Neuro Assessment PDF

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Outline of Neuro assessment for practicum, what we have to know to correctly assess neuro...

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Neuro Assessment Assess Mental Status LOC and cognitive function test LOC  Arouse by speech, then touch, then pressure to nail beds ** Alert, opens eyes spontaneously Cognitive Function Test  Person, Place, Time, situation **A&O x4 Assess Cranial Nerves:  II (Optic Nerve)  III, IV, VI ( Extraocular muscle)  V (Trigeminal nerve)  VII (Facial mobility) II Optic Nerve Snellen chart Static confrontation Test  Stand 2-3 ft. in front of patient having them cover one eye at a time.  Hold 1-4 fingers up midway between ya’ll.  Ask how many you are holding up without looking directly at the fingers.  Do this in all 4 quadrants then repeat with other eye  Pt will accurately report the correct numbers in all four quadrants Kinetic Confrontation Test  Same technique as the static test except you will hold fingers outside of each quadrant wiggling them into view.  Have patient tell you when they see your fingers Diagnostic positions test Cranial Nerves III, IV, VI Oculomotor, Trochlear, abducens    

Further testing of the extra ocular muscles assessing for symmetrical movements of the eys using the CARDINAL FIELDS OF GAZE TEST PT holds head steady and follows penlight with their eyes. Hold penlight 12- 14 inches away and move through positions 2- 9 slowly Eyes move smoothly and symmetrical in all nine cardinal fields of gaze

V Trigeminal Nerve  Light touch and superficial pain  Scalp, cheek and chin  Patient eyes closed, use cotton swab and safety pin and test 3 sites taking turns ** Note face expression VII Facial Mobility  Raise eyebrows, smile, show teeth, puff out cheeks Gait Test Tandum test

 Patient walks straight line one foot in front of the other one

**Walking smoothly without swaying Balance Test Romberg Test

 Patient stand with feet together with hand at side with eyes closed STAND CLOSE TO THEM **Maintains position without opening eyes. Slight swaying is normal Knee flexion  Hop and bend knees Vibration sensation  Arms and legs (distal to top)  Patients eyes closed use tunning fork activated and placed at distal point (toes or fingernails) ** If sensation felt@ distal point no further testing needed Reflexes: Biceps (pointed part of hammer)  Partially flex elbow with palm down  Place one finger or thumb on the biceps tendon  Strike the finger or thumb with reflex hammer briskly ** Observe for flexion at the elbow and contraction of the bicep muscle ** If the pt reflexes are symmetrically diminished or absent, ask pt to clench the teeth, or squeeze one hand tight with the opposite hand to aid in detection

Triceps (pointed part of hammer)  Have the pt flex the arm at the elbow and turn the palm toward the body if supine.  Palpate the triceps muscle and strike it directly just above the elbow ** Observe for extension of the elbow and contraction of the triceps muscle Patellar (pointed part of hammer)  Have the pt flex the knee at 90 degrees, allowing the lower leg to dangle  Support the upper leg with the hand  Palpate the patellar tendon directly below the patella ** Observe for extension of the lower leg and contraction of the quadriceps muscle ** If the pt. reflexes are symmetrically diminished or absent, ask the pt to lock the fingers in front of the chest and pull one hand against the other. Achilles (wider part of hammer)  With the pt sitting and legs dangling, hold the pt’s foot  Palpate the Achilles tendon;  Strike the tendon directly near the ankle malleolus ** Observe for plantar flexion of the foot and contraction of the gastrocnemius muscle...