Clinical Assessment in Respiratory Care
Neurological Assessment
Clinical Assessment in Respiratory CareChapter 6, Wilkins 7th
Edition
Exercise due Friday January 29,2016
Upload to FOL RESP3012 Dropbox before midnight
NAME: __Mohamad Rahman1OverviewInjuries of the nervous system
May affect respiratory systemMay affect patient cooperation with
respiratory proceduresHistory may indicate nature of
dysfunctionExam localizes and quantifies severity of
dysfunctionInitial interaction with patient is first step in
neurologic assessment2Overview (contd)Neurologic assessment
evaluates:Mental statusCranial nerve functionMotor
systemCoordinationSensory systemReflexes Meaningful neurologic
assessment requires adequate _neurologic history and
examination.3Functional NeuroanatomyNeurologic systemCentral
nervous systemBrainSpinal cordPeripheral nervous systemCranial
Nerve How many? _12Spinal Nerve__ How many? _31
4Functional Neuroanatomy (contd)Functional divisionSensory
system (afferent )Motor system (efferent )Cerebrum Functions:
movement, LOC, ability to speak and write, emotions,
memory5BrainstemConsists of midbrain, pons, and medulla.Most
cranial nerves originate in Brainstem.Regulation of heart rate,
blood pressure, and breathing.Functional Neuroanatomy
(contd)CerebellumPosterior_ part of the brainResponsible for
equilibrium, muscle tone, and coordination of muscle
movements.Cerebellar lesions cause: Loss of coordination
(ataxia)TremorsDisturbances in gait and balance.Functional
Neuroanatomy (contd)7
Spinal cordFrom base of the brain down to thelevel of the first
lumbar (L1) vertebra. (_45 cm long)Connects brain to the body for
motor and sensory function pairs of spinal nervesC1-C8, T1-T12,
L1-L5, S1-S5, one coccygealPosterior (dorsal) roots = _carry
sensory information into spinal cord.Anterior (ventral) roots =
coduct motor impulses out of the spinal cord.Functional
Neuroanatomy (contd)10Spinal cordHerniated vertebral disk is the
most common spinal nerve root pathologyInvolvement of multiple
nerve roots Guillain-BarrPhrenic nerves arise from spinal roots
Where? _cervical spine roots of C3 to C5.Damage can result in in
completeparalysis of the diaphragm as well as the intercostal
muscles and make the patient dependent on a ventilator for
life._________________Functional Neuroanatomy (contd)11
Mental Status and LOCLOC and mentation: most important parts of
the neurologic examChanges due to CNS dysfunctionInitial goal of
exam is to determine patients awarenessStarts with patient
encounterCompromise of LOC may be due to: Lesions inthe
cerebrumAbnormality in specific area.13
Glasgow Coma Scale (GCS)Most widely used instrument to quantify
__Neurologic impairment.TestEye_movementverbal responsePoorly
suited for patients with impaired verbal response (e.g., aphasia,
hearing loss, tracheal intubation)Motor response.17
17Glasgow Coma Scale (contd)Scale goes from __3 (deep coma) to
15 (fully awake)GCS of 12-15 = non-ICU observationGCS of 9-12 =
significant insultGCS 27/30 = normal20-26 = mild dementia10-19 =
moderate dementia
