolonged unconsciousness.

Finger to Finger Test

index finger to touch your finger then touch nose with eyes closed.

Right brain damage

left side neglect spatial perceptual defects ( cant recognize object, incorrect perception of self and illness, judging distance) denial or minimize problems Rapid performance, short attention span impaired time concepts Difficulty in judging position, distance, and movement Impulsive, impatient, and deny problems related to stroke Respond best to directions given verbally

Ischemic Stokes

results from inadequate blood flow to the brain from partial or complete occlusion of an artery. This type of stroke accounts for nearly 80% of strokes. Ischemic strokes are further divided into thrombotic and embolic strokes. A transient ischemic attack is usually a precursor to ischemic stroke.

The temporal lobe integrates

somatic, visual, and auditory data and contains Wernicke's speech area. Wernicke's - fluent aphasia/have great difficulty understanding speech and speak in long sentences with no meaning

Transient Ischemic Attack

temporary interruption in the blood supply to the brain

Aphasia occurs when a stroke damages

the dominant hemisphere of the brain

Autonomic Nervous System

the part of the peripheral nervous system that controls the glands and the muscles of the internal organs. Its sympathetic division arouses; its parasympathetic division calms.

Rinne Test

tuning fork is struck, placed on the mastoid process behind the ear, and held there until the client indicates the sound is no longer present

Ischemic: Thrombotic

Higher in Men Warning: TIA (30%-50% of cases) Onset: Often during or after sleep occurs from injury to a blood vessel wall and formation of a blood clot. The lumen of the blood vessel becomes narrowed and, if it becomes occluded, infarction occurs.

Ischemic: Embolic

Higher in Men Warning: TIA (uncommon) Onset: Lack of relationship to activity, sudden onset occurs when an embolus lodges in and occludes a cerebral artery, resulting in infarction and edema of the area supplied by the involved vessel. Embolism is the second most common cause of stroke, accounting for about 24% of strokes.1 Most emboli originate in the endocardial (inside) layer of the heart, with plaque breaking off from the endocardium and entering the circulation.

Hemorrhagic: Intracerebral

Higher in Women Warning: Headache (25% of cases) Onset: Activity (often) is bleeding within the brain caused by a rupture of a vessel and accounts for about 10% of all strokes. The prognosis of patients with intracerebral hemorrhage is poor; the 30-day mortality rate is 40% to 80%. Fifty percent of the deaths occur within the first 48 hours. Hypertension.

Nerve Impulse Transmission

Each neuron receives an impulse and must pass it on to the next neuron and make sure the correct impulse continues on its path. Through a chain of chemical events, the dendrites (part of a neuron) pick up an impulse that's shuttled through the axon and transmitted to the next neuron.

Cranial Nerve 11

Spinal Accessory:Head Shoulders and Neck Test: Ask the patient to shrug and apply pressure to the shoulders. Ask the patient to rotate the head forcibly against resistance applied to the side of the chin. These movements should feel equally strong on both sides.

Levels of Consciousness

Awake and Alert Lethargy Stuporous Comatose (Glasgow)

Expressive Aphasia

Cannot speak or write

Receptive Aphasia

Cannot understand written or spoken words