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Week 3 NUR 230 Notes

by: Issy Notetaker

Week 3 NUR 230 Notes NUR 230

Issy Notetaker
GPA 3.96
Health Appraisal Across the Lifespan
Marjorie Pyron

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Book, clinical, and lecture notes!
Health Appraisal Across the Lifespan
Marjorie Pyron
Class Notes
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This 23 page Class Notes was uploaded by Issy Notetaker on Friday September 11, 2015. The Class Notes belongs to NUR 230 at Ball State University taught by Marjorie Pyron in Fall 2015. Since its upload, it has received 88 views. For similar materials see Health Appraisal Across the Lifespan in Nursing and Health Sciences at Ball State University.

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Date Created: 09/11/15
Book Notes Objectives Clinical Lecture Chapter 22 Musculoskeletal Bones Joints mm 0 Support movement protection production RBCs WBCs platelets storage minerals Components 0 Bones skeleton o Joints 206 Connective tissue Hard and very dense Continuous turn over Union of 2 bones Functional unit Needed for ADL Nonsynovial or Synovial Non Fibrous tissue and immovable or slightly moveable Synovial move freely bones are separated from each other and enclosed cavity 0 Cavity is lled w uid to grease movement sliding 0 Layer of cartilage covering surface Receives nourishment from uid Stable Slow turn over Flexible Cushions bones Surrounded by capsule Capsule is supported by ligaments Fibrous bands 0 Strengthen joint Prevent movement in wrong direction Bursa Sac lled w uid 0 In areas of friction Help mm and tendons to gluide 4050 body weight Produce movement Skeletal voluntary Bundle of fasciculi Attached to bone w tendon Flexion Extension Adduction Abduction Pronation Supination Circumduction Inversion Eversion Rotation Protraction Retraction Elevation Depression o TemporomandibularJoint TMJ Chewing and Speaking Hinge and slidinggliding protrusion and retraction and side to side actions Mandible and temporal bone Vertebra 33 7C 12T 5L SS 34C Landmarks Spinous Process C7 and T1 Inferior angle of Scapula T7 and T8 0 Line cross iliac crest L4 Dimples overlaying sacrum C and L are Concave T and S are convex Curves allow for shock absorption lntervertebral Disks Elastic brocartilaginous plates Center is made of soft semi uid mucoid Provide shock absorption When pressure is too great slipped disk occur Allow for turning o Shoulder Glenohumeral Joint Ball in socket Four mm make up rotator cuff Subacromial Bursa Abduction Landmarks Acromion Process Clavicle and Scapula Greater Tubercle On Humorous lateral to Acromion Coracoid Process is medial o Elbow 3 bones Hinge Landmarks Medial and Lateral Epicondyles humorous Olecranon Process Ulna bw epicondyles 0 Wrist and Carpals WristRadiocarpaljoint Radius and carpals Movement is side to side and exionextension Midcarpal Two rows of carpals Flexion extension rotation Metacarpophalangeal and interphalangeal nger exion and extension 0 Hip Acetabulum and Femur Ball in socket Less ROM than shoulder More stability Landmarks lliac Crest lschial Tuberosity When hip is exed under glut max 0 Greater Trochanter 3 Bones Femur Tib patella Largest and most complex Hinge Largest synovial membrane Menisci Cruciate and Collateral ligaments Numerous Bursa Landmarks Quadriceps 0 Four mm heads merge at tendon to knee Tibial Tuberosity Boney protrusion Lateral and Medial condyles of Tibia Medial and Lateral Epicondyles of Femur o Ankle and Foot AnkleTibiotalarJoint Tib Fib Talus Hinge Landmarks o Medial Malleolus and Lateral Malleolus Ligaments extend for stability Joints distal give additional mobility Subtalar Longitudinal Arch 0 Heel and Ball of foot 0 Calcaneus and heads of metacarpals Developmental Competence 0 Infants and Children Skeleton formed by 3 months cartilage Bone is formed through rest of development and after birth 0 Rapid in infancy and adolescence Long bones increase width and length epiphyses closes around 20 years