logging in or signing up Neuro Assessment.Audio 2.2010 aSGuest62787 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 238 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: August 25, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript According to Lower's article, is loss of short- or long-term memory more pathological? : According to Lower's article, is loss of short- or long-term memory more pathological? According to Lower's article, is loss of short- or long-term memory more pathological? : According to Lower's article, is loss of short- or long-term memory more pathological? Short term! e.g. ask pt to remember your name and test in 5 minutes. Or what did you have for breakfast? who just visited you? Why are you in the hospital? (few pts lose long –term, e.g. dementia: test with, where were you born? what is your birthday?) What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? : What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? : What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? Most sensitive: a change in the level of consciousness! The pt needs more stimulation to display the same responses loses details in test of orientation forgetful restless (“Bad Boy Syndrome”) suddenly quiet after severe restlessness See Table in Lower article (p. 40) for more For language/speech changes, what is dysarthria? How is it different from aphasia? : For language/speech changes, what is dysarthria? How is it different from aphasia? For language/speech changes, what is dysarthria? How is it different from aphasia? : For language/speech changes, what is dysarthria? How is it different from aphasia? dysarthria = difficulty with speech; aphasia = absence of speech, e.g. post CVA How would you test for orientation in the patient with dysarthria? : How would you test for orientation in the patient with dysarthria? How would you test for orientation in the patient with dysarthria? : How would you test for orientation in the patient with dysarthria? have pt speak slowly and listen carefully; have pt write answers on pad; give multiple choices and pt chooses ("are you in a school, at home, at hospital?"); have answer yes/no to questions (is this a school, your home, a hospital?) How would you test for orientation in the patient with aphasia? : How would you test for orientation in the patient with aphasia? How would you test for orientation in the patient with aphasia? : How would you test for orientation in the patient with aphasia? much as above but no speech Can you be completely oriented and have dysarthria? : Can you be completely oriented and have dysarthria? Can you be completely oriented and have dysarthria? : Can you be completely oriented and have dysarthria? Of course, just don't confuse difficulty speech with lack of mental ability! What is the proper technique for assessment of pupillary response to light? : What is the proper technique for assessment of pupillary response to light? What is the proper technique for assessment of pupillary response to light? : What is the proper technique for assessment of pupillary response to light? Dim the lights;the room should be completely dark! Hold a penlight about 8 inches from the pt's face in the peripheral field of vision. Look at the pupil: how big is it before the exam? Come in from the side and shine the light directly into the eye. Both pupils should constrict immediately, but the one receiving direct light should constrict more than the other. Don’t hold the light in eye for more than 5 seconds! Repeat the test in the other eye. Record the size and reaction (slow, brisk) of the pupil after the light is in the eye (maximum constriction) What is the proper technique for assessment of pupillary response to light? : What is the proper technique for assessment of pupillary response to light? Suggestions for very dark pupils: Have more light in the room though still dim Look at the pupil from the side before the exam in order to determine the size of the pupil Sometimes you can’t see the constriction, but you know that it happened because it dilates when you take the light away! Define anisocoria. What is the clinical significance of anisocoria? : Define anisocoria. What is the clinical significance of anisocoria? Define anisocoria. What is the clinical significance of anisocoria? : Define anisocoria. What is the clinical significance of anisocoria? Anisocoria: a naturally occurring unequal pupil. Does anyone here have one? Clinical significanse: don't confuse with acute neuro problem! Don’t be confused by misshaped pupils from eye surgery! Don’t be confused by misshaped pupils from eye surgery! : Don’t be confused by misshaped pupils from eye surgery! What is the clinical significance of acute onset of one dilated pupil in a neuro patient? : What is the clinical significance of acute onset of one dilated pupil in a neuro patient? What is the clinical significance of acute onset of one dilated pupil in a neuro patient? : What is the clinical significance of acute onset of one dilated pupil in a neuro patient? acute neuro problem, e.g. severe bleeding or swelling in brain; usually accompanied by other neuro signs/symptoms According to Lower's article, how do you test for "obeys commands" for Motor Response? : According to Lower's article, how do you test for "obeys commands" for Motor Response? According to Lower's article, how do you test for "obeys commands" for Motor Response? : According to Lower's article, how do you test for "obeys commands" for Motor Response? after establishing orientation, ask the pt to hold up two fingers highest ability is to follow commands