Unit 4-6 Study Ch 43:

Assessment of the Nervous System CNS: Brain and spinal cord. PNS/ANS: Sympathetic (fight or flight), Parasympathetic (rest and digest). Cranial nerves: II Optic- central and peripheral vision, IV Trochlear- eye movement, VI Abducens- eye movement by lateral rectus muscles. Assess by the Six Cardinal field of vision. Sensory: Pain and light touch are most commonly assessed. Assess with any sharp or dull object (cotton tip or paperclip). Instruct pts with diminished touch sensation to look at feet for placement when walking, do not walk barefoot and avoid throw rugs. Motor Function: Observe for involuntary movements such as tremors, pill-rolling or intention tremors. Romberg sign, the problem is propriception (awareness of body position) this is done by having the pt. stand with arms out and eyes closed, check for swaying. Babinski sign- positive is the abnormal response with toe upgoing; this can occur with drug and alcohol intoxication, after a seizure, multiple sclerosis and liver disease. Posturing: Decerebrate is seen with dysfunction of the brain stem area, characterized by extension of arms and legs, pronation of the arms, feet are planter flexed and opisthotonos (body spasms in which the body is bowed forward). Decortication is seen with lesions that interrupt the corticospinal pathway, characterized by arms, wrist and fingers flexed with internal rotation and planter flexion of the feet. You will also see pinpoint or dilated, nonreactive pupils with these as well. Pupil constriction is a function of cranial nerve III. Accommodation: pt is asked to focus on a distant object and then immediately look at an object 4-5 inches from the nose. These eyes should cross and the pupil contract. Lab Test: PET scan- provides info about the function of the brain and cerebral blood flow. CT scan- assess for allergies, increase fluids after the procedure to flush the kidneys. EEG- records the electrical activity of the cerebral hemispheres, requires sleep deprivation and possible anticonvulsants withheld. Evoked Potentials: confirms neurological conditions such as MS, brain tumor, acoustic neuromas (tumors of the inner ear) and spinal cord injuries. Auditory evoked assess hearing loss, visual evoked assess loss of vision due to optic nerve damage, and somatosensory measures response to stimuli to detect nerve or spinal cord damage or nerve degeneration. Lumbar Puncture: insertion of spinal needle between the 3rd and 4th lumbar vertebrae, done to obtain CSF for testing and can be used to inject drugs and anesthetics, and to reduce pressure. This test is contraindicated in pts with ICP and skin infection on or near site. Spinal headache is possible. Be sure the pt does not move, make sure proper placement by seeing CSF. Normal CSF pressure ranges from 50-180mm for children it is 10100mm. CSF can be tested for meningitis, bacterial, TB and fungal CSF will be yellow and viral meningitis will be clear. If a brain hemorrhage has occurred CSF may change from red to yellow to brown. Cloudy CSF may mean an infection such as meningitis or a brain abscess. CSF values: pressure <20cm H2O is normal, color clear is normal, cells- < 0.5, protein- 15-45 and up to 70 in older adults, glucose- 50*75 or 60-70% of glucose is normal.