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NEUROLOGIC ASSESSMENT.pptx

  1. 1. NERVOUS SYSTEM ASSESSMENT BY: ROMMEL LUIS C. ISRAEL III
  2. 2. MENTAL STATUS
  3. 3. LEVEL OF CONSCIOUSNESS - It also describes the degree to which a person can respond to standard attempts to get his or her attention. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  4. 4. LEVEL OF CONSCIOUSNESS - There are a variety of medical conditions and drugs that contribute to the level of a person's consciousness. Sometimes impaired consciousness is reversible, while other times it is not. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  5. 5. TERMINOLOGIES IN LOC • CONSCIOUSNESS - identifies a state in which a patient is awake, aware, alert, and responsive to stimuli. • UNCONSCIOUSNESS - identifies a state in which a patient has a deficit in awareness and responsiveness to stimuli (touch, light, sound). A person who is sleeping would not be considered unconscious, however, if waking up would result in normal consciousness. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of- consciousness-1132154 [Accessed 7 Jul. 2022].
  6. 6. ALTERED LOC (ALOC) •Altered or abnormal levels of consciousness describe states in which a person either has decreased cognitive function or cannot be easily aroused. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  7. 7. ALTERED LOC (ALOC) •Most medical conditions affect the brain and impair consciousness when they become serious or life- threatening, and an altered state of consciousness usually signals a serious medical problem. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  8. 8. ALTERED LOC (ALOC) • CONFUSION - describes disorientation that makes it difficult to reason, to provide a medical history, or to participate in the medical examination. - Causes include sleep deprivation, fever, medications, alcohol intoxication, recreational drug use, and postictal state (recovering from a seizure). Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of- consciousness-1132154 [Accessed 7 Jul. 2022].
  9. 9. ALTERED LOC (ALOC) • DELIRIUM - an acute confusional state characterized by impaired cognition. - attention, alteration of the sleep-wake cycle, hyperactivity (agitation), or hypoactivity (apathy), perceptual disturbances such as hallucinations (seeing things that are not there) or delusions (false beliefs), as well as instability of heart rate and blood pressure may be seen in delirium. - Causes includes alcohol withdrawal, recreational drugs, medications, illness, organ failure, and severe infection Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  10. 10. ALTERED LOC (ALOC) LETHARGY AND SOMNOLENCE (DROWSINESS) - severe drowsiness, listlessness, and apathy accomp anied by reduced alertness. - lethargic patient often needs a gentle touch or verbal stimulation to initiate a response. - Causes can include severe illnesses or infections, recreational drugs, and organ failure. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  11. 11. ALTERED LOC (ALOC) OBTUNDATION - a reduction in alertness with slow responses to stimuli, requiring repeated stimulation to maintain attention, as well as having prolonged periods of sleep, and drowsiness between these periods. - Causes: poisoning, stroke, brain edema (swelling), sepsis (a blood infection), and advanced organ failure. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  12. 12. ALTERED LOC (ALOC) STUPOR - a level of impaired consciousness in which a person only minimally responds to vigorous stimulation, such as pinching the toe or shining a light in the eyes - Causes can include stroke, drug overdose, lack of oxygen, brain edema, and myocardial infarction (heart attack). Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  13. 13. ALTERED LOC (ALOC) COMA - a state of unresponsiveness, even to stimuli - may lack a gag reflex (gagging in response to a tongue depressor placed at the back of the throat) or a pupillary response (pupils normally constrict in response to light). - Causes: severely diminished brain function, usually due to extreme blood loss, organ failure, or brain damage. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].
  14. 14. GLASGOW COMA SCALE (GCS) - provides a practical method for assessment of impairment of conscious level in response to defined stimuli. Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  15. 15. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  16. 16. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  17. 17. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  18. 18. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  19. 19. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  20. 20. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  21. 21. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  22. 22. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  23. 23. GLASGOW COMA SCALE (GCS) Reference: Royal College of Physicians and Surgeons of Glasgow (2018). The Glasgow structured approach to assessment of the Glasgow Coma Scale. [online] Glasgowcomascale.org. Available at: https://www.glasgowcomascale.org/ [Accessed 7 Jul. 2022].