What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? : What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? : What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? many pts (e.g. comatose) who cannot follow commands still have a primitive grasp reflex like an infant. Show family: will grasp fingers automatically but cannot follow the command, "open your hand, let go of my fingers" Describe what a localized or purposeful response to pain would look like. : Describe what a localized or purposeful response to pain would look like. Describe what a localized or purposeful response to pain would look like : Describe what a localized or purposeful response to pain would look like pt will try to remove the irritant or try to avoid pain: e.g. try to grab source of pain (your hand), pull N/G tube, or suction tube This is not as high a level: he cannot follow commands, even with painful stimulation How does withdrawal to pain differ from localized or purposeful response to pain? : How does withdrawal to pain differ from localized or purposeful response to pain? How does withdrawal to pain differ from localized or purposeful response to pain? : How does withdrawal to pain differ from localized or purposeful response to pain? localized or purposeful response to pain: it is purposeful, that is pt actively goes toward the source of pain/irritation versus withdrawal to pain: some part of the body moves pain inflicted but doesn't try to remove, specific part where pain is may not move; movement may not be purposeful Describe the two types of posturing and the level of brain where each occurs. : Describe the two types of posturing and the level of brain where each occurs. Describe the two types of posturing and the level of brain where each occurs : Describe the two types of posturing and the level of brain where each occurs decorticate/flexion: flexion of arms to chest (arms move toward the core) with legs rigidly extended; part of brain still functioning decerebrate/extension: arms and legs are rigidly extended; functioning on brain stem only Note: not uncommon to have both at same time (decorticate one side, decerebrate the other) and alternating How do you perform the motor test for the upper and lower extremities?Review motor strength scale in Lower. : How do you perform the motor test for the upper and lower extremities?Review motor strength scale in Lower. How do you perform the motor test for the upper and lower extremities? : How do you perform the motor test for the upper and lower extremities? upper extremity strength: with both arms extended (stretched out in front of pt), apply pressure downward on both arms at same time while pt actively resists hand grip strength: using only your index and middle fingers, have pt squeeze them with both hands at same time (test for equality) How do you perform the motor test for the upper and lower extremities? : How do you perform the motor test for the upper and lower extremities? lower extremity strength: raising each leg, one at a time, apply pressure downward while pt actively resists; repeat on other side ankle dorsiflexion: at the same time, have pt press both feet downward against your hands "like pressing on the gas pedal"; Note: usually down with ankle plantar flexion - have pt press both feet upward against your hands "towards your nose"; dorsiflexion and plantar flexion = "pushes and pulls" How is motor testing modified for patients with neck, back or extremity problems/surgery? : How is motor testing modified for patients with neck, back or extremity problems/surgery? How is motor testing modified for patients with neck, back or extremity problems/surgery? : How is motor testing modified for patients with neck, back or extremity problems/surgery? Because of the risk of damage to an injured area or surgical site, NEVER have pt actively resist against gravity when pt has neck, back or extremity problems/surgery!! How is motor testing modified for patients with neck, back or extremity problems/surgery? : How is motor testing modified for patients with neck, back or extremity problems/surgery? Modification: • upper extremity strength: test the biceps strength in each arm by having pt flex arm against your slight resistance • lower extremity strength: have pt bend one knee at a time, you apply slight resistance downward against knee as pt tries to keep knee bent the Glasgow Coma Scale : the Glasgow Coma Scale Developed in Glasgow, Scotland, as a trauma triage tool for use in the field, into the ER/Trauma Center, to ICU Categories: Eye Opening Best Verbal Best Motor Limitations If pt is intubated (no best verbal) With pediatric pts (no best verbal, etc.) Slide 39: Categories of Glasgow Coma Scale What’s the highest score possible? What’s the lowest score possible? Slide 40: Categories of Glasgow Coma Scale What’s the highest score possible? 15 (alert & oriented) What’s the lowest score possible? 3 (deeply comatose) Slide 41: GCS allows for sequential analysis Let me now show you the Neuro Flow Sheet from Mercy Hospital and do a Basic Neuro Exam on a volunteerRemind me to discuss the proper documentation on the Flow SheetWe will be practicing this Neuro Assessment on Neuro Lab Day. : Let me now show you the Neuro Flow Sheet from Mercy Hospital and do a Basic Neuro Exam on a volunteerRemind me to discuss the proper documentation on the Flow SheetWe will be practicing this Neuro Assessment on Neuro Lab Day. You do not have the permission to view this presentation. In order to view it, please contact the author of the presentation.
