central nervous system vidhya
DESCRIPTION
physical assessment of CNSTRANSCRIPT
BY
G.VIDHYA
PBBSC II yr
VCCON
NERVOUS SYSTEMThe nervous system consists of
1. The central nervous system (CNS)
2. The peripheral nervous system
3. The autonomic nervous system
NURSING ASSESSMENTHistory collection
Physical examination
Diagnostic evaluation
HISTORY COLLECTIONPast history
Fall or trauma that may have involved the head or spinal cord.
Family history
Alzheimer’s disease, epilepsy, parkinson’s disease, spina bifida, etc.
Personal history
Alcohol, medications and illicit drugs.
NEUROLOGICAL ASSESSMENTA complete neurological assessment consists of five
steps:
1. Consciousness and cognition assessment
2. Cranial nerve assessment
3. Reflex testing
4. Motor system assessment
5. Sensory system assessment .
CONSCIOUSNESS AND COGNITION ASSESSMENT
Cerebral abnormalities may cause disturbances in
mental status, intellectual functioning, thought
content and emotional status.
CRANIAL NERVES ASSESSMENT
EQUIPMENTS NEEDED FOR CNS ASSESSMENT
Tongue depressor
Flash light
Sugar and salt samples
Watch
Cotton – tipped swab
Snellen chart
Opthalmoscope
Samples of familiar odours
Tuning fork
Knee hammer
CRANIAL NERVE I (Olfactory )
CRANIAL NERVE II (optic)
CRANIAL NERVE III (Occulomotor)
CRANIAL NERVE IV (Trochlear)
CRANIAL NERVE (Trigeminal)
CRANIAL NERVE VI (Abducens)
CRANIAL NERVE VII (Facial)
CRANIAL NERVE VIII(Acoustic)
ROMBERG TEST
CRANIAL NERVE IX (Glossopharyngeal)
CRANIAL NERVE X (Vagus)
CRANIAL NERVE XI (Spinal accessory)
CRANIAL NERVE XII (Hypoglossal)
REFLEX TESTINGBiceps reflex
Triceps reflex
Brachioradialis reflex
Patellar reflex
Achilles reflex
BICEPS REFLEX
1- Have the patient's elbow at about a90° angle of flexion with the armslightly bent down as shown infigure 2-6 .
2- Grasp the elbow with your lefthand so the fingers are behind theelbow and your abductee thumbpresses the biceps brachial tendon .
3- Strike your thumb a series of blowswith the rubber hammer, varyingyour thumb pressure with eachblow until the most satisfactoryresponse is obtained .
4- Normal reflex is elbow flexion(bending(
TRICEPS REFLEX
Grasp the patient's wrist withyour left hand and pull hisarm across his chest so theelbow is flexed about 90° andthe forearm is partially bentdown .
Tap the triceps brachialtendon directly above theolecranon process. Thenormal response is elbow
extension .
Triceps reflex
Triceps jerk with one arm flexed
Triceps jerk with arms folded
BRACHIORADIALIS REFLEXWith the patient’s forearm resting on the lap or acrossthe abdomen, the brachioradialis reflex is assesses.
A gentle strike of the hammer 2.5 to 5 cm above thewrist results in flexion and supination of the forearm.
PATELLAR REFLEX
The patellar reflex is elicited bystriking the patellar tendon justbelow the patella. The patientmay be in a sitting or a lyingposition.
If the patient is supine, theexaminer supports the legs tofacilitate relaxation of themuscles.
Contraction of the quadricepsand knee extension are normalresponses.
ACHILLES REFLEXTo elicit an achilles reflex, thefoot is dorsiflexed at the ankleand the hammer strikes thestretched achilles tendon.This reflex normally producesflexion
Deep tendon reflexes should be graded on a scale of 0-4as follows:
=0 absent despite reinforcement
=1 present only with reinforcement
=2 normal
=3 increased but normal
=4 markedly hyperactive, with clonus
EXAMINING THE MOTOR SYSTEMMotor ability
Muscle strength
Balance and coordination
MOTOR ABILITYThe patient is instructed to walk across the room, if
possible while the examiner observes posture and
gait. the muscles are inspected and palpated if atrophy
or involuntary movements is noted.
Muscle strengthAsk client to flex muscle and then resist when you apply
opposing force against the muscles
Compare contralateral sides
Neck, Trapezius, arms (Biceps, Triceps), wrists, fingers, hips,
legs, ankles and feet
Balance and coordinationSeat the patient. Instruct him to pat his knees with hishands, palms down then palms up. Have him alternatepalms down and palms up rapidly.
Watch the patient to notice if his movements are stiff, slow,nonrhythmic, or jerky.
The movements should be smooth and rhythmic as he doesthe task faster.
EXAMINING THE SENSORY SYSTEMTactile sensation
Superficial pain
Temperature
Vibration and position sense
DIAGNOSTIC EVALUATIONSComputed tomography scanningMagnetic resonance imagingPositron emission tomographySingle photon emission computed tomographyCerebral angiographyMyelographyUltrasound imageryDopplerEEGEMGLP