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Essential Components of Neurological Assessment
Sep 25, 2024
Neurological Assessment Lecture Notes
Introduction
Focus on neurological assessment of a patient.
Key components: level of consciousness, motor function, pupillary function, respiratory function, and vital signs.
Importance of understanding these components prior to class.
Level of Consciousness
Most crucial part of the neurological exam.
Glasgow Coma Scale (GCS):
Objective tool measuring eye opening, verbal response, and motor response.
Max score of 15, indicating higher levels of function.
Levels of consciousness:
Alert:
Aware and oriented.
Confused:
Awake but disoriented.
Delirium:
Uncontrolled excitement/emotion.
Lethargic:
Sleepy but easily arousable.
Obtunded:
Difficult to arouse, confused.
Stuporous:
Near unconsciousness.
Comatose:
Unconscious and unresponsive.
Motor Function
Assessment includes motor strength, tone, and reflexes.
Gross and fine motor skills.
Reflex evaluation; corresponding cranial nerve review advised.
Levels of motor response:
Spontaneous:
Follows commands.
Localization:
Responds to painful stimuli.
Withdrawal:
Moves away from pain.
Decortication:
Abnormal posturing, related to corticospinal pathway lesions.
Decerebration:
Linked to brain stem injury.
Flaccid:
No movement, even with painful stimuli.
Pupillary Function
PERLA:
Pupils Equal, Round, Reactive to Light and Accommodation.
Assess pupil size, shape, and reaction to light.
Pay attention to past eye surgeries or medications affecting pupil appearance.
Oculocephalic Reflex:
Eye movement with head rotation.
Caloric Test:
Cold or warm water in ear canal; eyes should move toward water.
Respiratory Function
Evaluate breathing patterns:
Cheyne-Stokes:
Alternating apnea and rapid breathing.
Central Neurogenic Hyperventilation:
Deep and rapid breaths.
Apneustic Breathing:
Gasping inspiration with pauses.
Cluster Breathing:
Series of respirations followed by apnea.
Ataxic Respirations:
Irregular breathing and pauses.
Ensure airway is clear and maintained.
Vital Signs
Monitor blood pressure, heart rate, and rhythm.
Cushing's Triad:
Late sign of increased intracranial pressure.
Symptoms: severe hypertension, widened pulse pressure, bradycardia.
Conclusion
Comprehensive assessment necessary for neurologically impaired patients.
Understanding these components critical for patient care.
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