23)Neuro - Chapter 23 Chapter 23 NEUROLOGIC SYSTEM...

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Unformatted text preview: Chapter 23 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 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 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 Consists of: Reflex Arc Cranial Nerves Spinal Nerves Autonomic Nervous System Neurologic System Neurologic System 1. 2. 3. 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 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. 2. 3. 4. 5. 6. 7. 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? Dizziness/Vertigo/Syncope Seizures: how often, course, duration: Is there an aura? (subjective sensation i.e. auditory,visual or motor) Tremors Weakness: Where 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. 2. 3. 4. 5. Additional History Infants and Children Health problems with mother during pregnancy? Was it term or premature? Reflexes: Sucking and swallowing coordinated? Balance problems Motor development milestones reached? Neurological System Neurological System Additional History for Aged Any dizziness, especially with position change How does dizziness affect ADL’s Decreased memory? Tremors? Alcohol use? Visual changes? 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. 2. 3. 4. 5. Sequence: Mental status Cranial Motor Sensory Reflexes Mental Status: Appearance Behavior Cognition: i.e. Attention span, learning, memory Thought Process MiniMental Exam (Chapter 6 Jarvis) Do not memorize this however Neurologic System 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 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 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 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 Finger­to­finger test Finger­to­nose test 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 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 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. 2. 3. 4. 5. Summary Checklist: Mental status Cranial Nerves Motor function Sensory function Reflexes ...
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