  24. 24. WHAT IS A GOOD SCORE ON THE GLASGOW COMA SCALE? - Recording components can help you to build a 9GCS by averaging the GCS components among them - The higher the score, the more often a mild brain injury is occurring - the lower the score, the more common is moderate brain injury, or the lower the score, the more severe the injury. Reference: Merchant City Glasgow (2022). How To Score A 4 For Glasgow Coma Scale? – MerchantCityGlasgow. [online] Merchant City Glasgow. Available at: https://merchantcityglasgow.com/how-to-score-a-4-for-glasgow-coma-scale/#:~:text=Glasgow%20Coma%20Scale%20%28GCS%29%20uses%20a%20scoring%20range [Accessed 7 Jul. 2022].
  25. 25. WHAT DOES A GCS OF 3 MEAN? - A GCS rating of 3 or less is the least suitable score, and can lead to a very high mortality rate Reference: Merchant City Glasgow (2022). How To Score A 4 For Glasgow Coma Scale? – MerchantCityGlasgow. [online] Merchant City Glasgow. Available at: https://merchantcityglasgow.com/how-to-score-a-4-for-glasgow-coma-scale/#:~:text=Glasgow%20Coma%20Scale%20%28GCS%29%20uses%20a%20scoring%20range [Accessed 7 Jul. 2022].
  26. 26. CAN GCS 4 SURVIVE? - It is generally poor for all patients over the age of 40 to survive a traumatic brain injury (TBI), which severely compromises function and causes deep coma. -mortality rates generally range up to 89% for patients over 70 years old. Reference:
  27. 27. GCS HEAD INJURY CLASSIFICATION Severe Head Injury-GCS score of 8 or less Moderate Head Injury-GCS score of 9 to 12 Mild Head Injury- GCS score of 13 to 15 (Adapted from: Advanced Trauma Life Support: Course for Physicians, American College of Surgeons, 1993).
  28. 28. GCS Based on motor responsiveness, verbal performance, and eye opening to appropriate stimuli, the Glascow Coma Scale was designed and should be used to assess the depth and duration coma and impaired consciousness. (Adapted from: Advanced Trauma Life Support: Course for Physicians, American College of Surgeons, 1993).
  29. 29. GCS This scale helps to gauge the impact of a wide variety of conditions such as acute brain damage due to traumatic and/or vascular injuries or infections, metabolic disorders (e.g., hepatic or renal failure, hypoglycemia, diabetic ketosis), etc. (Adapted from: Advanced Trauma Life Support: Course for Physicians, American College of Surgeons, 1993).
  30. 30. OBSERVE APPEARANCE AND BEHAVIOR For Appearance: observe for gait, posture, clothes and grooming For Behavior: observe for mannerisms, gestures, expression , eye contact, ability to follow commands/requests, compulsions
  31. 31. OBSERVE MOOD, FEELINGS, AND EXPRESSIONS Mood is a sustained state of inner feeling Feelings an expression of inner feeling, commands/requests, compulsions
  32. 32. OBSERVE THOUGHT PROCESSES AND PERCEPTIONS (THOUGHT FORM) Thought form refers to the formation and coherence of a patient's thoughts. Formal thought disorders are derangements of this form, resulting in thoughts that are often difficult to follow or understand.
  33. 33. THOUGHT FORM: NORMAL VARIATIONS Concrete thinking: thought that is almost exclusively informed by immediate sensory experiences, rather than abstractions. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  34. 34. THOUGHT FORM: NORMAL VARIATIONS Abstract thinking: - thought that is almost exclusively informed by cognitive abstractions, rather than immediate sensory experiences. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  35. 35. THOUGHT FORM: FORMAL THOUGHT DISORDERS Circumstantiality: - overly detailed speech with eventual return to the topic of focus after many digressions. (Schizophrenia, dementia) Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  36. 36. THOUGHT FORM: FORMAL THOUGHT DISORDERS Tangentiality: - continuous diversion from the topic of focus with no return to it. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  37. 37. THOUGHT FORM: FORMAL THOUGHT DISORDERS Looseness of associations: - continuing change of topic with only loose associations between topics. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  38. 38. THOUGHT FORM: FORMAL THOUGHT DISORDERS Derailment: - a sequence of completely unrelated thoughts with change of frame of reference between sentences. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  39. 39. THOUGHT FORM: FORMAL THOUGHT DISORDERS Flight of ideas: - jumping from topic to topic with no discernable associations (Acute mania) Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  40. 40. THOUGHT FORM: FORMAL THOUGHT DISORDERS Word salad: - an incoherent mix of words and phrases. (Wernicke’s area lesion, dementia, schizophrenia) Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  41. 41. THOUGHT FORM: FORMAL THOUGHT DISORDERS Thought blocking: - sudden cessation of speech in the middle of a thought followed by silence. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  42. 42. THOUGHT FORM: FORMAL THOUGHT DISORDERS Clang associations: - thoughts connected by association of similar sounds (e.g. compulsive rhyming). Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought- form [Accessed 7 Jul. 2022].