of age Spine Curves Birth spine is C shaped 34 months w raising of head Cervical neck region is developed o 1 year 18 months w standing Lumbar curve is developed 0 Weight increase 0 Most growth is during adolescent spurt Depend on genetic programming nutrition and exercise 0 Pregnant Women 0 Aging Increased hormone levels increase mobility in joints Progressive Lordosis to compensate for fetus Creates low back pain Anterior neck exion and shoulder slumping occur Adult After 40 bone loss occurs 0 Loss of density in bones osteoporosis Women more than men Decreased height Shortening of vertebral column in intervertebral disks 0 Progressive Can begin as early as 40 0 Greatest decrease is in 705 and 805 Kyphosis is curvature change hump back Less fat in extremities and more in center MM decrease in size and atrophy Physical activity decreases risks for all of the above 0 Culture and Genetics 0 RaceEthnic differences in bone mineral density occur Higher BMDDense bone Higher in AfroCaribbean Earlier peak in White women Earlier peak faster decline Subjective Data 0 Joints Pain 0 Pain and loss of function are common 0 Location 0 Quality Severity Onset Timing 0 Some forms are worse at different times RA in morning OA afternoon AggravatorsRelievers 0 Movement can increase or decrease Associated w anything Stiffness swelling heat redness limitation of movement 0 Knee if injured How did injury occur Was there a pop can stand or ex 0 MM Pain or cramping Myalgia Mm Aches Weakness Location Symmetry bilat 0 Bones Pain Affected by movement Deformity caused by ROM Accidentstrauma ever affected bonesjoints Onsettime occurred treatment problemslimitations Back Pain Numbness tingling 0 Functional Assessment Safety of independent living need for services and QOL screening Do problems create limits on ADLs Which ones 0 Pt Centered Care Occupational hazards or safety risks Exercise program 0 Pain during Weight gainloss Medicationsupplements Chronic illness and effects Smoking Drinking 0 Additional for Infants and Children Trauma to infant during labor head rst forceps resuscitation Milestones at right age Broken bones dislocations treatment Deformities age treatment 0 Additional for Adolescents After school activities frequency Special equipment training program What happens if get hurt 0 Additional for Aging Adult Change in weakness over past months or years increase in fallsstumbling Mobility aids screening for osteoporosis Objective Data 0 Prep Assess for function of ADL and screen for abnormalities 0 Head to toe manner Flexion is bending Extension is straightening Adduction is moving towards body Abduction is moving away Additional data is gained from general survey Screening Inspection and palpitation Observation of ROM Age speci c screenings Complete For particular disease history of symptoms or ADL problems Make comfortable throughout exam Head to toe proximal to distal Support joints at rest 0 Gentle support and movement Compare joints elbow w elbow Symmetry bilat And normal measurements 0 OrderofExamination Inspection Size and contour of every joint Color Swelling masses deformities o Swellingirritation excess uid thickening of lining bone enlargement in ammation 0 Deformities Dislocation subluxation Contracture Ankylosis Palpation Each joint Note skin temp mm boney artics area of capsule Note heat tenderness swelling masses 0 Localize tenderness o Warmth and tendernessin ammation Palpable uid is NOT normal ROM 0 Active ROM while modeling movements Gently attempt passive ROM on limited mm 0 Note pain tenderness or crepitation audible and palpable crunching MM Testing Test strength of prime mover mm for ech joint Repeat ROM motions but asking to ex while applying force Should be equal bilat and opposing to force TM 0 Seat person 0 Inspect area anterior to ear Place ngers in front of ears and ask to open and close mouth and slide ngers into groove that is created Palpable and audible crack should occur Ask to open moth fully Open mouth slightly and move jaw side to side Stick