Quizlet Achilles Reflex Aphasia Babinskis sign Balance Test Abnormal Findings Basal Ganglia Biceps Reflex Brachioradialis Reflex Brainstem Chapter 23 Health Assessment Jarvis ‘Study online at quizlet.com/_aspsu ‘Weak Response creased pain sensation nereased pain sensation ‘geabsent paint sensation creased touch sensation ‘2eabsent touch sensation nereased touch sensation ‘Normal Response Cerebellar System Exaggerated Response Hyperreflexia with clonus ‘Normal response isthe ipsilateral contraetion ofthe abdominal muscles ‘with an observed deviation of the umbilieus towards the stroke. Cerebellar System Location Foot plantar flexing againist your hand is the normal response the loss of the ability to speak, write, and/or comprehend the writen or spoken ‘words usually caused by damage to left hemisphere Pathologie Reflex Abnormal response is dorsiflexion of the big toge and fanning ofall toes, "Upgoing toes” ‘Occurs with upper motor neuron disease of the corticospinal tract. Cerebellum Stiff, immobile posture. Staggering oF reeling. Wide base of support Lack of arm swing or rigid arms, ‘Unequal rhythm of steps Slapping of foot. Seraping of toe of shoe. Cerebral Cortex large bands of gray matter buried deep ‘within the 2 cerebral hemispheres that form the subcortical associated motor system. they help to initiateand ‘coordinate movement and control automatic associated movements of the body (arm swing alternating with legs while walking) Cerebral Cortex Funetion ‘Normal responses the contraction of the biceps muscleandilexion ofthe forearm. >. Corticospinal/Pyramidal ‘Normal response is flexion and ‘Tract supination of the forearm Central core ofthe brain consisting mostly of nerve fibers. Cranial nerves IIL - ‘Xl originate from nuded in brainstem. Has three areas: midbrain, pons, medulla Cranial Nerve Cranial Nerve Il In frontal lobe, mediates motor speech. ‘When injured, expressive aphasia results meaning the person cannot talk. (Can understand language and know what heor she wants to say but can produce it) Complex motor system coordinates movement, ‘maintains equilibrium and helps maintain posture and maintains musele tone, Coiled structure under the occipital lobe. Receives information about what kind of motor messages are being sent from the cortex to the muscles. Coiled structure under occipital lobe that is concerned with rotor coordination of voluntary rmovernents, equilibrium (postural balance of bods), and muscle tone. Does NOT initiate movement but coordinates and smoothes (the complex and quick coordination of many different muscles needed in playing piano, swimming, sigaling) Is the cerebrum's outer layer of nerve cell bodies which look like "gray matter” because tacks rnyelin| Is the center for humans highest fanetions governing thought, memory, reasoning, sensation and voluntary movement, Brain and Spinal Cord state of profound unconsciousness from which person cannot be aroused Higher motor system that humans have that permits very skilled and purposeful movements, Example: Writing Olfactory Function: Smell Optic Function: VisionCranial Nerve Mm Cranial Nerve Vv Cranial Nerve 1x Cranial Nerve v Cranial Nerve VI Cranial Nerve vu Cranial Nerve vu Cranial Nerve x Cranial Nerve XI Cranial Nerve x Crossed Representation Oculomotor Funetion: Motor Funetion of extragceular ‘movement, opening of eyelids Parasympathetic functions of pupil constriction and lens shape. Trochelear ‘Motor Function: Down andinward ‘movement of the eve Glossopharyngeal ‘Motor Funetion-pharynx including swallowing and phonation Sensory Function- taste on posterior one- third ofthe tongue, pharynx (gag reflex) ‘Trigeminal ‘Motor Function: Museles of mastication (chewing) Sensory Function:sensation of face and sealp, comea, mucous membranes of mouth and nose Abducens ‘Motor Function: Lateral movement of the ee Facial ‘Motor Function: facial muscles, close eye, labial speech, close mouth Sensory Function: Taste (sweet, salty, sour, bitter) on the anterior 2/3 of the tongue Parasympathetie function-saliva and tear secretion Acoustie Sensory Function: Hearing and equilibrium Vagus ‘Motor Function: Pharynx and Larynx: (talking and swallowing) Sensory Function: General sensation from carotid body, earotid sinus, pharynx , Parasympathetie function: carotid reflex spinal ‘Motor Function: Movement ofthe trapecius and sternomastoid muscles Hypoglossal ‘Motor Function: Movement ofthe tongue ‘Theleft cerebral cortex receives sensory information from and controls motor functions tothe right side ofthe body, while the right cerebral cortex receives sensory information from the left side of the body. decerebrate rigidity decorticate rigidity Decreasein cerebral blood flow Deep tendon reflex deep tendon reflex Dermal ‘Segmentation Dermatone Dermatones €6, C7, C8 Dermatones Li Dermatones Dermatones Level Ts Dermatones Level T4 Dermatones Level To Upper extremities- sty extended, adducted, internal rotation,palms pronated. Lower extremitis-stifly extended, plantar flexion; teeth clenched:hyperestended backsindicates lesion in thebrain stem at midbrain or upper pons Decorticate rigidity occurs when there are lesions ofthe cerebral hemispheres. Damage to the brain oceurs above the brainstem and cerebellum (i. above the tentorum). There is upper extremity flexion (arms i fetal position) and