Module 4A/B

Questions

Findings

Current Neuro Symptoms

Any neuro-related symptoms? (except headache, which will be evaluated below).

Past History

1. Head or spinal cord injury?

2. Meningitis, encephalitis or stroke?

Family History of Neuro issues

1. High blood pressure?

2. Stroke?

3. Alzheimer disease?

4. Epilepsy?

Lifestyle and Health Practices

1. Wearing of seat belts/protective headgear?

2. Frequent repetitive movements with hands—that might cause carpal tunnel syndrome?

3. Any neuro-related problems in functioning/daily activities?

Headache Evaluation

According to the World Health Organization, half to 3/4 of all adults globally get occasional headaches (WHO, 2016)! Documentation of headache evidence is something every nurse should be comfortable doing!

This is found in chapter 15 where the head is covered, but because serious forms of headache may have neuro implications, we will revisit it here. You will not be evaluated on the conclusion you deduced since you are not in a position to give a medical diagnosis, but you will be evaluated on your documentation of the evidence.

Character of the pain

Onset/precipitating factors

Location—area most involved.

Duration

Severity

Pattern

Associated factors

Which of the types of headaches described in table 15-1 is most likely the problem in this instance in your opinion? State simply the type of headache here.

Again, your conclusion my differ from mine and you will not be marked wrong if we disagree—the objective of this is to make you aware of the sum of the symptoms and the importance of addressing possible causes.

Questions

Findings

Mental Status

1. Assess level of consciousness.

2. Observe mood, feelings, and expressions.

Selected Cranial Nerves

Your Weber & Kelly textbook has illustrations given in order—it is an efficient and instructive method—Pg 558. You may omit testing the corneal reflex—people with contacts are often desensitized to it and patients with allergies will find it particularly irritating.

1. Test cranial nerve I—olfactory, stating substances you are using to test your patient’s sense of smell.

2. Test cranial nerve II—optic.

3. Test cranial nerve III—oculomotor.

4. Test cranial nerve IV—trochlear.

5. Test cranial nerve V—trigeminal.

6. Test cranial nerve VI—abducens.

7. Test cranial nerve VII-noting both motor and sensory functions

Motor and Cerebellar Systems

1. Test balance.

2. Test coordination.

Sensory System

1. Test light touch, pain, and temperature sensations.

2. Test vibratory sensations.

3. Test position sensations.

Reflexes

Not all the reflexes in the textbook are required. I list the ones that ARE required below.

You may use a reflex hammer, but patellar reflexes can be tested well using the edge of your hand—as if you were doing a gentle “karate chop” to the patellar area. You will need to practice it a few times, and not everyone has a noticeable kick—practice on more than one person, if necessary, to find someone with a visible patellar reflex. Bicep reflexes are checked best using the edge of your stethoscope to tap your own thumb which is placed over the bicep tendon (described on page 569 and shown on page 570).

1. Test deep tendon reflexes (bicep, patellar, and ankle clonus required, others optional). State the number of the response: 1+ to 4+

Bicep:

Patellar:

Ankle clonus:

2. Test superficial reflexes (plantar, abdominal).

Plantar:

Abdominal:

3. Test for meningeal irritation/inflammation (Brudzinski and Kernig signs).

Brudzinski sign:

Kernig sign: