Hey everyone, it's Sarah with RegisteredNurseRN.com and in this video I'm going to go over how to assess the deep tendon reflexes. What I'm going to do for you in this video is I'm going to go over a short overview on how to assess the deep tendon reflexes as a nursing student or nurse. Then I'm going to show you how to individually assess the following deep tender reflexes.
The bicep, the tricep, the brachioradialis, the patellar, and the achilles. And in order to do this, you will need a reflex hammer. And this is what a common reflex hammer looks like. So you may be asking yourself, what is the purpose? Why do we even assess the deep tendon reflexes?
Well, the deep tendon reflexes help us to evaluate the lower motor neurons slash fibers at specific levels in the body. So what that means is say you're going to take your reflex hammer and you're going to assess the brachioradialis tendon. This tells us how the spinal nerve root C5 to C6 is working. Is it working appropriately? Or the triceps.
So you're going to hit on the tricep tendon. It tells us how C7 to C8 is working. And I'll go over those individually whenever I show you how to do them.
Now as nurses, whenever we are completing our assessments, our head to toe assessments, this is generally conducted during the neuro assessment part. And depending on what specialty you work in as a nurse, you will do this a lot more routinely than compared to other specialties. Now in nursing school, you're going to have to learn. How to do this? Probably get checked off by your professor in a listening responses in those five deep tendons.
As a nurse, you're not going to do it as commonly as you are listening to the lungs. Every nurse is going to listen to all their patient's lungs, but not necessarily check their deep tendon reflexes. For instance, neuro settings and labor and delivery settings are probably going to use this skill a lot more than compared to a cardiac nurse. Just to give you an idea, in labor and delivery you have pregnant women.
Pregnant women are at risk for preeclampsia. One of the signs and symptoms of preeclampsia is hyperactive deep tendon reflexes. As a nurse, you're going to be checking those deep tendon reflexes to see if that's happening. Also, these women sometimes get magnesium sulfate because of these conditions and you want to be also checking those deep tendon reflexes.
We talked about in the electrolyte videos, with some of the electrolyte imbalances, you can have diminished deep tendon reflexes. Say you are working on... on a med-surg floor and your patient has really low electrolyte levels or high electrolyte levels, you'd want to check those deep tendons to make sure you have a baseline compared to before.
So all of a sudden they're diminished. How were they whenever you assessed them earlier? So that is why we want to do this as nurses. Now for documentation purposes, whenever you do assess your deep tendon reflexes, you use a grading scale.
Now whenever you're checking deep tendon reflexes, you need to practice. this skill over and over because you have to understand what hyperreflexive versus hyporeflexive is because this skill is really subjective and it takes practice to understand it so let me go over how you would grade okay a 4 plus this is what is super really active this is the highest score you can get it's considered hyperactive or clonus next is a 3 plus this is where it's brisker than normal it's considered hyper reflexive. And two, this is where you want the patient.
This is normal. So hopefully your patient is scoring a two plus. And a one plus is diminished.
They're not very reflexive. And you would consider this hypo reflexive. And zero, a score of zero means they're completely absent. You get no response at all.
So now let's go over these five deep tendon reflexes and show you how to elicit response in one. Now let's elicit the responses of the deep tendon reflexes. Okay, a lot of people, whenever you're first starting out, they have trouble eliciting a response.
So some tips whenever you are going to get that tendon to respond, you want to make sure you swing your hammer nice and brisk, not too slowly, not too fastly. Make sure you move it back because you don't want the hammer to rest on the tendon after you hit because you're not going to get the response you want. Also, you want to make sure that you're hitting a tendon.
A lot of people, whenever they're beginning, they really don't know what they're hitting. And what you're hitting is the tendon. tendon of that particular muscle.
So always make sure you're finding that and a good way to get to find that tendon is that to have the patient flex the muscle and you can feel a cord-like area which is the tendon of where you're supposed to hit. So the first one we're going to hit is the bicep tendon. Okay the first tendon reflex we're going to check is the bicep tendon.
And the bicep tendon is located below the bicep muscle in the antecubital fossa area. If you're beginning out, what you want to do is you want to find that tendon. So to find the tendon, we are going to have the patient flex the arm and flex the bicep, and you will find it right in there, and it feels like a cord-like area. And whenever you find it, just put your thumb over it. And this is going to elicit a response of C5 to C6.
So I have my thumb over the tendon area and I'm going to have him relax the muscle and just drape his forearm over his lap and then I'm just going to hit with my hammer briskly. And what you're looking for is contraction of the bicep and flexion of the forearm. We had a little bit of a response and there we go.
Okay, now let's do the tricep. Okay, now we're going to check the tricep deep tendon. And it is located on the back of the arm right... above the elbow and if you're just new you're trying to find it what you can do is just extend the arm out and you can feel just right above the elbow that deep tendon so what you're going to do is you want this whole area to be relaxed so we're going to help the patient dangle their arm, tell them to let it go limp. And this is going to check C7 to C8.
What we're going to do is we're going to take the hammer and just briskly hit on that deep tendon. And what you'll see is extension of the forearm and a slight contraction of the tricep. So here we go. And seeing that flex and that contract, do it one more time.
There we go. Now let's check our brachioradialis. Okay, we're going to check the brachioradialis deep tendon, and this is checking C5 to C6. This can be one of the most difficult tendons to find because it's not as pronounced as the other tendons. So what you want to do is you want to find the radial styloid process, which is the nodule on the wrist, and go about two to three centimeters above that.
Have the patient turn. turn, where their thumb's upward, relaxing the forearm, resting it on their leg. So we're going to go right above that. And what we're looking for is for the hand to supinate, which the palm will turn out upward, and you will see a little bit of flexion in the forearm.
Okay. Did you notice that right there? Okay, now let's check our patellar and our Achilles. Okay, to check the patellar reflex, this is going to be looking at L2 to L4. And to find the tendon, what you want to do is...
locate the kneecap and then go just a little bit right below it and the best way is to have the patient extend the leg out and then that tendon will pop out and that is where you're going to go okay after locating the tendon put your hand behind the knee just to support it have them relaxed and the tendons right here and what you're going to do is you're just going to tap briskly and what we're looking for is this lower leg to extend outward so here we go response there and one more time and got really good response there. Okay now let's check the Achilles. The Achilles is going to look for L5 to S2 and this is best done having the patient dangle their feet just like whenever you're checking the patella.
you usually want to tuck those two together. And what you're going to do is you're going to dorsiflex the foot up like that and you will see the tendon which is located right above the heel. It's right there and what we're going to do is we're looking for the foot to plantar flex. So it's going to go down like that to elicit response, but in order to do it you're going to dorsiflex the foot by supporting your hand underneath it and just tapping the bottom of it and flex. Okay so that is how you check the deep tendon reflexes.
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