  43. 43. THOUGHT FORM: FORMAL THOUGHT DISORDERS Perseveration: - continued repetition of a word or phrase after it is no longer appropriate to respond in this way. For example, the patient may correctly answer ˜Monday' when asked the day of the week and then answer all further questions with ˜Monday'. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  44. 44. THOUGHT FORM: DISSOCIATIVE SYMPTOMS •Derealisation: - feeling that the world or surroundings are not real •Depersonalisation: - feeling detached from or outside of oneself Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  45. 45. THOUGHT FORM: DISSOCIATIVE SYMPTOMS •Dissociative personalities: - the feeling that more than one person is within their head •Amnesia: - memory loss Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  46. 46. THOUGHT FORM: SENSORY DISTORTION •Hyperaesthesia - Increased intensity of sensation •Hyperacusis: - increased sensitivity to noise Anxiety, depression, migraine, hangover Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  47. 47. THOUGHT FORM: SENSORY DISTORTION • Hyperaesthesia - Increased intensity of sensation 1. Hyperacusis: - increased sensitivity to noise Anxiety, depression, migraine, hangover 2. Intense colour: - Epileptic aura, hallucinogenic agents Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  48. 48. THOUGHT FORM: SENSORY DISTORTION •Hypoaesthesia - Decreased intensity of sensation. - Causes: Dementia Depression Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  49. 49. THOUGHT FORM: SENSORY DISTORTION • Dysmegalopsia - Change in the perceived form of an object • Micropsia (lilliputian hallucination): - objects appear to be smaller than they are • Macropsia: - objects appear to be larger than they are Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  50. 50. THOUGHT FORM: SENSORY DISTORTION Causes of Dysmegalopsia • Benign - especially if perceived only while falling asleep (hypnagogic) or waking up (hypnopompic). • Retinal disease • Disorders of accommodation • Temporal / parietal lesions Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  51. 51. THOUGHT FORM: SENSORY DISTORTION Causes of Dysmegalopsia • Benign - especially if perceived only while falling asleep (hypnagogic) or waking up (hypnopompic). • Retinal disease • Disorders of accommodation • Temporal / parietal lesions • Schizophrenia Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  52. 52. THOUGHT FORM: SENSORY DISTORTION ILLUSIONS - Distortions of perception based on external stimuli. Perceives things as different to usual, but accepts that they are not real or that things are perceived differently by others. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  53. 53. THOUGHT FORM: SENSORY DISTORTION ILLUSIONS Complete illusions: - inattention resulting in misinterpretation, such as misreading words in a newspaper Affect illusions: - related to a particular mood state, such as mistaking shadows for people when particularly anxious or paranoid Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  54. 54. THOUGHT FORM: SENSORY DISTORTION • ILLUSIONS Pareidolia: - vivid illusions without any effort required, such as interpreting the markings on a picture of burnt toast as the Virgin Mary Tactile illusions - such as phantom limb syndrome in those who have undergone amputation Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  55. 55. THOUGHT FORM: SENSORY DISTORTION • ILLUSIONS Significance: - depression, anxiety, mania or delirium may trigger illusions. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  56. 56. THOUGHT FORM: SENSORY DISTORTION • HALLUCINATIONS - are abnormal sensory symptoms that may manifest as visual, auditory, tactile or extraordinary disturbances - is a false perception as the pertinent external stimuli is actually absent. - may be caused by organic disease or psychiatric disorders. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  57. 