310: Neurological System/Mental Status (Exam 4)

total expression of a persons emotional response, mood, cognitive functioning and personality

mental status

__ activating system (RAS) - in brainstem regulates wake, fullness, arousal

reticular

disruption in descending RAS can lead to __ mental status

altered

oriented to person, place, or __; answers question appropriately and reacting to stimuli - what we are looking for

time

disoriented - cerebral trauma, ___, or amnesia; disoriented to place - psychiatric disorder, delirium, cognitive __; disoriented to time - anxiety, delirium, depression, cognitive impairment

seizures, impairment

LOC - awake and __?; level of awareness - oriented to person, place, and time = AAO x3

alert

assessing cognitive abilities - use mini __ status exam

mental

AVPU - A= __ - no stimuli needed; V= verbal stimuli - responsive to; P= painful stimuli - responsive to; U= __ to verbal and pain stimuli

alert, unresponsive

decrease in LOC = severe brain __ or hypoxemia or hypovolemic shock

injury

__ ___ scale is used to quantify consciousness in person with head trauma or hypoxic event

Glasgow coma

Glasgow coma scale score: 3-15 with 15 being __ level of consciousness

optimal

infants and children - all brain cells are present at birth but it takes 1st few years of life for them to __ and myelinize

develop

infants and children - brain insults can __ brain cells leading to potentially serious dysfunction and mental status; evaluate speech, language, and behavior; self care activities: dress, feed, bathe; personality - change related to trauma, learning

damage

infants and children - brain insults include infection, __, and metabolic imbalance

trauma

adolescents - ___ maturation: continue with greater capacity to learning

intellectual

adolescents - abstract __ develops: ability to develop theories, use logical reasoning, make future plans, make generalizations, know risks and possibilities

thinking

adolescents - ___: begins to develop with education, intellect; evaluate for risk taking behaviors, school performance, and interactions with peers, family, and reluctance to discuss behaviors, attitudes, or experiences

judgement

older adults - cognitive functions most sensitive to aging include the speed at which new information is perceived, encoded, __, and retrieved

processed

older adults - minimal __ in cognitive and daily functioning should occur unless systemic or neurologic disorder develops

decline

older adults - changes in __ function and memory may be associated with medications; activity of daily living - money management and food prep; symptoms of depression - decrease hygiene and feel hopeless; minimal decline - should occur unless systemic thi

cognitive

older adults - loss of recent memory, delayed response time, and diminished ability to __ complex information may occur

learn

older adults - remote __ may be more efficient than short-term memory; higher education attainment and memory

memory

history of __ illness - disorientation and confusion; associated health problems; medications; low energy, hurting themselves, suicide, depression; anxiety

present

past __ history - neuro disorder, brain injury, brain surgery; chronic diseases

medical

__ history - autism, alzheimer's; include all from history of present illness

family

__ and social history - emotional status, life goals, attitude; use of alcohol, street drugs; mood altering drugs

personal

mental status is assessed throughout the physical examination and is used to evaluate: physical appearance and behavior, state of __, cognitive abilities, speech and language skills, emotional stability

consciousness

cranial nerves arise from the brain; there are __ pairs; each has motor and or sensory functions

12

peripheral nerves carry to and from CNS; ___ NS includes PNS and SNS

autonomic

__ nerves arise from spinal cord; 31 pair (each has motor and sensory function); location related to vertebrae; areas of body surface innervated by particular spinal nerves

spinal

spinal nerves - __ cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccyx

8

history of __ illness - pain, seizures, gait, pupil

present

__ medical history - trauma, brain, spinal cord injury, meningitis, brain surgery

past

__ history - alcoholism, alzheimer's

family

__ and social history - chemicals, street drugs, mood altering drugs

personal

CRANIAL NERVES

...

3 nerves that are sensory

1, 2, 8

5 nerves that are motor

3, 4, 6, 11, 12

4 nerves that are both sensory and motor

5, 7, 9, 10

cranial nerve 1 - ___; smell

olfactory

cranial nerve 2 - ___; sight

optic

cranial nerve 3 ___, 4 ___, and 6 ___; are for eye movement/pupillary response (tested together)

oculomotor, trochlear, abducens

cranial nerve 5 __; motor - clench teeth, sensory - touch, corneal reflex (sharp/dull)

trigeminal

cranial nerve 7 __; motor is facial expressions and sensory is taste

facial

cranial nerve 8 ___; hearing

acoustic

cranial nerve 9 ___; motor for swallowing and speech and sensory for taste

glossopharyngeal

cranial nerve 10 __; sensory and motor for gag reflex and motor for swallow

vagus

cranial nerve 11 ___; trapezius, sternocleidomastoid (test these 2 muscles)

spinal accessory

cranial nerve 12 ___; tongue

hypoglossal

awareness of body position

proprioception

coordination and __ motor skills (touch fingers to thumb); alternating movements; accuracy of movements

fine

balance - use __ test: loss of balance is positive test; check gait and heal to toe

Romberg

primary sensory function - ___, vibration, position of joints

superficial

cortical sensory functions - interpretation: ___ - identify familiar objects

stereognosis

cortical sensory functions - interpretation: two point discrimination, ___ - draw letter or number in hand, point location (identify where they feel sensation

graphesthesia

used to evaluate function of specific spine levels; superficial is with plantar reflex; deep tendon is biceps, brachioradial, triceps, patellar, achilles

reflexes

deep tendon reflexes scores - 0: __, 1+ sluggish, 2+ active or expected, 3+ slightly hyperactive, 4+ hyperactive

no response

___ sign = dorsiflexion of great toe (2 or less years old is when this is used more common

Babinski

how to examine CNs for newborns and infants - 2, 3, 4, 6 - __ reflex: shine light at the infants open eye, observe quick closure of eye and dorsiflexion of head

blink

how to examine CNs for newborns and infants - 5 - __ reflex: touch one corner of infants mouth; infant should open mouth and turn head to side of touching

rooting

how to examine CNs for newborns and infants - 7: observe the infants __ expression when crying

facial

how to examine CNs for newborns and infants - 8: __ blink reflex - loudly clap hands and see if patient blinks

acoustic

how to examine CNs for newborns and infants - 9 and 10: swallowing ability and __ reflex

gag

how to examine CNs for newborns and infants - 12: coordinated __ and swallowing ability

sucking

developmental variations - __: observe at play (gait/fine motor skills, grasping toys, walk, hop, jump); toddler, older child, pregnant woman, older adults (hearing loss, sleep disturbances)

children

signs of meningitis - __, stiff neck, altered mental status, headache, nausea, __, chills, myalgia, rash, nuchal rigidity, brudzinski sign, kernig sign

fever, vomiting

__ sign - flex neck and will see involuntary flex of hips

Brudzinski

__ sign - flex leg at knee and they will attempt to straighten leg

Kernig

posturing an __ patients (indicative of brain injury) - associated with severe brain injury, decorticate or flexor posture, decerebrate or extensor posture

unconsious

which cranial nerve in not routinely tested unless a problem is detected?

1

REVIEW QUESTIONS

...

the patient is able to touch each finger to his thumb in rapid sequence. what does this finding mean? the patient has appropriate __ function

cerebellar

The examiner is assessing deep tendon reflex response in a 12-year-old boy. The response is an expected reflex response. Which score should be documented?

2+

How can an examiner best gain the cooperation of a child to perform a neurologic examination? create a __ from various aspects of the neurologic examination

game