out lower jaw Clench teeth and palpate mm Note bilat strength size rmness Ask to move jaw forward and lat against resistance and open mouth against resistance Test CN V Cervical Spine O 0 Inspect alignment straight and erect Palpate spinous process sternomastiod trapezius and paravertebral mm Firm wout spasm Ask to move head forward and back quotYesquot Left and right quotNoquot movement Repeat w opposing force Test CN XI 0 Upper Extremity o Shoulder lnspect and compare both 0 Size and contour equal landmarks Redness atrophy deformity swelling Palpate both noting spasm atrophy pain swelling heat tenderness Start at clavicle Test ROM 0 Cup hand over should to note crepitation Hyperextend back forward exion arms straight to above head clasp wrist behind back and above head jumping jack arm movement Ad and Abduction Test Strength Shrug shoulders ex forward and up abduct o resistance 0 CNXI o Elbow lnspect size and contour in relaxed and exed position 0 Note abnormality 0 Check hollows on each side of olecranon process Palpate w exed at 70 degrees and relaxed Heck for swelling thickening nodules tenderness ROM 0 Bend and straighten elbow Pronate and Supinate Strength Stabilize ex elbow against pulling opposition force at wrist Extend against resistance 0 Wrist and Hand lnspect both sides for size contour shape 0 Note abnormalities Palpate each joint w thumb and making sure pt hand is relaxed and straight in alignment Gentle but rm 0 Use pointer an thumb to palpate sides of ngers for swelling or tenderness c From at Bend up at wrist extension and down exion From at Bend ngers down and on surface up 0 Spread ngers apart and make a st Move wrist side to side 0 Touch thumb to each nger Strength 0 Flex wrist against opposition Phalen Test 0 Hold hands back to back while exing wrists at 90 degrees 0 No pain unless Carpal tunnel Tinel Sign o Percussion of median nerve o No movement in normal 0 Lower Extremity 0 Hip lnspect w spine when standing 0 Note symmetry of iliac crests gluteal folds and equal size 0 Smooth Even gait Palpate ln supine Stable and symmetric Raise w knee extended exion Bend knee at chest and keep other leg straight exion Knee at 90 move ankle in and out while holding at thigh and ankle feel opposite movement Leg laterally and medially Ad and Abduction When standing swing leg back Hyperextension o Knee Inspect Supine or sitting dangling Lower leg on same axis as upper Hollow areas should be present on either side 0 Check mm of atrophy Palpation Start on thigh 10 cm above and move down 0 Note soft from swelling tissue or increased uid in the joint 0 Bulge Sign Swelling in suprapatellar pouch Move uid from one side ofjoint to another Small amounts of uid 0 Ballottement Larger amount of uid Hold thig above patellar and push up on patellar It will move if there is uid ROM 0 Bend and extend and hyperextend Check during walking Squat and duck walk Strength 0 Maintain exion while pull leg forward and pushing back Tests for meniscal tears o McMurray Test Supine stand on affected side Hold heel and knee ex at knee and hip rotate leg in and out rotate externally and push inward on knee straighten Normal is no pain 0 Ankle and Foot lnspect while sitting and nonweight bearing 0 Note locations of calluses or bursal reactions Palpate w thumb feeling grooves and spaces 0 Use pinching motion with whole hand to move up foot ROM 0 Point toes at oor toward nose turn soles of feet in and out ex and straighten toes Strength 0 Maintain dorsal and plantar exion against force Spine 0 Standing in open back gown 0 Inspect Straight vertical and horizontal Knees and feet should be aligned Note curvatures by standing at side 0 Palpate spinous process and paravertebral mm 0 ROM Bend forward and touch toes Note smoothness and symmetry on way down Note single C curve of spine Stabilize pelvis and Bend sideways back and twist shoulders from side to side Walk on toes away and on heels back 0 Straight Leg Raising or Lasegue Test Reproduce back and leg pain Keep leg and knee straight