1. Copyright 2002, Delmar, A division of Thomson Learning Chapter 19 Mental Status and Neurological Techniques

2. Copyright 2002, Delmar, A division of Thomson Learning Competencies Discuss the divisions of the nervous system and their functions. Relate blood flow to the brain to the functional area supplied. Describe the characteristics of the most common neurological complaints. (continues)

3. Copyright 2002, Delmar, A division of Thomson Learning Competencies Perform a mental status assessment and document the results. Explain the pathophysiology of any abnormal results obtained. Document a complete health history as it relates to the neurological system.

4. Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Protective layers  Scalp  Skull  Meninges  Dura mater  Arachnoid mater  Pia mater

5. Copyright 2002, Delmar, A division of Thomson Learning Central Nervous System Brain Cerebrum: right and left hemispheres Cerebral cortex  Memory storage and recall  Sensation  Vision, hearing, motor function

6. Copyright 2002, Delmar, A division of Thomson Learning Lobes of the Cerebrum Parietal  Somatic sensory Frontal  Higher intellectual function  Speech production  Ipsilateral motor control (continues)

7. Copyright 2002, Delmar, A division of Thomson Learning Lobes of the Cerebrum Temporal  Hearing  Memory  Speech perception Occipital  Vision Limbic  Emotion

8. Copyright 2002, Delmar, A division of Thomson Learning Brain Diencephalon  Body temperature regulation, pituitary hormone control, autonomic nervous system responses Cerebellum  Maintains posture and equilibrium Brain stem  Respiratory and cardiac regulation, level of awareness, reticular activating system

9. Copyright 2002, Delmar, A division of Thomson Learning Spinal Cord Gray matter White matter Dorsal horn Ventral horn (continues)

10. Copyright 2002, Delmar, A division of Thomson Learning Spinal Cord Motor pathways of CNS  Pyramidal tract  Extrapyramidal tract  Cerebellum Sensory pathways  Spinothalamic tracts  Posterior column

11. Copyright 2002, Delmar, A division of Thomson Learning Blood Supply Circle of Willis Carotid arteries Cerebral arteries Basilar artery Cerebellar arteries

12. Copyright 2002, Delmar, A division of Thomson Learning Peripheral Nervous System 31 pairs of spinal nerves  Eight cervical  Twelve thoracic  Five lumbar  Five sacral  One coccygeal Dorsal (afferent) root Ventral (efferent) root Dermatomes

13. Copyright 2002, Delmar, A division of Thomson Learning Cranial Nerves Motor, sensory, or both Olfactory (I) Optic (II) Oculomotor (III) Trochlear (IV) Trigeminal (V) (continues)

14. Copyright 2002, Delmar, A division of Thomson Learning Cranial Nerves Abducens (VI) Facial (VII) Acoustic (VIII) Glossopharyngeal (IX) Vagus (X) Spinal accessory (XI) Hypoglossal (XII)

15. Copyright 2002, Delmar, A division of Thomson Learning Reflexes Specific response to adequate stimulus Monosynaptic Polysynaptic Classes  Muscle strength or deep tendon  Superficial  Pathological

16. Copyright 2002, Delmar, A division of Thomson Learning Health History Age  Early adult  Middle adult  Older adult Gender  Female  Male Race  African American

17. Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Seizure Syncope Pain Paresthesia (continues)

18. Copyright 2002, Delmar, A division of Thomson Learning Common Chief Complaints Disturbances in gait Visual changes Vertigo Memory disorders Difficulty with swallowing or speech

19. Copyright 2002, Delmar, A division of Thomson Learning Characteristics of Chief Complaints Quality Quantity Associated manifestations Aggravating factors Alleviating factors Setting Timing

20. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical  Neurologic specific  Non-neurologic specific Surgical Medications Communicable diseases (continues)

21. Copyright 2002, Delmar, A division of Thomson Learning Past Health History Injuries and accidents Family health history Social history  Alcohol, tobacco, drug use  Sexual practices  Work and home environment Health maintenance activities

22. Copyright 2002, Delmar, A division of Thomson Learning Assessment Equipment  Touch  Hearing  Visual acuity  Reflexes  Smell General approach  Assess mental status first

23. Copyright 2002, Delmar, A division of Thomson Learning Mental Status Physical appearance and behavior Level of consciousness  Glasgow Coma Scale Cognitive abilities and mentation  Mini Mental State Examination

24. Copyright 2002, Delmar, A division of Thomson Learning Sensory Assessment Exteroceptive sensation  Light touch, superficial pain, temperature Proprioceptive sensation  Motion, position, vibration Cortical sensation  Stereognosis, graphesthesia, extinction

25. Copyright 2002, Delmar, A division of Thomson Learning Cranial Nerves Olfactory (I) Optic (II) Oculomotor (III) Trochlear (IV) Trigeminal (V) Abducens (VI) (continues)

26. Copyright 2002, Delmar, A division of Thomson Learning Cranial Nerves Facial (VII) Acoustic (VIII) Glossopharyngeal (IX) Vagus (X) Spinal accessory (XI) Hypoglossal (XII)

27. Copyright 2002, Delmar, A division of Thomson Learning Motor System Extrapyramidal rigidity  Decerebrate  Decorticate Cerebellar function  Coordination  Gait  Station

28. Copyright 2002, Delmar, A division of Thomson Learning Reflexes Deep tendon  Grading scale 0–4+  Compare right to left  Biceps, brachioradialis, triceps, patellar, archilles Superficial  Abdominal, plantar, cremasteric, bulbocavernosus Pathological  Grasp, snout, glabellar, sucking, Babinski, clonus

29. Copyright 2002, Delmar, A division of Thomson Learning Advanced Techniques Meningeal irritation  Nuchal rigidity  Kernig’s sign  Brudzinski’s sign

30. Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Increased risk for ischemic brain injuries Decreased rate of nerve conduction Decreased number of neurons Decreased neurotransmitter production Sensory alterations Cognitive changes

31. Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Posture erect, smooth gait, symmetrical body movements Clean, well-groomed, appropriate clothing for age and weather Facial expressions appropriate to conversation content, symmetrical (continues)

32. Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Affect appropriate to situation and cultural norms Able to produce spontaneous, coherent speech Alert, oriented to person, place, time (continues)

33. Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Intact cognitive abilities Able to accurately perceive light touch, superficial pain, temperature Able to identify changes in position of body, vibration, common objects (continues)

34. Copyright 2002, Delmar, A division of Thomson Learning Normal Findings Cranial nerves intact Cerebellar function intact, gait stable Deep tendon reflexes present 2+ bilaterally