Essential barrier to provide the best environment for the neurons Certain substances can not enter or enter very slowly many medications are not able Hazards Neurological Disorders Blood Brain Barrier to pass this barrier Neurological Assessment Health History Current health symptoms Major illnesses medication Family history Psychosocial history Education Level of performance Personality or behavior changes Smoking drug use abuse Physical Examination Physical Examination Looking for abnormalities so understanding normal is essential Vitals Mental status Head neck back Cranial nerves Motor function Sensory function Reflexes Initial Physical Examination Level of Consciousness Glasgow Coma Scale 1 15 used for unconscious states Best Eye Opening Best Motor Response how to elicit Best Verbal Response Orientation What year is this Memory Family or home Affect mood Communication Judgment Neuro Checks in Acute Care Will depend on level of injury LOC orientation X4 The most important indicator of neurologic function Vital signs Pupils PERLA Muscle strength movement against resistance Sensory assessment dull v sharp Head Neck Back Inspect head for size shape lesions eye position drainage Wounds asymmetry Palpate head neck back for lesions fractures pain Percuss gently over spine for pain Auscultate for carotid bruit Cranial Nerve Assessment Cranial Nerves Olfactory smell Optic visual acuity peripheral vision eye position Occulomotor trochlear abducens shape size of pupils nystagmus reaction to light accommodation Trigeminal face sensation chewing jaw muscles Facial taste frown smile eyebrow movement corneal reflex Cranial Nerves continued Acoustic whisper test watch tick Glossopharyngeal gag say ah Vagus check voice for hoarseness swallow reflex Spinal accessory shrug shoulders turn head move head against resistance Hypoglossal deviation of tongue asymmetry How to Memorize Cranial Nerves Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Glossopharyngeal Vagus Spinal Accessory Hypoglossal O n Old Olympus Towering Tops A Fin And German Viewed Some Hops S ome Say Marry Money But My Bother Says Bad Business Marries Money S Sensory only M Motor only B Both Sensory and Motor Motor Assessment Muscle size Muscle strength 5 point scale 0 5 contraction movement absent 1 5 trace of contraction 2 5 movement with gravity only 3 5 movement against gravity 4 5 full ROM but with some weakness 5 5 Full ROM normal strength Motor Assessment continued Muscle tone Flaccid or spastic Tremors fasciculations Coordination Rapid alternating movement Point to point Truncal balance sitting standing Gait proprioception sense of body position Types of Gait Disturbances Ataxic staggering Dystonic irregular poor direction Dystrophic broad based waddling Equine high steps like a show horse Festinating on toes fast pace Hemiplegic one arm and leg swing wide with each step Parkinsonian short shuffling leaning forward Scissor steps slow short steps with legs crossing Steppage foot and toes high foot slaps down similar to equine Sensory Assessment Touch vibration pain proprioception discrimination sharp dull Hearing vision smell taste Test with eyes closed Always compare sides Think about the dermatomes Sensory Assessment Terms Stereognosis ability to feel a familiar object without looking Absence is astereognosis Graphesthesia ability to recognize a written symbol agraphesthesia Extinction simultaneous stimulation 2 point stimulation ability to differentiate 2 pin pricks from 1 Abnormal Sensations Paresthesia distorted sensation Light touch feels like burning pain Dysesthesia localized irritating sensation Prickly crawling Hypoesthesia reduced sensation Hyperesthesia abnormal excessive sensation Response to Painful Stimulation Localization push away source of pain Flexion withdrawal move s purpose Abnormal Flexion Decorticate posturing Response to Pain Abnormal Extension Decerebrate posturing No response flaccid Superficial Reflexes Corneal touch cornea Pharyngeal touch posterior pharynx with cotton tip applicator Abdominal stroke skin at umbilicus Plantar stroke sole of foot Deep Tendon Reflexes Causes the muscle to stretch Bicep jerk Tricep jerk Brachioradial jerk Knee jerk Ankle jerk Abnormal Reflexes Babinski Snout tap around mouth pursing Rooting stroke side of face mouth opens head turns toward stim Sucking touch lips lips tongue and jaw move forward Rooting sucking normal in infants abnormal in adults Diagnostic Testing for Neurologic System Skull Spine X ray fractures CT scan edema space occupying lesions intracranial bleeds If contrast used allergy to shellfish Important for traumas MRI cerebral infarction demyelinization Remove all metal Caution with aneurysm clips some orthopedic hardware More Neuro Tests PET positron emission tomography Blood flow to a specific area Adequacy of nutrients oxygen Mapping of receptors May require 4 hour fast Electorencephalogram EEG Central Neurologic Disorders Coma Sustained unconsciousness No response to verbal stimuli Varying response to painful stimuli No voluntary movement Often altered respirations Often altered pupil response No blinking Consciousness wakefulness PLUS aware of self surroundings Measures electrical activity in cortex For seizures assess for brain death Antidepressants tranquilizers stimulants should be avoided for 24 48 hours Causes of Coma Lesion putting pressure on brain stem especially the RAS Gunshot wound Auto accident or head trauma leading to bleeding tumors Symptoms generally unilateral Metabolic disorders which affect the brains supply of glucose or oxygen Hypoxia blood loss ischemia from cardiac condition diabetes Symptoms usually bilateral Lesion space occupying tumor abscess hematoma foreign body Nursing care in Coma Do not lay flat unattended Mouth care flat side lying with suction ready then reposition ROM q 1 hr Change position q 2 hr Watch for skin breakdown Glasgow Coma Scale Vitals q 4 hr resp B P HR means brain irritation likely from swelling Cerebral Vascular Accidents CVA Stroke Brain Attack Neurovascular deficit resulting in decreased blood flow to brain Ischemic Thrombus Embolus Hemorrhagic Neurologic deficit Determined by area or brain injured Risk Factors for CVA Hypertension DM Sickle Cell Anemia Substance Abuse Atherosclerosis Obesity Oral contraceptives Anything that can change the lumen of a blood vessel Atherosclerosis http www youtube com watch v fLonh7ZesKs Good review about the development of vascular