while raising leg normal is no pain The dorsi ex foot 0 Measure Leg Length Discrepancy Measure from anterior iliac spine to medial malleolus for true leg length Measure from umbilicus to medial malleolus for apparent leg length 0 Developmental Competence Know milestones Use Denver ll Test for ne and gross motor skills Infants 0 Fully undressed and lying on back 0 Feet and Legs 0 Note positional deformities Fixed or selfcorrected posture scratch bottom of foot to tell if leg moves to 90 degree angle Check for tibial torsion twisting of tib Check for developmental congenital dislocation dysplasia Flex knees and abduct moving knees apart to touch table Ortolani Maneuver Place baby s feet at and ex knees up note gluteal folds Allis test 0 Hands and Arms Palpate and inspect for the normal shape number and position Feel clavicle for smoothness and free of fracture Perform ROM Note normal C curve or curve for age lnspect for air dimples cyst or mass where none should be present 0 Observe ROM w normal movements 0 Strength is tested by holding up infant and having them wedge securely into place 0 Slipping shows weakness Preschool and School age 0 Back 0 Note posture plum line lordosis is common Legs and Feet 0 O O 0 Note position Bowlegged stance is normal for 1 year after walking and is xed by growth Genu varum Knock knees occur bw 2 and 35 years Genu valgum Check gait Wider from 12 and narrows w age Sit for remaining bit and go through like normal Make sure to check for arm full ROM Adolescents 0 Same as adult but note spinal posture 0 Screen for scoliosis w the forward bend test 0 Pregnant Women 0 Same as adult 0 Remember waddling gait lordosis slumped shoulders and kyphosis are normal 0 Aging Adult 0 Decrease in height shortening of trunk o Kyphosis is common with back bend of neck slight o Flexion of hips is common 0 Decrease in periphery fat and more showing boney prominences 0 ROM is tested the normal ways 0 Get up and Go test Stand up walk ten feet walk back sit down 0 Under 10 seconds means decreased risk of falling 0 Functional Assessment ROM and strength to activities Walk climb up down stairs pick up object from oor rise up for chair or lying in bed Abnormal Findings 0 In ammatory Conditions Rheumatoid Arthritis RA Chronic Autoimmune in ammation of synovial tissues Ankylosing Spondylitis AS Fusion of in amed vertebrae o Degenerative Osteoarthritis OA Nonin ammatory localized deterioration of articular cartilages Common Stiffness pain loss of ROM 0 Adults over 60 are at risk 0 Weight 0 Women 0 Previous injury to the jointoverusing 0 Weak thigh mm 0 Chronic progressive New bone forms at joints 0 Hard nodules atjoints Osteoporosis Loss of bone density 0 Due to low estrogen level Prevent w diet weight bearing exercise and calciumVitamin D o Shoulder Abnormalities Atrophy Dislocation Joint Effusion Swelling from excess uid in capsule Rotator Cuff Tear Frozen Shoulder Adhesive Capsulitis Subacromial Bursitis o Elbow Abnormalities Olecranon Buritis Gouty Arthritis Subcutaneous Nodules Epicondylitis Tennis Elbow 0 Wrist and Hand Abnormalities Ganglion Cyst Colles Fracture Carpal Tunnel w Atrophy of Thenar Eminence Synovial uid become edematous Repetitive motion Younger adults 0 More in females Ankylosis Dupuytren Contrancture OA Acute RA Polydactyly Syndactyly Gout in Thumb 0 Conditions Caused by Chronic RA 0 Knee Swan Neck and Boutonniere Deformity Ulnar Deviation Drift Osgood Schlatter Disease PostPolio Atrophy Mild Synovitis Perpatellar Bursitis Swelling of Menisci o Ankle and Foot Achilles Tenosynovitis Tophi w Chronic Gout Acute Gout Hallux Valgus w Bunion and Hammertoes Callus lngrown Toenail Plantar Wart Scoliosis S or C urvature Mainly identi able in younger children 0 Females are more common 0 Assess by bending forward and watching spine curve Brace is usually treatment and surgery is a LAST resort Herniated Nucleus Pulpous Chapter 23 O O Congenital or Pediatric Congenital Dislocated Hip Talipes Equinvarus Spina Bifida Coxa Pana Fibromyalgia Syndrome