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