57. THOUGHT FORM: SENSORY DISTORTION • HALLUCINATIONS Auditory hallucinations - including commentary, insulting voices Visual hallucinations - may be simple (such as flashes or colours) or complex (such as people, animals or objects) Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  58. 58. THOUGHT FORM: SENSORY DISTORTION • HALLUCINATIONS Olfactory (smell) / gustatory (taste) hallucinations - Suggestive of frontal / temporal injury Tactile (touch) hallucinations - Can occur in delirium tremens (alcohol withdrawal delirium) or with cocaine Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  59. 59. THOUGHT FORM: SENSORY DISTORTION • HALLUCINATIONS Extracampine hallucinations: - sensations that would be physically impossible, such as seeing through walls Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  60. 60. THOUGHT FORM: SENSORY DISTORTION Causes of Hallucinations: • Psychiatric - schizophrenia, schizoaffective disorder, psychotic depression, delirium, Lewy body dementia • Neurological - space-occupying lesion, temporal lobe epilepsy, migraine • Metabolic - hepatic encephalopathy • Drugs - amphetamines, delirium tremens Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  61. 61. THOUGHT FORM: SENSORY DISTORTION VISUAL HALLUCINATIONS • Simple visual hallucinations - flashes, dots, colours, patterns (Suggestive of ocular pathology, seizure or migraine aura) • Complex visual hallucinations - objects, animals, people - Suggestive of Lewy body dementia (degeneration and death of nerve cells in the brain) or delirium, though can occur in severe psychosis) Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  62. 62. THOUGHT FORM: SENSORY DISTORTION VISUAL HALLUCINATIONS Autoscopic hallucinations: - a visual hallucination of the patient's own self. Anton's syndrome (cortical blindness): - the patient reports that they are able to see and can describe the world around them, despite clear evidence that they are blind - Occurs in the setting of bilateral occipital strokes Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  63. 63. THOUGHT FORM: SENSORY DISTORTION CAUSES OF VISUAL HALLUCINATION • Sensory deprivation in normal people • Dementia with Lewy Bodies • Delirium • Severe psychosis • Anton's syndrome (cortical blindness) • Migraine aura • Seizure Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  64. 64. THOUGHT FORM: SENSORY DISTORTION INSIGHTS - the patient's awareness of the situation they are in, and an understanding of the implications of their condition as well as the potential complications that may occur as a result of it. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  65. 65. THOUGHT FORM: SENSORY DISTORTION SIGNS OF GOOD INSIGHTS • Acknowledgement of a possible mental problem • Understanding of treatment options • Ability to comply • Ability to identify potentially pathological events such as hallucinations or suicidal impulses Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  66. 66. THOUGHT FORM: SENSORY DISTORTION JUDGEMENT • Recent decision-making or by posing a practical dilemma (what should you do if you see smoke coming out of a house?) Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  67. 67. THOUGHT FORM: SENSORY DISTORTION CAUSES OF IMPAIRED JUDGEMENT • Organic disorder • Acute intoxication • Schizophrenia • Bipolar disorder Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  68. 68. THOUGHT FORM: SENSORY DISTORTION Significance: - Assessing judgement is important for deciding whether a patient is able to give consent. Reference: medschool.co. (n.d.). Thought Form. [online] Available at: https://medschool.co/exam/psych/thought-form [Accessed 7 Jul. 2022].
  69. 69. OBSERVE COGNITIVE ABILITIES •Assess if the Client is aware of self and others, time, home address and current location
  70. 70. CRANIAL NERVE ASSESSMENT
  71. 71. CRANIAL NERVE 1 - OLFACTORY – Olfactory (assessment of the sense of smell and patency of the nostrils) - ask the client to clear his/her nose. - Occlude one nostril and let client identify the odor of the object that you are holding. Do the same for the other nostril.