CNS brain and spinal cord PNS CN 12 Spinal nerves 31 and branches Sensory to CNS Afferent Motor from CNS Efferent Dysphasia Swallowing Dysarthria Speech mm control CNS 0 00000 Cerebral Cortex Outer layer of brain Gray not myelinated highest functions thought memory reasoning sensation voluntary movement Left Hemi is dominant in most people Frontal Personality behavior emotions intelligence Parietal Sensation Occipital Vision Temporal Auditory taste smell Wernck39s area Language comprehension in temporal lobe Broca39s Area mediate motor speech frontal lobe Basal Ganglia lnitiate and coordinate movement Thalamus Rely station Hypothalamus Life functions Cerebellum Coordination mm tone balance Brain Stem Central Core CN lllXll originate from Midbrain Motor neurons and tracts Pons Respiratory centers Medulla Vitals and CN crossing of nerves Spinal Cord upper 23 of column white matter myelinated Posture urination pain response Pathways of CNS Cross representation Sensory Pathways Spinothalamic Tract o Sensations od pain temp crude lighttouch Posterior Columns 0 Position Vibration nely localized touch 0 Position Proprioception 0 Travel to thalamus Motor Pathways CorticospinalPyramidal Tract motor cortex brainstem Cross D lat Column of spinal cord 0 Skilled purposeful movements Extrapyramidal Tracts All motor bers outside pyramidal tract Cerebellar System receive info from joint position and mm all subconscious 0 Upper and Lower Motor Neurons Upper all descending motor neurons that in uence or modify lower motor neurons Lower Mainly in PNS Translates movements into actions CN and spinal nerves PNS o Re exArc Re ex is defense mechanism involuntary quick Fourtypes Arc oCN Deep tendon knee jerk Super cial corneal Visceral Pupillary Pathologic Abnormal Babinski Hit tendon Tendon stretches Sensory afferent nerve is activated Sensory afferent bers carry message to spinal cord synapsing directly w motor neuron Motor efferent leaves traveling to mm Stimulation of sudden contraction LMN entering and leaving brain l and II are from cerebrum lllXll are from lower brain stem 0 Spinal Nerves Length of spinal cord 8C 12T 5L SS 1C Sensory and motor Exit in dermal segmentation o ANS Dermatome is skin are supplied by one nerve 0 Important in epidural and spinal pain killers 0 Be prepared to know where the pt won39t have feeHng Ove ap Smooth involuntary mm cardia mm glands Maintains homeostasis Developmental Competence O 0 Infants NS is not fully developed at birth Spinal cord and medulla control activity Primitive re exes Presence of these after cerebral cortex should have developed is a sign of dysfunction Milestones occur in an orderly manner Strong stimulus is needed bc infant cannot localize yet Aging Adult General atrophy Steady loss of neurological function Strength and agility decrease Culture and Genetics 0 0 Age related memory loss Alzheimer39s Stroke is common in the US Most common in AlAN Burden is higher among African Americans Subjective Data 0 OOO 000000000 0 Headache Frequency Head Injury EVER had one and describe DizzinessVertigo Seizures Ever had and describe Age Times How Many Types Frequency Triggers Tremors Weakness lncoordination NumbnessTingling Dif culty Swallowing Dif culty Speaking Pt Centered Care Past History EnvironmentalOccupational Hazard Additional for Infants and children Health problems during pregnancy Birth information Re exes Balance Seizures and describe Milestones came in correct order and age Lead exposure Learning problems Fam history of neurological disorders Teen play sports Screened for concussion Additional for Aging Adult Dizziness problems Decrease in mental function or memory Noticed a tremor Sudden vision changes 0 Objective Data 0 Prep Screening neurological exam is when there is no signi cant data from subjective history 0 Mental Status Cranial Nerves Motor Function Sensa on Re exes Complete exam is done when there are concerns Neurological recheck s done when there are de cits Sitting up w head at eye level 0 Test Cranial Nerves CN