Unformatted text preview: Chapter 23
NEUROLOGIC SYSTEM Neurologic System
Neurologic System Divided into 2 parts 1. CNS=Brain and spinal cord 2. Peripheral nervous system=12 cranial nerves and 31 pairs of spinal nerves and all their branches Central Nervous System
Central Nervous System Cerebral Cortex or gray matter is center for highest function
Governs thought, memory, reasoning, sensation, and voluntary movement.
2 Hemispheres: Right and Left
4 lobes: Frontal, Parietal, Temporal, and Occipital: Know the function of each of these lobes CNS
CNS Frontal lobe: Personality, behavior, emotions, and intellectual functions
Parietal: center for sensation
Occipital: visual reception
Temporal: Primary auditory reception
Wernicke’s: Language Broca’s: motor speech CNS
CNS Basal Ganglia: Deep in cerebral hemispheres these gray bands control movement
Thalamus: Relay station for nervous system
Hypothalamus: controls temperature, heart rate, blood pressure, sleep center
Cerebellum: equilibrium, coordination : the complex and quick coordination needed in playing piano, swimming or juggling CNS
Brain Stem: 1. Midbrain: Motor neurons and tracts 2. Pons: ascending and descending fiber tracts 3. Medulla: spinal cord fibers with autonomic centers such as respiration, heart, G.I. Function Spinal Cord: Highway for ascending and descending fiber tracts CNS
CNS Pathways of the CNS:
Sensory Pathways consists of Spinothalamic and Posterior Tracts
Spinothalamic Tract: transmits pain, temperature, and crude or light touch
Posterior Tract: Position, vibration fine touch, this tends to diminish with age CNS
Motor Pathways consists of Pyramidal and Extrapyramidal Tracts 1. Corticospinal tract: higher motor system which produces very skilled and purposeful movements 2. Extrapyramidal tract: older, lower motor system which maintains muscle tone and controls body movements, such as walking. CNS
CNS Cerebellar System: Coordinates movement, maintains equilibrium, and helps maintain posture.
Upper and Lower Motor Neurons These convey impulses from motor areas of cerebral cortex to the lower motor neurons which are the final pathways (Cranial nerves and Spinal nerves) The Peripheral Nervous System
The Peripheral Nervous Syste Peripheral Nervous System: Nerves out side the CNS
Autonomic Nervous System Neurologic System
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4. Reflex Arc: These are involuntary and act as defense mechanisms to potentially painful situations
Deep tendon reflexes: patellar or knee jerk
Superficial: corneal reflex, abdominal Visceral: pupillary response to light
Pathologic (Abnormal) Babinski’s Neurologic System
Cranial Nerves: 12 of them
I. Olfactory; Sensory; Smell
II. Optic; Sensory; Vision
III. Oculomotor; Mixed; EOM, eyelids, pupils
IV. Trochlear; Motor; down and inward (eyes)
V. Trigeminal; Mixed; chewing, facial sensation Neurologic System
Neurologic System VI. Abducens; Motor; lateral eye movement VII. Facial; Mixed; facial muscles, taste, saliva or tear secretion
VIII. Acoustic; Sensory; Hearing and equilibrium
IX. Glossopharyngeal; Mixed; pharynx, taste, parotid gland, carotid reflex
X. Vagus; Mixed; pharynx and larynx; talking, swallowing Neurologic System
Neurologic System X. Vagus; sensation from carotid body, carotid sinus, pharynx, viscera, carotid reflex
XI. Spinal; Motor; movement of SCM and trapezius
XII. Hypoglossal; Motor; tongue movement Neurologic System
Neurologic System Spinal Nerves: 31 pairs arise from the length of spinal cord and supply rest of body
Named:Cervical(8), Thoracic(12), Lumbar(5), Sacral(5), and Coccygeal(1) Enter and exit the cord through roots
Contain both sensory and motor fibers Neurologic System
Neurologic System Autonomic Nervous System: Voluntary and involuntary muscles
Mediates unconscious activity Developmental Considerations Developmental Considerations Infants : Primitive reflexes are in place: sucking, startle, rooting reflex
The process is cephalocaudal to proximodistal
As myelinization develops the infant is able to locate the stimulus
Aged : General atrophy and decreased neurons
Decreased muscle strength, impaired coordination slower reflexes, loss of vibratory sense in the ankle, position sense in lower extremities particularly the toes and decreased pupillary reflex
Position change must be deliberate and cautious Neurologic System
Neurologic System 1.
8. Subjective Data:
Headache: How often, when, where? Do they complain of the worse headache of their life? If so, send them to the ER stat!!!
Head Injury: Loss of consciousness?
Seizures: how often, course, duration: Is there an aura? (subjective sensation i.e. auditory,visual or motor)
Incoordination: One side, both sides? Neurological System
Neurological System 8. Numbness or tingling 9. Difficulty swallowing
10. Difficulty speaking
11. Past history such as a stroke, spinal cord injury, meningitis alcoholism
12. Environmental/ Occupational hazards: Are you exposed to chemicals, medications, alcohol, moodaltering drugs? Neurologic System
Neurologic System 1.
