HPI seizures
did you fall, shrill cry, motor activity, loss of consciousness, chewing or lip smacking, post-ictal
HPI pain
sudden or progressive,
... [Show More] deep aching, throb or stabbing, where is pain, radiate
HPI gait coordination
lose balance, fall forward\backward, feel stiff, legs give way
HPI weakness parathesia
sudden onset, with activity, tingling, numbness or confusion, chronic illness, medications like zidovudien or chemotherapy
CNI
test the patient's ability to identify familiar odors, such as coffee & mint extract, one naris at a time with the eyes closed
CNII
test visual acuity and the visual fields
CNIII, IV, VI
assess the 6 cardinal points of gaze; inspect eyelids for drooping; & observe pupils for equality of size, shape, & reaction to light & accommodation
Headaches -severe unremitting
evaluate movement of the eyes for the presence or absence of lateral (temporal) gaze. The 6th cranial nerve is commonly one of the first to lose function in the presence of increased intracranial pressure.
legal blindness
Vision not correctable to better than 20/200
CNV
four assessments:
1. inspect face for muscle atrophy, jaw deviation, & tremors.
2. palpate clenched jaw muscles for tone & strength.
3. test superficial pain & touch sensations in each branch of the nerve.
4. test the corneal reflex
CNVII
observe for facial symmetry while the pt makes a series of facial expressions. test taste on sides of the tongue
signs of muscle weakness
Drooping of one side of the mouth, a flattened nasolabial fold, & a sagging lower eyelid for CNVII
CNVIII
test the sense of hearing & bone & air conduction of sound & note sound lateralization
CNIX
tastes on the posterior 3rd of the tongue. eval of the vagus nerve for nasopharyngeal sensation (gag reflex) & the motor function of swallowing
CNX
inspect the palate & uvula for symmetry with speech sounds. Check gag reflex & ability to swallow; say AH
CNXI
evaluate the size, shape & strength of the trapezius & sternocleidomastoid muscles; shrug
CNXII
4 assessments:
1. inspect tongue
2. movement side to side nose to chin
3. tongue against cheek; pressing
4. say l, t, d, n
evaluate proprioception & cerebellar function
rapid rhythmic alternating movements; slowed nonrhythmic, or jerky clonic movements are unexpected
types of movements for proprioception
finger-to-finger test, finger-to-nose test, & heel-to-shin test on both sides of the body
Romberg test
patient stand with the eyes closed, feet together, & arms at the sides (also seen with arms out)
stereognosis
hand the pt a familiar object, such as a coin or key
graphesthesia
tracing a letter, number, or shape on the palm of the hand
pronator drift
push arms down & observe rebound; strong rebound = ok
primary sensory functions
superficial touch & pain; temp, vibration on joints, joint position
cortical sensory functions
stereognosis, 2 pt discriminication, extinction phenomenon, graphesthesia, point location
superficial reflexes
abdominal, cremasteric & plantar reflexes
Babinski reflex
plantar flexion of all toes
deep tendon reflexes
biceps, triceps, brachioradial, patellar, achilles, ankle clonus
protective sensation
5.07 monofilament for neuropathy
meningeal signs
checking for a stiff neck with the supine patient's head raised & by eliciting Brudzinski sign & Kernig sign
patellar deep tendon reflex
spinal segments L2, L3, & L4
Autonomic dysreflexia
severe HTN caused by dysregulation of sympathetic & parasympathetic nervous systems reacting to a noxious stimulus (tight; foley) below the site of spinal injury
Autonomic dysreflexia other sx
bradycardia, anxiety, blurred vision, headache, flushing, & sweating.
cerebellum
smooth & accurate coordination of voluntary movements
What are the abnormal findings when testing Cranial nerve I (olfactory)?
inability to perceive an odor on either side, anosnia (loss of smell), & the inability to discriminate odors.
What are the abnormal findings when testing Cranial nerve II (optic)?
abnormal fundi exam with opthalmoscope & problems with distant or near vision.
What are the abnormal findings when testing cranial nerve III, IV, & VI?
abnormal pupillary response, drooping eyelid, abnormal extraocular movements, problems with consensual pupillary response.
What are the abnormal findings when testing cranial nerve V (trigeminal)?
facial atrophy, facial tremors, decreased tone & strength in the jaw, inability to discern pain in each branch or touch, absent corneal reflex.
What are the abnormal findings when testing cranial nerve VII (facial)?
asymmetrical facial features, inability to taste salty or sweet.
What are the abnormal findings when testing cranial nerve VIII (acoustic)?
bone or air conduction hearing deficit, lateralization of sound with Weber test, inability to hear whispers.
What are the abnormal findings when testing cranial nerve IX (glossopharyngeal), & X (vagus)?
Inability to taste sour or bitter on either side of the tongue, absent gag reflex, inability to swallow, asymmetry in uvula with speech, gutteral speech sounds.
What are the abnormal findings when testing cranial nerve XI (spinal accessory)?
cannot shrug shoulders against resistance, cannot turn head side to side against resistance.
What are the abnormal findings when testing cranial nerve XII (hypoglossal)?
protruded tongue is not symmetrical, tremors, atrophy. Tongue does not move up towards nose or down towards chin, test tongue strength with index finger when tongue is pressed against the cheek (weakness), evaluate lingual speech (l, t, d, n).
How do you evaluate proprioception?
through coordination, fine motor skills, and balance.
What are some proprioception coordination tests?
rapid rhythmic alternating movements such as thumb to fingers as quickly as possible , the finger-to-nose test, & the heel-to-skin test.
How is balance evaluated?
with the Romberg test, fast recovery of balance when shoved, eyes closed standing on one foot, hopping in place on one foot then the other.
What is the Romberg test?
ask patient (with eyes open then closed) to stand, feet together & arms at the side. Stand close, prepared to catch them. Loss of balance is a positive Romberg sign.
What does a positive Romberg sign mean?
indicates cerebellar ataxia, vestibular dysfunction or sensory loss.
What is the cerebellum responsible for?
voluntary movement, sensory information processing, reflexive control of muscle tone, balance, and posture to produce steady and precise movements.
What are possible differential diagnoses for abnormal cerebellar functioning?
cerebellar ataxia (cerebellitis) affects gait & balance. Can be caused by chicken pox, Epstein- Barr, & coxsackie viruses. [Show Less]