Olfactory Don t do routinely Test both nostril with wellknown scent CN Optic Nerve acuity and elds by confrontation Ophthalmoscope is sued to see ocuar fundus 0 Determine size shape and color of optic disc 0 Show pt object and have them tell coor CN III IV VI Oculomotor Trochlear Abducens Papebra ssures are equal in width Pupil size regularity equality direct and light reaction Asses position of gaze Hold head steady foow movement of pencil w eye and report parallel tracking CN V Trigeminal Motor Function Mastication mm when clenching teeth and try to separate jaw by pressing on chin you can39t Sensory Function Close eyes and lightly touch cotton swab on face and have pt say now when they are touched CN V Facial Mobility and symmetry Smile frown cose eyes tightly eft eyebrows show teeth puff cheeks o Press on cheeks and air should escape equally CN V Acoustic Whispered voice test 0 2 syabus word CN IX and X Glossopharyngeal and Vagus Motor Function 0 Depress tongue and say ahh o Uvula should rise and piars should move 0 Note gag re ex by touching wa w tongue blade 0 Stick out tongue say ahh CN XI Spinal Accessory Examine sternomastoid and Trapezius for equal size Rotate head against hand Shrug shoulders while pushing down CN XII Hypoglossal Inspect tongue 0 Move tongue left and right 0 Inspect and Palpate Motor System MM 0 Size Compare R and L mm groups based on age and size symmetric bilat Strength Test mm groups 0 Tone Normal degree of tension in voluntary relaxed mm 0 Move extremities through passive ROM 0 Mild even resistance Involuntary movements location frequency rate amplitude Cerebellar Function 0 Coordination and Skilled Movements 0 Rapid Alternating Movements Pat knees with front and back of hands and pick up speed Touch thumb to each nger and then reverse the order 0 Finger to Finger Ask person to touch your nger and then their nose move nger after several times 0 Finger to Nose Touch tip of nose w eyes closed 0 Heel to Shin Supine touch heel to shin and run heel down leg to ankle Balance Tests 0 Gait Observe walking 10 ft there and back Heel toe walk 0 Romberg Test Stand w feet together and arms at sides close eyes and hold position wait 20 seconds Hop on one leg or the other 0 Assess Sensory System Identify stimuli Only in those w symptoms for complete testing Avoid leading questions Use quottell me what you feelquot Spinothalamic Tract Pain Ability to perceive pinprick 0 Test Re exes 0 Break depressor in half and alternate randomly bw dull and prickly part asking pt which they feel Light Touch Wisp of cotton on skin say yes when feel Posterior Column Tract Vibration Tuning fork lace on skin and strike pt identi es when starts and stops Position Passive movements of extremities move extremities w pt eyes closed and have them say which direction movement is in Tactile Discrimination o Stereognosis Recognize object by feeling it o Graphesthesia Read number when it is traced on skin Two Point Discrimination Separate two points on the skin Extinction Touch both sides of body at same point and time ask how many and where sensations are Point Location Touch and withdraw have pt point where they were touched Stretch or Deep Tendon Relaxed limb w mm partially stretched Stimulate w short snappy blow Reinforcement is needed when pt I focusing on re ex ask to perform isometric exercise grasp forearms and pull Biceps C5 and C6 Contraction of bicep occurs when striking the tendon through your thumb when arm is resting on table Triceps C7 to C8 Let arm go dead as suspended and strike just above elbow arm should extend Brachioradialis C5 to C6 hold thumb suspending forearm strike above styloid process Quad or knee jerk L2 to L4 Let leg dangle and strike just below patellar Achilles L5 to SZ Knee exed hip rotated eternally foot in dorsi exion and strike Achilles tendon Clonus Support leg in one hand move foot up and down and dorsi exion foot quickly Super cial Re exes Abdominal T8 to T10 T10T12 Supine w knees bent and scrape handle of hammer across and see exion