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Resources

http://philschatz.com/anatomy-book/contents/m46577.html

https://lane.stanford.edu/portals/cvicu/HCP_Neuro_Tab_4/Neuro_Assessment.pdf

Pupillary Assessment:

Neurological/ Sensory Perception Assessment

Assessing the pupils:

- size

-shape

-reactivity of light

-comparison of one pupil to the other.

Level of Consciousness:

Cerebellar Function:

- Observe patient's:

~ normal voice

~ shout

~ light touch

~ pain

Use Glasgow Coma Scale (GSC) if

assessment of awareness progresses.

The cerebellum is responsible for muscle coordination and balance on the same side.

Testing:

- Finger to Finger test

- Finger to nose test

- Tandem Walking

- Romberg Test

Interview:

- Gather subjective and objective data

- Background information

- Clarify information

- Develop a relationship with client

Tone:

The Assessment

-Look at the muscles on each side of the body.

-Reflex response:

0 no response

1+ diminished, low normal

2+ average, normal

3+ brisker than normal

4+ very brisk, hyperactive

Assessment Overview:

Sensory Function:

Understanding:

- Interview

- Level of Consciousness

- Pupillary Assessment

- Vital Signs

- Motor Function

-Sensory Function

- Tone

- Cerebellar Function

Definitions:

-Receptors are sensitive to the five senses.

- Perception is dependent on sensations, but not all sensations are perceived.

There are three main pathways for sensation and they should be compared bilaterally:

- pain and temp. sensation

- position sense

- light touch

Motor Function:

- Observe:

~ muscle size

~ muscle tone

~ muscle strength

~ involuntary movements

~ posture, gait

- Sensory Perception: occurs in organisms capable of performing neurophysiological processing of the stimuli in their environment.

~ the five senses

- Perception: the central processing of sensory stimuli into a meaningful pattern

- Receptors: the cells or structures that detect sensations.

- Trransmembrane protein receptor: a protein in the cell membrane that mediates a physiological change in a neuron

- Ligands: chemicals that activate transmembrane protein receptors.

Vital Signs:

Focus should be on arm and leg movement

Respiratory:

- Ensure patient airway is maintained

- Assess rate, rhythm, and characteristics of inspiration/ expiration

- Assess gas exchange, tissue perfusion, airway clearance, and risk of aspiration

- Assess for causes of respiratory disturbances or secondary conditions that can cause respiratory complications

-Assess for actual respiratory complication/ insufficiency and intervene appropriately

- Blood Pressure, Temperature, Pulse

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