neurological 1
TRANSCRIPT
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Neurologic System
Chapter 23
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Structure and Function
Subjective Data—Health History Questions
Objective Data—The Physical Exam
Abnormal Findings
Chapter 23
Neurologic System
Slide 23-1
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Structure and Function
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
Chapter 23
Neurologic System
Slide 23-2
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Structure and Function, cont.
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
Chapter 23
Neurologic System
Slide 23-3
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 23
Neurologic System
Structure and Function, cont.
Peripheral Nervous System
Cranial nerves
Spinal nerves
Autonomic nervous system
Reflex arc
Slide 23-4
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Subjective Data—Health History Questions
Headache
Head injury
Dizziness/vertigo
Seizures
Tremors
Weakness
Incoordination
Numbness or tingling
Difficulty swallowing
Difficulty speaking
Significant past history
Environmental/occupational hazards
Chapter 23
Neurologic System
Slide 23-5
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 23
Neurologic System
Objective Data—The Physical Exam
Preparation– Screening neurologic examination– Complete neurologic examination– Neurologic recheck
Equipment needed– Penlight– Tongue blade– Cotton swab– Cotton ball– Tuning fork (128 Hz or 256 Hz)– Percussion hammer– Occasionally need: familiar aromatic substance
Slide 23-6
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Objective Data—The Physical Exam, cont.
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—HypoglossalSlide 23-7
Chapter 23
Neurologic System
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Objective Data—The Physical Exam, cont.
Motor System—Inspect and Palpate
Muscles– Size– Strength – Tone– Involuntary movements
Cerebellar function– Balance tests
• Gait• Tandem walking• Romberg test• Shallow knee bend
– Coordination and skilled movements• Rapid alternating movements (RAM) • Finger-to-finger test• Finger-to-nose test • Heel-to-shin test Slide 23-8
Chapter 23
Neurologic System
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Objective Data—The Physical Exam, cont.
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 23-9
Chapter 23
Neurologic System
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
•StereognosisGraphesthesia
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Objective Data—The Physical Exam, cont.
Test the stretch or deep tendon reflexes (DTRs)– 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 23-10
Chapter 23
Neurologic System
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
–Biceps reflex
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Triceps reflex
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Brachioradialis reflex
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Let the Lower Legs Dangle Freely to Flex the Knee and Stretch the Tendons. Strike the Tendon Directly Just Below the Patella.
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Achilles reflex (“ankle jerk”)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Test the reflexes
Copare right and left
The response should be equal
4+ Very brisk, hyperactive with clonus (short jerking contraction of the same muscle), indicative of disease
3+ Brisker than average, may indicate disease
2+ average, normal
1+ diminished, low normal
0 no response
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 23
Neurologic System
Objective Data—The Physical Exam, cont.
Neurologic recheck
Level of consciousness– Person– Place– Time
Motor function
Pupillary response
Vital signs
Glasgow coma scale (GCS)
Slide 23-11
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Fully alert- 15, a score of 7 or less reflects coma. (Kozier p. 703-704)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Decorticate Rigidity (abnormal flexion)
Decerebrate Rigidity (abnormal rigidity)
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Paralysis• Loss or impairment of the ability to
move a body part, usually as a result of damage to its nerve supply.
• Loss of sensation over a region of the body. Hemiplegia• paralysis of one side of the bodyParaplegia• paralysis of both lower limbs due
to spinal disease or injury Quadriplegia• paralysis of all four limbs or of
the entire body below the neck Paresis• partial motor paralysis
Abnormal FindingsAbnormalities in Muscle Movement
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
FasciculationsRapid, continuous twitching of resting muscle
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
TicRepetitive twiching of a muscle group
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
MyoclonusRapid, sudden jerk at a fairly regular intervals
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
TremorInvoluntary contraction of opposing muscle groups
•Rest tremor•Intention tremor
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
ChoreaSudden, rapid, jerky, purposeless movement involving limbs, trunk, or face
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Athetosis
Slow, twisting, writhing, contiuous movement, resembling a snake or worm
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 23
Neurologic System
Abnormal FindingsAbnormal Gaits
Spastic hemiparesis
Cerebellar ataxia
Parkinsonian (festinating)
Scissors
Steppage or footdrop
Waddling
Short leg
Slide 23-13
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 23
Neurologic System
Abnormal FindingsCommon Patternsof Sensory Loss
Peripheral neuropathy
Individual nerves or roots
Spinal cord hemisection (Brown-Séquard syndrome)
Complete transection of spinal cord
Thalamus
Cortex
Slide 23-14
Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.Copyright © 2003, Elsevier Science (USA). All rights reserved.
Chapter 23
Neurologic System
Abnormal FindingsAbnormal Postures
Decorticate rigidity
Decerebrate rigidity
Flaccid quadriplegia
Opisthotonos
Slide 23-15