of mm Cremasteric L1 to L2 stroke inner thigh to note contraction of testicle Plantar L4 to 52 Thigh on external rotation stroke lat side of foot to ball and around for shape of upside down 0 Developmental Competence Infants 01 year Dramatic growth 0 Note milestones 0 000 0M0 Fl 0 000000 00000 Newborn alter eye open sucking loud angry lusty cry Note waking behaviors and responses to stimuli ad social interaction 2 months Smiles response and know parent face 4 Months Babbling 9 months one or two words used r System Spontaneous activity for smooth and symmetry Assess mm tone Use Denver ll test 2 months gradual exion 3 months sts begin opening 4 months is purposeful reach head can be held in straight line 7 months transfer hand to hand 9 months grasp 10 months purposeful release 18 months ambidextrous Strength is noted by sucking and spontaneous activity Sensory System little is done 0 79 months pt can wdraw from pain stimulus Re exes o Infantile automatisms o Rooting brush cheek near mouth and note if head turns Disappears around month 34 0 Sucking Touch lips w gloved nger Disappears at 1012 months 0 Palmar Grasp Offer nger and note grab Disappears 34 months 0 Plantar grasp Touch thumb to foot note toe curl Disappears 810 months 0 Babinski Stroke nger up lateral edge of foot and note fanning of toes Disappears at 24 months O O o Tonic Neck Turn head and watch arm and leg of opposite side ex Disappears 46 months 0 Moro Stratle and see if baby looks like it is hugging a tree Disappears 14 months 0 Placing Re ex Hold upright and let top part of foot touch able 0 Note exing of hip o Stepping Use position from placing and note walking movements Disappears before walking Preschool and School Age Asses behaviors Ask to imitate funny faces Assess balance gait and posture Assess ne and gross motor using Denver ll test Don t perform DTRs Aging Adult Same exam as w adult Slower responses Senile tremor occur Sensation may be impaired Decrease in ne motor skills Neurologic Recheck O O O 0 Those w injury or de cit that must be checked and monitored closely Level of conscious CHANGE in level is important ask person place time Motor Function Voluntary by giving commands Pupillary Response Size shape symmetry of both in the presence of bright light constrict Vital Signs T P R BP Glasgow coma Test Standarized objective assessment by giving number value Abnormalities O 0 Alzheimer39s Neuron Cote and hippocampus degeneration Cholinergic neuron loss Loss of neurotranmitters Better long term memory Mm Tone Flaccidity Spasticity Rigidity Cogwheel rigidity Small regularjerks 0 MM movement 0 Stroke 0 Gaits Paraylsis Fasciculation Myoclonus Tic Chorea Athetosis Seizure Disorder Uncontrolled discharge of electrical impulses Types 0 Generalized 0 Partial 0 Simple 0 Complex Phases 0 Prodromal Aural Ictal and Postictal What to do 0 Remove pillows 0 Position on side 0 Loosen clothing 0 Safety measures protecting head Tremor Rest Tremor Intention Tremor schemic Interruption of blood ow Hemorrhagic Acute rupture and bleeding Spastic Hemiparesis Cerebellar taxia Parkinson Degeneration of basal ganglion Imbalance in dopamine Increased involuntary movement O 55 0 Tremor Rigidity o Dysphagia o UnparaIIeI Gait o No postural control 0 Mask face expressinon 0 Wide open eyes Scissors Steppage or Footdrop Waddling Short Leg 0 Patterns of Motor Dysfunction Cerebral Plasy Bell s Palsy CN VII In ammatory response Unilateral paralysis Muscular Dystrophy Hemiplegia Parkinsonism Cerebellar Paraplegia MS Damage to myelin sheath leading to in ammation and permanent loss of nerve function SS Weakness stiffness Spastic mm Hyperactive DTR Clonus No abdominal re exes Intention tremor clumsy loos of balance Decreased pain sensation or abnormal sensation facial pain 0 Tinnitus facial weakness vision changes 0000000 0 Postures Decorticate Rigidity Flaccid Quadriplegia Decerebrate Rigidity Opisthotonos Discuss common abnormalities of the musculoskeletal system


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