5. Additional History Infants and Children
Health problems with mother during pregnancy?
Was it term or premature?
Reflexes: Sucking and swallowing coordinated?
Motor development milestones reached? Neurological System
Neurological System Additional History for Aged
Any dizziness, especially with position change
How does dizziness affect ADL’s
Tremors? Alcohol use?
Loss of consciousness? Neurologic System
Neurologic System Objective Data:
Perform a Screening Neurological Examination on seemingly well persons Perform a Complete Neurological Exam on persons with neurological deficits who have neurologic concern Perform a Neurologic Recheck on persons with demonstrated Neurologic System
Neurologic System 1.
Reflexes Mental Status: Appearance
Cognition: i.e. Attention span, learning, memory
MiniMental Exam (Chapter 6 Jarvis) Do not memorize this however Neurologic System
Test Cranial Nerves I. Olfactory: assess patency, close eyes and use an aromatic substance such as coffee, toothpaste, peppermint, orange, vanilla Can person identify each odor.
II. Optic: Test V/A and confrontation
III., IV., VI., : Oculomotor,Trochlear,Abducens Check pupils, EOM’s, presence of nystagmus, amplitude, frequency Neurologic System
V. Trigeminal: Assess chewing, jaw movement, test sensory function using a cotton swab illustrated on 674 Corneal Reflex: Omit unless person has abnormal facial sensation. Use a cotton swab from side to side of orbit (2310)
VII. Facial: Smile, lift brows, show teeth, puff cheeks Neurologic System
VII. Sensory: Use salt, sugar, lemon juice to test sense of taste.
VIII. Acoustic: Test ability to hear normal conversations, by whispered words, Weber, and Rinne using tuning fork.
IX and X. Glossopharygeal and Vagus: Motor; Say “ahhh” or yawns. Tonsils and uvula should move. Test gag reflex. Voice should be smooth. Neurologic System
XI. Spinal Accessory : Check strength of both neck and shoulders: Strength should be equal.
XII. Hypoglossal: Inspect tongue, look for atrophy. Have pt. say “light, tight and dynamite” Motor System:
Muscles (See Previous Chapter) Size, strength, tone Cerebellar Function (Balance Tests) Observe pt. walking 1020 feet, turn and return. Should return with sense of freedom
Perform tandem walking: heeltotoe fashion
Romberg Test: Posture and balance: (feet together arms at side, eyes closed) Cerebellar Function
Cerebellar Function Coordination and skilled movements: RAM or rapid alternating movements
Heeltoshintest Neurologic System
Neurologic System Sensory System : Compare sensations such as superficial pain, light touch, and vibrations Spinothalamic Tract: Pain; apply sharp object spontaneously and unpredictably to different areas of the body using a fracture tongue blade. Let 2 seconds elapse between each test. Neurologic System
Neurologic System Temperature: Only checked if pt. has an abnormal pain sensation test. Use 2 test
tubes; one with cold water, one with hot water. Posterior Column Tract; Use a tuning fork and test vibrations. Start at bony surface of toes or fingers. If distal vibrations are felt, no further testing is needed. Neurologic System
Neurologic System Position (Kinesthesia): Test pt. ability to perceive passive movement of extremities.
Tactile Discrimination: Stereognosis is the ability to identify objects with one s eyes closed.
Graphesthesia: ability to read numbers written on one’s palm
2 point discrimination Neurologic System
Neurologic System Deep Tendon Reflexes (DTR’s): Measured by 4+, 3+, 2+, 1+, 0. Biceps Reflex (C5 to C6) 2330 Use bicep tendon to elicit a reflex. Contraction of biceps with flexion of forearm
Triceps: (C7 to C8) 2331: Strike triceps tendon and elicit extension of the forearm. Neurologic System
Neurologic System Brachioradialis (C5 to C6)
Quadriceps or Knee Jerk (L2 to L4) Use reinforcement technique as needed here Achilles Reflex (L5 to S2)
Clonus: pg 690
Abdominal Reflex: (T8T10) fig. 2338
Plantar or Babinski Neurologic System
Neurologic System Developmental Considerations: Note milestones
Child should be alert with eyes open
Table 232 page 691
Observe motor function; Movement should be smooth
Use Denver ll test to evaluate fine and gross motor development Neurologic System
Infantile automatisms are reflexes that have predictable timetable of appearance and departure.
1. Rooting Reflex
2. Sucking Reflex
3. Palmar Grasp
4. Plantar Grasp
5. Babinski’s Reflex: Toes fan out until 2 years *This is a positive finding in age 2 or above Neurologic System
6. Tonic Neck Reflex : Turn head, observe for a fencing reflex
7. Moro: Startle reflex; like hugging a tree
8. Placing Reflex
9. Stepping Reflex Neurologic System
Neurologic System 1.
5. Summary Checklist: Mental status
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- Fall '10
- Nursing, neurologic concern, Neurologic Recheck