  72. 72. CRANIAL NERVE 2 - OPTIC • Assesses client visual acuity, near vision, visual fields • Use Snellen chart to assess the vision in each eye • Ask the client to read a newspaper or a paragraph from a book or magazine. • Evaluate the visual fields of each eye
  73. 73. CRANIAL NERVE III, IV AND VI – OCULOMOTOR, TROCHLEAR, ABDUCENS • Checks for eyelids, extraocular movements, pupillary response • Check for the extraocular movements, pupillary response to light and accommodation in both eyes
  74. 74. CRANIAL NERVE V – TRIGEMINAL • Facilitates assessment of the motor function of the temporal and masseter muscles for contraction • Ask the client clench his teeth. Palpate the temporal and masseter muscle for contractions.
  75. 75. TEST CRANIAL NERVE VII- FACIAL • assessment of the motor and sensory function of the facial nerve • Ask the client smile, frown, wrinkle forehead, puff out cheeks, purse lips, raise eyebrows, close eyes tightly against resistance.
  76. 76. CRANIAL NERVE IX AND X – GLOSSOPHARYNGEAL AND VAGUS NERVE • assessment of the motor function of the tongue and gag reflex , ability of the client to swallow • Ask the client to open mouth wide and say “ah” then make use of a tongue depressor on the client’s tongue. • Touch the posterior pharynx with the tongue depressor to assess gag reflex.
  77. 77. CRANIAL NERVE XI –SPINAL ACCESSORY • To test the cranial nerve that supplies the sternocleidomastoid and trapezius muscles • Let client shrug his/her shoulder as you put resistance (to check the Checks the trapezius muscle) • Have the client turn the head. against resistance, on the right then to the left (Assesses sternocleidomastoid muscle)
  78. 78. CRANIAL NERVE XII – HYPOGLOSSAL • To assess the strength and mobility of the tongue • Let client put out his tongue, move it to each side. Apply resistance through the use of a tongue depressor.
  79. 79. MOTOR AND CEREBELLAR SYSTEMS
  80. 80. CONDITION AND MOVEMENT OF MUSCLES • Assessment of the symmetry and size of all muscle groups • Evaluate the symmetry and size of all muscle groups. Check its strength and tone
  81. 81. TEST BALANCE • Facilitates assessment of the gait of the client • Have client walk naturally across the room. Observe the client’s posture, symmetry, movement, balance and rhythm. • Perform the Romberg’s test • Let client stand erect with arms on side and feet together. Observe for any imbalance or swaying. Then have the client close his/her eyes for 20 seconds. Observe for any swaying.
  82. 82. TEST COORDINATION • To test accuracy of movement • Demonstrate finger to nose test and let client repeat this three times with eyes closed. • Have the client sit comfortably and perform rapid alternating movements. • Repeat with the other side.
  83. 83. SENSORY SYSTEM
  84. 84. LIGHT TOUCH, PAIN AND TEMPERATURE SENSATION • Evaluates somatic sensation of the client • Assess vibratory sensation • Check position sensations • Assess for client’s tactile discrimination (fine touch)
  85. 85. REFLEXES
  86. 86. REFLEXES • Test deep tendon reflexes - Determines the integrity of the spinal cord and peripheral nervous system, and they can be used as baseline parameter for the presence of a neuromuscular disease • Check the superficial reflexes - Facilitates assessment of the upper motor neuron above the spinal level and can be used as baseline data for any abnormality
  87. 87. ASSESS FOR MENINGEAL IRRITATION OR INFLAMMATION
  88. 88. BRUDZINSKI SIGN - Position client in supine position. As you flex the client’s head, watch the hips and knees in reaction to the maneuver. - Brudzinski’s sign is seen if client passively flex his/her hip and knee in response to neck flexion. Client also reports pain in the vertebral column
  89. 89. ASSESS FOR KERNIG'S SIGN • Flex the client’s leg at both the hip and the knee then straighten the knee. • Kernig’s sign is seen when the client flexes the legs at the hip and knee and when leg is extended, complains of pain along the vertebral column.
  90. 90. DOCUMENTATION • Document and report client’s response and pertinent assessment data according to agency policy • Provides for communication and continuity of care
  91. 91. LEVEL OF CONSCIOUSNESS - is a medical term for identifying how patients are awake, alert, and aware of their surroundings someone is. Reference: Angela Morrow (2020). The Categories of Level of Consciousness in Medicine. [online] Verywell Health. Available at: https://www.verywellhealth.com/level-of-consciousness-1132154 [Accessed 7 Jul. 2022].

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