* Increased talkativeness or pressure to keep talking, may involve excessive rhyming or puns; flight of ideas * Impaired attention, easily distracted * Impaired judgment * Hypersexual behavior Examination findings of a patient with Diabetic Peripheral Neuropathy 3. Examination findings of a patient with Diabetic Peripheral Neuropathy A disorder of the peripheral nervous system that results in motor and sensory loss in the distribution of one or more nerves. Common causes are diabetes mellitus or alcohol abuse. Other causes include nerve compression (compartment syndrome), HIV infection, nutritional disorders, and neurotoxic chemotherapy. Inflammatory processes from biochemical exposures (hyperglycemia, lipoproteins, neurotoxins) damage axons and nerve fibers may lead to sensory deficits. Present in 8% of population by 55 years of age, but present in up to 66% of patients with diabetes. Subjective data: * Gradual onset of numbness, tingling, burning, and cramping, most commonly in the hands and feet * Night pain in one or both feet * Early signs may be unusual sensations of walking on cotton, floors feeling strange, or inability to distinguish between coins by feel. * Sensation of burning accompanied by hyperalgesia and allodynia (all sensation is painful) Objective data: * Reduced sensation in the foot with the monofilament; reduced sensation of pain or touch sensation * Distal pulses may be present or diminished * Diminished or absent ankle and knee reflexes * Decreased or no vibratory sensation below the knees; temperature sensation may be less impaired * Distal muscle weakness, inability to stand on toes or heels * Skin ulceration or injuries to extremities the patient does not feel Examination findings of all Cranial Nerves Examination techniques of all Cranial Nerves
Cranial Nerves CN – I – Olfactory * Test ability to identify familiar aromatic odors, one naris at a time with eyes closed * Anosmia – loss of sense of smell or an inability to discriminate odors CN – II – Optic: * Test distant and near vision * Perform ophthalmoscopic examination of fundi CN– III – Oculomotor, CN – IV – Trochlear and CN VI - Abducens: * Test visual fields by confrontation and extinction of vision * Inspect eyelids for dropping * Inspect pupils’ size for equality and their direct and consensual responses to light and accommodation * Test extraocular eye movements * The sixth cranial never is commonly one of the first to lose functioning the presence of increased intracranial pressure CN – V – Trigeminal: * Inspect face for muscle atrophy and tremors * Palpate jaw muscles for tone and strength when patient clenches teeth * Test superficial pan and touch sensation in each branch (test temperature sensation if there are unexpected findings to pain or touch) * Test corneal reflex CN – VII – Facial: * Inspect symmetry of facial features with various expressions (e.g. smile, frown, puffed cheeks, wrinkled forehead)
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- Summer '15