Assessing Deep Tendon Reflexes

Introduction

• Presenter: Sarah from RegisteredNurseRN.com
• Purpose: Overview of assessing deep tendon reflexes as a nursing student or nurse.
• Focus Reflexes: Bicep, Tricep, Brachioradialis, Patellar, Achilles
• Tool Needed: Reflex Hammer

Importance of Assessing Deep Tendon Reflexes

• Evaluates lower motor neurons/fibers at specific body levels.
• Example:
  • Brachioradialis reflex assesses C5 to C6.
  • Tricep reflex assesses C7 to C8.
• Part of the neuro assessment in head-to-toe evaluations.
• More frequent in specific nursing fields like neurology and labor & delivery.

Situational Uses

• Labor & Delivery:
  • Hyperactive reflexes can indicate preeclampsia.
  • Reflexes need monitoring when administering magnesium sulfate.
• Electrolyte Imbalances: Baseline reflex assessment on med-surg floors for patients with abnormal electrolyte levels.

Grading Deep Tendon Reflexes

• 4+: Hyperactive (Clonus)
• 3+: Brisker than normal (Hyperreflexive)
• 2+: Normal
• 1+: Diminished (Hyporeflexive)
• 0: Absent response

Tips for Eliciting Responses

• Swing hammer briskly, not too slow or fast.
• Ensure hammer does not rest on the tendon after hitting.
• Locate the tendon by having the patient flex the associated muscle.

Detailed Reflex Assessment

1. Bicep Tendon

• Location: Below bicep muscle in the antecubital fossa.
• Technique:
  • Patient flexes arm to locate tendon.
  • Place thumb over tendon, patient relaxes forearm on lap.
  • Briskly hit thumb with hammer.
• Response: Bicep contraction, forearm flexion (C5 to C6).

2. Tricep Tendon

• Location: Back of the arm, above the elbow.
• Technique:
  • Extend arm to find tendon.
  • Arm should be relaxed.
  • Briskly hit tendon with hammer.
• Response: Forearm extension, tricep contraction (C7 to C8).

3. Brachioradialis

• Location: Above radial styloid process on the wrist.
• Technique:
  • Find radial styloid process, go 2-3 cm above.
  • Thumb upward, forearm relaxed on leg.
  • Briskly hit area.
• Response: Hand supination, forearm flexion (C5 to C6).

4. Patellar Reflex

• Location: Below the kneecap.
• Technique:
  • Have patient extend leg, locate tendon.
  • Support knee with hand.
  • Tap tendon briskly.
• Response: Lower leg extension (L2 to L4).

5. Achilles Tendon

• Location: Above the heel.
• Technique:
  • Patient’s foot dangling, dorsiflex foot.
  • Tap tendon briskly.
• Response: Plantar flexion of the foot (L5 to S2).

Conclusion

• Practice is crucial to differentiate hyperreflexive vs. hyporeflexive responses.
• Encouragement to view more nursing skill videos.
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