lower extremity extension. Oceurs with aging Can cause dizziness and loss of balance with position change. These people need tobe taught to get up slowly to prevent alls Reveals the intactness of the reflex ae at specific spinal levels as well asthe normal ‘override on the reflex of the higher cortical levels. Consists of: Biceps, Ticeps, Brachioradialis, Quacriceps, Achilles Reflexes Reveals the intactness of the reflex ae at specific spinal levels as well as the normal ‘override on the reflex of the higher cortical levels. Consist of Patella, Biceps, Triceps, Brachioradialis, Quadriceps, Achilles Reflexes cutaneous distribution ofthe various spinal a cireumseribed skin area thatis supplied rainly from one spinal cord segment through a particular spinal nerve. They overlap, a biologi insurance if one nerveis severed, ost of sensations can be transmitted by the ‘one above or below thumb, middle finger, fith Ginger (within those dermatones) Groin (within level ofthis dermatone) Knee (within level of this dermatone) Axilla (within level of this dermatone) Nipple (within level ofthis dermatone) Umbilicus (within level of this dermatone)| During an assessment of the eranial nerves, the nurse finds the following: lack of blinking in the right eye with corneal reflex, intact ability to sense light touch on face, loss of movement with facial features on the right side. This, would indicate dysfunction of which cranial nerves? During the assessment of deep tendon reflexes, the nurse finds that a patients responses are normal bilaterally. Indicate what number is used to indicate normal deep tendon reflexes when documenting this finding? dysphasia Finger to finger test Motor component of vir 26 Reflex impairmentin speech consisting of lack of coordination and inability toarrange words in their proper order With person's eyes open, ask thatheor she use the index fingerto touch your finger, then his or her After afew times move your finger to ‘different spot Normal Finding: Persons ‘movement smooth and accurate Finger tonose test Frontal Lobe glasgow coma seale Graphesthesia Hypothalamus Kinesthesia Knee Bend/Hop in Place Left Cerebral Cortex Light Touch, Loss of vibration Medulla ‘Ask the person to close their eyes and to stretch out the arms. ‘Then ask person to touch the tip of their nose with each index finger, alternating hhands and increasing speed, Areas Concerned with personality, behavior, ‘emotions, and intelleetual function, PRECENTRAL GYRUS: Initiates voluntary movement. 15 = no coma, 7 coma, 3 profound coma. Eye ‘opening, verbal response, motor response Is the ability to"read" a number by having it traced on the skin, With the person's eyes closed, usea blunt instrument to trace a single digit number ora letteron the palm. Ask the person to tell you what itis. ‘This is a Good measure of sensory loss ifthe person cannot make the hand movements needed for stereognosis, Major respiratory center with basic vital functions: temp, appetite, sex drive, heart rate, and blood pressure control, sleep ‘enter, anterior and posterior pituatary gland regulator, and coordinator of autonomic nervous system activity and stress respons ‘Test the persons ability to perceive passive movements ofthe extremities. (Positions) Movea finger on the big toe up and won and ask the person to tell you which way it moved. Make sure the persons's eyes are closed and that they understand the test. Demonstrates normal position sense, muscle strength and cerebellar function Receives sensory information fromand controls motor function tothe right side of the body Apply a wisp of cotton to the skin Brush itover the skin in a random order of sites and at irregular intervals, ‘Ask person to say now when felt ‘Occurs with peripheral neuropathy like Diabetes, and alcoholism Often first sensation lost ‘continuation of spinal cord in the brain that contains all ascending and descending traets; has vital autonomie centers (respiration, heart GI funetion), as well as nucle for eranial nerves VII XIL Pyramidal decussation (crossing of motor fibers occurs here)Midbrain Motor Nerve fibers nystagmus objective vertigo Oceipital Lobe Pain Paralysis Paresthesia Parietal Lobe Peripheral Neuropathy Plantar Reflex PNS PNS » Pons o Positive Romberg Sign most anterior part of brainstem that still has the basic tubular strueture of the spinal cords ‘merges into the thalamus and hypothalamus; contains motor neurons and tacts. Origniate in the motor cortex and travel to the Drain stem where they eross tothe opposite or ‘contralateral side and then pass down in the lateral column of the spinal cord. Proprioception back-and-forth oscillation of the eyes; oceurs with disease ofthe vestibular system, cerebellum, or brainstem Quadriceps Reflex Rapid Alternating Movements feels like the room is spinning Pri ry visual receptor. ‘Tested by the person's ability to pereeivea pinprik Right Cerebral Cortex Loss of motor funetion due to lesion in the neurologic or muscular system or loss of sensory innervation Romberg Test abnormal sensation (such as burning, pricking, or tingling sensation, often in the ‘extremities; may be caused by nerve damage or peripheral neuropathy Postcentral gyrus: Primary center for sensation Spinal Cord Abnormal Finding for Vibration Test Is worse atthe feet and gradually improves as {you move