Neuro Assessment.Audio 2.2010 aSGuest62787 Download Post to : URL : Related Presentations : Share Add to Flag Embed Email Send to Blogs and Networks Add to Channel Uploaded from authorPOINT lite Insert YouTube videos in PowerPont slides with aS Desktop Copy embed code: (To copy code, click on the text box) Embed: URL: Thumbnail: WordPress Embed Customize Embed The presentation is successfully added In Your Favorites. Views: 238 Category: Entertainment License: All Rights Reserved Like it (0) Dislike it (0) Added: August 25, 2010 This Presentation is Public Favorites: 1 Presentation Description No description available. Comments Posting comment... Premium member Presentation Transcript According to Lower's article, is loss of short- or long-term memory more pathological? : According to Lower's article, is loss of short- or long-term memory more pathological? According to Lower's article, is loss of short- or long-term memory more pathological? : According to Lower's article, is loss of short- or long-term memory more pathological? Short term! e.g. ask pt to remember your name and test in 5 minutes. Or what did you have for breakfast? who just visited you? Why are you in the hospital? (few pts lose long –term, e.g. dementia: test with, where were you born? what is your birthday?) What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? : What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? : What are early changes in level of consciousness that could indicate signs of a clinical problem (increased ICP)? Most sensitive: a change in the level of consciousness! The pt needs more stimulation to display the same responses loses details in test of orientation forgetful restless (“Bad Boy Syndrome”) suddenly quiet after severe restlessness See Table in Lower article (p. 40) for more For language/speech changes, what is dysarthria? How is it different from aphasia? : For language/speech changes, what is dysarthria? How is it different from aphasia? For language/speech changes, what is dysarthria? How is it different from aphasia? : For language/speech changes, what is dysarthria? How is it different from aphasia? dysarthria = difficulty with speech; aphasia = absence of speech, e.g. post CVA How would you test for orientation in the patient with dysarthria? : How would you test for orientation in the patient with dysarthria? How would you test for orientation in the patient with dysarthria? : How would you test for orientation in the patient with dysarthria? have pt speak slowly and listen carefully; have pt write answers on pad; give multiple choices and pt chooses ("are you in a school, at home, at hospital?"); have answer yes/no to questions (is this a school, your home, a hospital?) How would you test for orientation in the patient with aphasia? : How would you test for orientation in the patient with aphasia? How would you test for orientation in the patient with aphasia? : How would you test for orientation in the patient with aphasia? much as above but no speech Can you be completely oriented and have dysarthria? : Can you be completely oriented and have dysarthria? Can you be completely oriented and have dysarthria? : Can you be completely oriented and have dysarthria? Of course, just don't confuse difficulty speech with lack of mental ability! What is the proper technique for assessment of pupillary response to light? : What is the proper technique for assessment of pupillary response to light? What is the proper technique for assessment of pupillary response to light? : What is the proper technique for assessment of pupillary response to light? Dim the lights;the room should be completely dark! Hold a penlight about 8 inches from the pt's face in the peripheral field of vision. Look at the pupil: how big is it before the exam? Come in from the side and shine the light directly into the eye. Both pupils should constrict immediately, but the one receiving direct light should constrict more than the other. Don’t hold the light in eye for more than 5 seconds! Repeat the test in the other eye. Record the size and reaction (slow, brisk) of the pupil after the light is in the eye (maximum constriction) What is the proper technique for assessment of pupillary response to light? : What is the proper technique for assessment of pupillary response to light? Suggestions for very dark pupils: Have more light in the room though still dim Look at the pupil from the side before the exam in order to determine the size of the pupil Sometimes you can’t see the constriction, but you know that it happened because it dilates when you take the light away! Define anisocoria. What is the clinical significance of anisocoria? : Define anisocoria. What is the clinical significance of anisocoria? Define anisocoria. What is the clinical significance of anisocoria? : Define anisocoria. What is the clinical significance of anisocoria? Anisocoria: a naturally occurring unequal pupil. Does anyone here have one? Clinical significanse: don't confuse with acute neuro problem! Don’t be confused by misshaped pupils from eye surgery! Don’t be confused by misshaped pupils from eye surgery! : Don’t be confused by misshaped pupils from eye surgery! What is the clinical significance of acute onset of one dilated pupil in a neuro patient? : What is the clinical significance of acute onset of one dilated pupil in a neuro patient? What is the clinical significance of acute onset of one dilated pupil in a neuro patient? : What is the clinical significance of acute onset of one dilated pupil in a neuro patient? acute neuro problem, e.g. severe bleeding or swelling in brain; usually accompanied by other neuro signs/symptoms According to Lower's article, how do you test for "obeys commands" for Motor Response? : According to Lower's article, how do you test for "obeys commands" for Motor Response? According to Lower's article, how do you test for "obeys commands" for Motor Response? : According to Lower's article, how do you test for "obeys commands" for Motor Response? after establishing orientation, ask the pt to hold up two fingers highest ability is to follow commands What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? : What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? : What do you say to the family of a comatose patient who grasps your fingers when placed in his palm but is unable to follow the command to release your fingers? many pts (e.g. comatose) who cannot follow commands still have a primitive grasp reflex like an infant. Show family: will grasp fingers automatically but cannot follow the command, "open your hand, let go of my fingers" Describe what a localized or purposeful response to pain would look like. : Describe what a localized or purposeful response to pain would look like. Describe what a localized or purposeful response to pain would look like : Describe what a localized or purposeful response to pain would look like pt will try to remove the irritant or try to avoid pain: e.g. try to grab source of pain (your hand), pull N/G tube, or suction tube This is not as high a level: he cannot follow commands, even with painful stimulation How does withdrawal to pain differ from localized or purposeful response to pain? : How does withdrawal to pain differ from localized or purposeful response to pain? How does withdrawal to pain differ from localized or purposeful response to pain? : How does withdrawal to pain differ from localized or purposeful response to pain? localized or purposeful response to pain: it is purposeful, that is pt actively goes toward the source of pain/irritation versus withdrawal to pain: some part of the body moves pain inflicted but doesn't try to remove, specific part where pain is may not move; movement may not be purposeful Describe the two types of posturing and the level of brain where each occurs. : Describe the two types of posturing and the level of brain where each occurs. Describe the two types of posturing and the level of brain where each occurs : Describe the two types of posturing and the level of brain where each occurs decorticate/flexion: flexion of arms to chest (arms move toward the core) with legs rigidly extended; part of brain still functioning decerebrate/extension: arms and legs are rigidly extended; functioning on brain stem only Note: not uncommon to have both at same time (decorticate one side, decerebrate the other) and alternating How do you perform the motor test for the upper and lower extremities?Review motor strength scale in Lower. : How do you perform the motor test for the upper and lower extremities?Review motor strength scale in Lower. How do you perform the motor test for the upper and lower extremities? : How do you perform the motor test for the upper and lower extremities? upper extremity strength: with both arms extended (stretched out in front of pt), apply pressure downward on both arms at same time while pt actively resists hand grip strength: using only your index and middle fingers, have pt squeeze them with both hands at same time (test for equality) How do you perform the motor test for the upper and lower extremities? : How do you perform the motor test for the upper and lower extremities? lower extremity strength: raising each leg, one at a time, apply pressure downward while pt actively resists; repeat on other side ankle dorsiflexion: at the same time, have pt press both feet downward against your hands "like pressing on the gas pedal"; Note: usually down with ankle plantar flexion - have pt press both feet upward against your hands "towards your nose"; dorsiflexion and plantar flexion = "pushes and pulls" How is motor testing modified for patients with neck, back or extremity problems/surgery? : How is motor testing modified for patients with neck, back or extremity problems/surgery? How is motor testing modified for patients with neck, back or extremity problems/surgery? : How is motor testing modified for patients with neck, back or extremity problems/surgery? Because of the risk of damage to an injured area or surgical site, NEVER have pt actively resist against gravity when pt has neck, back or extremity problems/surgery!! How is motor testing modified for patients with neck, back or extremity problems/surgery? : How is motor testing modified for patients with neck, back or extremity problems/surgery? Modification: • upper extremity strength: test the biceps strength in each arm by having pt flex arm against your slight resistance • lower extremity strength: have pt bend one knee at a time, you apply slight resistance downward against knee as pt tries to keep knee bent the Glasgow Coma Scale : the Glasgow Coma Scale Developed in Glasgow, Scotland, as a trauma triage tool for use in the field, into the ER/Trauma Center, to ICU Categories: Eye Opening Best Verbal Best Motor Limitations If pt is intubated (no best verbal) With pediatric pts (no best verbal, etc.) Slide 39: Categories of Glasgow Coma Scale What’s the highest score possible? What’s the lowest score possible? Slide 40: Categories of Glasgow Coma Scale What’s the highest score possible? 15 (alert & oriented) What’s the lowest score possible? 3 (deeply comatose) Slide 41: GCS allows for sequential analysis Let me now show you the Neuro Flow Sheet from Mercy Hospital and do a Basic Neuro Exam on a volunteerRemind me to discuss the proper documentation on the Flow SheetWe will be practicing this Neuro Assessment on Neuro Lab Day. : Let me now show you the Neuro Flow Sheet from Mercy Hospital and do a Basic Neuro Exam on a volunteerRemind me to discuss the proper documentation on the Flow SheetWe will be practicing this Neuro Assessment on Neuro Lab Day.