1. Neurological Assessment PN 2 Assessment Summer 2007 Liz Mathewson

2. What is the Nervous System? Involves the integration, coordination and regulation of body systems and all body functions Two principle parts: CNS and PNS CNS: brain and spinal cord PNS: cranial and spinal nerves Work together NS controls cognitive function and both voluntary and involuntary activities

3. Special Considerations Developmental Considerations Infants and Children The pregnant Female The older adult Psychosocial Considerations Cultural and Environmental

4. Infants and Children Growth is very rapid during fetal phase No neurons formed after 3 rd trimester During infancy neurons mature Neonate has some primitive reflexes at birth which disappear Absence of a “cry” indicates cerebral disease Benchmarks throughout childhood for normal Delays may be due to neurologic conditions such as fetal alcohol, autism, ADD

5. Pregnant Female Growing uterus may put pressure on nerves in the pelvic cavity = neurological changes in the legs Center of gravity shifts Lumbar curvature of spine is accentuated Change in posture may place pressure on nerve roots = sensory changes Hyperactive reflexes may = pregnancy- induced hypertension (PIH)

6. The older adult Some changes visible Some internal Impulse transmission decreases, as does reaction to stimuli Reflexes diminished or disappear Coordination not as strong, deep tendon reflexes not as brisk Coordination and movement slower

7. Older Adult Senses not as acute Taste not so good…..need to add more Na Muscle mass decreases Gait becomes short, shuffling, unsteady Posture changes Fatigues faster Deficits due to conditions such as stroke, MS and trauma/injury

8. Psychosocial considerations Changes in neurological function will impact on psychosocial aspect of health Self-esteem my be affected Social isolation my develop Safety becomes a concern especially if confusion, forgetfulness, tremors develop Depression may develop

9. Cultural and Environmental Considerations Most conditions not jeanetic Some studies say Alzheimer’s is environmental – aluminium Carbon monoxide, manganese and mercury may cause Parkinson’s Organophosphates in insecticides may cause peripheral neuropathy Lead poisoning = peripheral neuropathy and encephalopathy

10. F.A.S.T. F ace A rms S peech T ime

12. General Question Participation of client depends on symptoms Complete the following sentence “after I wake up, my day consists of……” What brings you here today? Are there changes in your ability to carry out daily activities? Medical history?

13. Questions r/t behaviour Do you have fainting spells, seizures or convulsions? Changes in vision? Changes in hearing? Change in ability to smell or taste? Describe your balance Do you have numbness or tingling anywhere?

14. Questions R/T behaviour Pain Headaches (PQRSTU) –Describe –Location –Frequency –Can you function with headache –What relieves the pain –Scale of 1-10

15. Questions for older adult Do you take longer to do things that 2 years ago When you stand do you have trouble starting to walk Do you have tremors What safety features do you have in your house

16. Now the Assessment… Inspection Palpation Auscultation Special equipment and procedures

17. Sequence of Assessment Mental status Cranial nerves Motor and sensory functions Balance Reflexes Distal to proximal Gross to fine movement Symmetry

18. Equipment Always explain and demo the purpose and uses of the equipment Standard precautions Exam gloves; percussion hammer; tuning fork; penlight; opthalmoscope; tongue blade; substances to smell; substances to taste; eye chart; colour blindness chart