up the leg. Position the thigh ina slight external rotation. ‘With the reflex hammer, draw a light stroke up the lateral side ofthe sole of the food AND. inward aeross the ball ofthe foot like in an upside down J shape. "Normal Response: Plantar flexion of the toes (toes curl) and inversion and flexion of the forefoot. Spinothalmie 12 Pairs of Cranial Nerves one 431 Paits of the spinal nerves Carries sensory afferent messages to the CNS from sensory receptors. ‘Stereognosis “Carries sensory messages to the CNS from Sensory receptors Carries motor messages from the CNS out to the museles and glands Controls autonomic messages that govern the internal organs and blood vessels. enlarged area of brainstem, containing ascending sensory and descending motor tracts. Has two respiratory centers (pneuotaxie ‘and apneustie) that coordinate with the main respiratory center in the medulla Loss of balance that oceurs when closing the eyes. Occurs with cerebellar ataxia (multiple sclerosis, aleohol intoxication) loss of proprioception and vestibular funetion Without looking you know where your body parts are in relation to space and each other, vibration and finely localized touch. Extension of the lower leg is the expected response “Assess coordination by asking person to patthe knees with both hands, lift up, tur hhands over and pat knees with the backs of the hands. Then ask them todo it faster. Normal Finding: Done with a equal turing ‘and quick rhythmie pace Receives sensory information fromand controls motor function on thelleft side of the body. ‘Ask the person to stand up with feet together and arms at the sides, Once in a stable position, wait 20 seconds. Normal Finding: a person ean maintain posture and balance even with visual orienting information blocked, although slight swaying may oceur. long, eylindeie structure of nervous tissue; ‘occupies upper two-thirds of the vertebral canal from the medulla to lumbar vertebrae Lu-La. Its white matter is bundles of myelinated axons that form main highway forascending and descending fiber tacts that connect brain to spinal nerves; it ‘mediates reflexes of posture control, urination, pain response; its nerve cell bodies, or gray matter, are arranged in a butterfly shape with anterior and posterior "horns" Has sensory fibers that transmit the sensations of pain, temperature, and light touch ‘Test the persons ability to recognize objects by feeling their forms, sizes and weights. Example: With person's eyes closed place a familiar object like a paperclip, key, coin, cottonball or pencil in their hands and ask them to identifyit, Normal Finding: Person will explore it with fingers and correetly nameit, ‘Assess with a different object in each hand.» subjective vertigo Summation Superficial Reflexes, ‘Tandem walking ‘Temporal Lobe Testing persons gait/balance ‘Testing the Deep tendon reflex ‘Thalamus Tie ‘Triceps Reflex » Vibration Test ___is present when the patient experiences Viseeral Reflex the sensation of turning or moving around in space. Objective vertigo is the sensation of, ‘objects moving around the patient. o) Wernicke's area ‘When frequent consecutive stimuli are perceived as one strong stimulus ‘Avoid this by letting 2 seconds lapse between cach stimulus, initiated by gentle cutaneous stimulation Ex) plantar reflex is initiated by stimulating the: When thenurse lateral aspect of the sole ofthe foot istesting the response is downward flexion of toes triceps reflex, indirectly test for proper corticospinal tract what is the functioning expected = Babinski’s sign: abnormal plantar reflex response? indicates corticospinal damage where the great toe dorsiflexes and the small toes fan laterally Assess balance by asking person to walk a straight linein a heel-to-toe fashion, ‘This deereases the base of support and will accentuate any problem with coordination, ‘Normal Finding: The person ean walk straight and stay balanced, Primary auditory receptor center with funetions in hearing, taste, and smell Observe persons gaitas they walk 10 to 20 feet, tums and retums to the starting point ‘Normal Finding:The person moves with a sense of freedom; The gaitis smooth, rhythmic ‘and effortless, the opposing arm swing is coordinated and the tums are smooth, Step Length about asinehes from heel to hee. ‘The limb should be relaxed and the muscle partially stretched, Stimulate the reflex by directing a short, snappy blow of the hammer ‘onto the muscles insertion tendon, Example: Knee Jerk or Patellar Area ‘Main relay station where sensory pathways of the spinal cord, cerebellum, and brainstem form synapses (sites of contact between two neurons) on their way to the cerebral cortex repetitive twitching ofa muscle at inappropriate times ‘Normal response is extension ofthe forearm ‘Testing the persons ability to feel ofa tuning fork over the body prominence Strike the tuning fork with the heel of your hhand and place ton the person's fingers oF sgreattoe. ‘Normal Finding: Feels buzzing sensation on these distal areas, you may assume proximal spots are normal and move on, Example: Pupillary response to lightand ‘accommodation In Temporal lobe Associated with language ‘comprehension. When damaged, receptive aphasia results meaning the person hears sound, butithas no meaning (Like hearing a foreign language) Extension of the arm