Professional Documents
Culture Documents
ASSESSMENT
Assessment
Review of systems
Dizziness, headaches, vision changes,
sensitivity to light, auditory changes, sinus
infections, difficulty swallowing, hoarseness,
slurred speech, sinusitis, infection
Pertinent medical history:
Family history
Surgical history
Social history
Medications
Subjective Data
Mental Status
Assess level of consciousness (LOC).
Glasgow Coma Scale
Score of 15= fully awake & alert.
Score of 8 or less= is associated with coma.
Score of 3= completely unresponsive patient.
Motor System
Strength.
Coordination.
Command.
Pupillary changes.
Changes in vital signs.
Late findings in neurological deterioration.
COMPONENTS OF
NEUROLOGICAL ASSESSMENT
1.
2.
3.
4.
5.
6.
Mental Status
Level of Consciousness
Reflexes
Motor Functions
Sensory Functions
Cranial Nerves
I. Mental Status:
a.
b.
c.
d.
e.
NEUROLOGICAL ASSESSMENT
A. Language
Aphasia inability to express oneself by
speech, writing or comprehend spoken or
written language due to disease of
cerebral cortex
Two Categories:
1. Sensory or receptive aphasia
2. Motor or expressive aphasia
NEUROLOGICAL ASSESSMENT
1.
Sensory/receptive aphasia
- loss of ability to comprehend written or
spoken words
Two types:
a. Auditory aphasia unable to understand
symbolic content associated with sounds
b. Visual aphasia unable to understand printed
or written figures
NEUROLOGICAL ASSESSMENT
2. Motor/ expressive aphasia
- loss of power to express oneself by writing,
making signs or speaking
How to assess language deficits:
Point to common objects and name them
Read some words and match printed and written
words with pictures
Respond to verbal/written commands
NEUROLOGICAL ASSESSMENT
Speech Patterns:
- pace, clarity, spontaneity
Abnormalities:
a. Perseveration
- repeating the same response as different
questions are asked
b. Paraphasia
- speech appropriately expressed but contains
incorrect words
NEUROLOGICAL ASSESSMENT
B. Orientation 3 spheres (person, time & place)
C. Memory
- Listen for lapses of memory
- If problems are present:
Three categories of memory:
1. Immediate recall
N: can repeat series of 5 8 digits in sequence
and 4 6 digits in reverse order
NEUROLOGICAL ASSESSMENT
C. Memory
2. Recent memory
- Ask to recall the events of the day
- Recall information given early in the
interview
- Provide 3 facts to recall (color, object,
address), then ask later
NEUROLOGICAL ASSESSMENT
C. Memory
3. Remote memory
- Previous illness or surgery (years ago), birthday,
anniversary
D. Attention Span
- Tests the ability to concentrate
(alphabet, count backward from 100)
NEUROLOGICAL ASSESSMENT
E. Calculation
- Serial seven or serial three test
N: can complete serial seven in 90 seconds
with 3 or less errors
Olfactory
Optic
Oculomotor
Trochlear
Trigeminal
Abducens
Facial
Vestibulocochlear/Acoustic
Glossopharyngeal
Vagus
Spinal Accessory
Hypoglossal
CN I-Olfactory
- Smell
CN II-Optic
- Visual acuity
CN III-Oculomotor
- Pupil response
CN IV-Trochlear) - Downward, inward eye movement
CN V-Trigeminal
- Jaw opening, chewing
CN VI-Abducens - Lateral Eye movement
CN VII-Facial
- Facial expression, close jaw
CN VIII-Acoustic - Hearing
CN IX-Glossopharyngeal - Swallowing, gag reflex
CN X-Vagus
- Speech
CN XI-Spinal Accessory - Shrug shoulders
CN XII-Hypoglossal
- Tongue movement
NEUROLOGIC ASSESSMENT
Level of Consciousness
Ease of arousal
State of awareness
Orientation
Motor Function
Person
Place
Time
Squeeze hand, smile,
stick out tongue, raise
eyebrows
NEUROLOGIC ASSESSMENT
Pupillary Response
Size
Shape
Symmetry of pupils
Document degree of
constriction to light
5/4
Score
4
3
2
1
Score
6
5
4
3
2
1
Score
5
4
3
2
1
Motor function
Motor strength and coordination:
Remembering.
Short-term: recall after 5 minutes.
Long-term: recall events of previous day.
Feeling (Affect).
Facial & body expression & mood.
Verbal description of affect.
Congruence of verbal, body indicators of mood.
Language.
Spontaneous speech, repetition, naming objects, writing, reading.
Thinking.
Orientation, information, knowledge of current events, calculations, problem solving.
Spatial Perception.
Copy drawings, demonstrate putting a coat, using a toothbrush; point out right
& left side.
Pupillary Changes:
Pupils are examined for size (best specified in
millimeters) and shape.
Anisocoria (unequal pupils).
The normal response to testing is
documented as PERRLA, or Pupils Equal,
Round, Reactive to Light and
Accommodation.
The assessment of pupillary response for
comatose patients is the same as for conscious
patients. Pupil reactivity to light, by direct and
consensual response, is easily obtained.
Pupillary Changes
Small Reactive: Metabolic &/ or
diencephalic dysfunction.
Dilated Fixed (unilateral): Blown,
dysfunction of CN III (Oculomotor).
Midposition, Fixed: Mid brain damage.
Large Fixed: Midbrain damage.
Temperature.
Very high hyperthermia due to CNS damage.
Hypothermia due to metabolic, pituitary & spinal cord injury.
Pulse.
Dysrhythmias.
Tachycardia as a result of increase ICP.
As ICP rises; Bradycardia occurs (terminal condition).
Assessment of Ocular
Movement
Oculovestebular Reflex
Continue.
Signs of Trauma:
BATTLES
RACCOONS EYE
- (periorbital edema and
bruising) suggests a
frontobasilar fracture.
Signs of Trauma:
Otorrhea
Kernigs sign
Brudzinksis sign