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NU 325 Exam 4 Study Exam Graded A+ 2025.
Nociceptive pain (NP) - ANSWERS-o specialized nerve endings located in the cutaneous and deep musculoskeletal tissue that detect painful stimuli from the periphery and communicate this information to the CNS o Nociceptors carry pain signal to the CNS by two primary sensory (afferent) fibers: Aδ and C fibers o NP starts outside of the nervous system from actual or potential tissue damage. It has 4 phases. Know the 4 phases of Nociception - ANSWERS-o Transduction o Transmission o Perception o Modulation Transduction - ANSWERS-noxious stimulus takes place in periphery Transmission - ANSWERS-pain impulse moves from spinal cord to brain Perception - ANSWERS-conscious awareness of painful sensation Modulation - ANSWERS-inhibition of pain message neuropathic pain (NEP) - ANSWERS-o results from an abnormal processing of the pain message from an injury to nerve fibers o Pain is described as: Constant dull ache, Burning, Stabbing, Electric shock, Tingling o Much more difficult to assess and treat
o Nociceptive pain can develop into Neuropathic pain if poorly controlled what can cause neuropathic pain - ANSWERS-diabetes mellitus, shingles (herpes zoster), HIV/AIDS, sciatica, trigeminal neuralgia, phantom limb pain, chemotherapy, stroke, multiple sclerosis, tumor visceral pain - ANSWERS-originates from larger internal organs (stomach, intestine, gallbladder, pancreas); described as dull, deep, squeezing, or cramping pain impulses transmitted along the autonomic nervous system (ANS) deep somatic pain - ANSWERS-comes from blood vessels, joints, tendons, muscles, bone; may result from pressure, trauma, or ischemia
- pain feels aching or throbbing cutaneous pain - ANSWERS-derived from skin surface and subQ tissues pain feels sharp, superficial, burning referred pain - ANSWERS-pain felt in a site different from pain origin (pain is referred to where the organ was located in fetal development) (Ex. Appendix felt in umbilical region) Acute pain - ANSWERS-Short-term self limiting; often follows a predictable trajectory and dissipates after an injury heals -Serves as a protective measure -Ceases after an injury heals
-Rapid Alternating Movements in UE & LE pain rating scales for children - ANSWERS-faces pain scale or oucher scale, CRIES scale, FLACC scale Reinforcement for patellar reflex - ANSWERS-... pain rating scales for adults - ANSWERS-PQRST initial pain assessment brief pain inventory short-form McGill Pain questionnaire pain-rating scales numeric rating scales verbal descriptor scale visual analogue scale descriptor scale the normal changes in mental status and neurological findings frequently seen with aging - ANSWERS-- Expect slower response
- Observe for tremors
- Peripheral sensation may be slightly diminished
- DTRs less brisk CRIES scale - ANSWERS-crying, requires O2, increased vital signs, expression, sleeplessness what subjective data do adults have for the neuro system - ANSWERS-headache, head injuries, weakness, seizures, dizziness/vertigo, tremors, weakness, incoordination, numbness/tingling, trouble swallowing
FLACC scale - ANSWERS-face, legs, activity, cry, consolability what subjective data do children have for the neuro system - ANSWERS-prenatal history, family history, balance, reflexes, if baby is pre-term, developmental issues/learning disabilities, environmental exposure (lead), if they play sports (concussion) PAINAD scale - ANSWERS-pain assessment in advanced dementia how to perform objective examination - ANSWERS-metal status, cranial nerves, motor system (tandom walk), sensory systems, reflexes, glasgow coma scale initial pain assessment - ANSWERS-asks the pt to answer 8 questions concerning location, duration, quality, intensity, and aggravating/relieving factors types of screening - ANSWERS-screening neurologic exam, complete neurologic exam, neurologic check numeric rating scale - ANSWERS-asks a pt to choose a number that rates the level of pain for each painful site; 0 is no pain 10 is excruciating pain screening neurologic exam - ANSWERS-healthy people with no significant history what is the PQRST method of pain assessment? - ANSWERS-provocation/palliation, quality/quantity, region/radiation, severity scale, timing complete neurologic exam - ANSWERS-people who have neurologic concerns (headache, weakness, loss of coordination) neurologic check - ANSWERS-hospital pt with head trauma or neurological defect (stroke, seizure, brain surgery); done frequently (abt every 15 min) Describe what is performed/assessed in each of the following mental status assessments (refer to student check off guidelines): - ANSWERS-Appearance Behavior Orientation
Test visual acuity: -Describe use of Snellen Chart, 20/ -Demonstrate use of Hand Held Vision Screener and interpret Cranial Nerve 3 - ANSWERS-Oculomotor Motor -PERRLAC: Check pupils for equal size/round, reactive (direct and consensual), accommodation, and convergence -Abnormal with tumor/lesion, increased intracranial pressure (unilateral dilation, nonreactive pupil), neuromuscular disease Cranial Nerve 5 - ANSWERS-Trigeminal Nerve (Facial) Motor and Sensory •Motor function: palpating temporal and masseter muscles as person clenches teeth, try to separate jaws by pushing down on chin •Sensory function: with person's eyes closed, test light touch sensation by touching a cotton wisp to forehead, cheeks, and chin Cranial Nerve 7 - ANSWERS-Facial Nerve Motor and Sensory Motor function: -Note mobility and facial symmetry as person responds to requests to smile,
frown, close eyes tightly (against your attempt to open them), lift eyebrows, show teeth, puff cheeks -Abnormal in stroke or Bell Palsy Sensory function: (not tested routinely) -Test only when you suspect facial nerve injury -Describe, test sense of taste by applying cotton applicator covered with solution of sugar, salt, or lemon juice to tongue and ask person to identify taste -Anterior 2/3 of tongue Cranial Nerve 8 - ANSWERS-Acoustic Nerve (Vestibulocochlear) Sensory Test hearing acuity by ability to hear spoken word whisper test Cranial Nerve 11 - ANSWERS-Spinal Accessory Nerve Motor -Symmetry of muscles of neck/shoulders -Check equal strength by asking person to rotate head against resistance applied to side of chin -Ask person to shrug shoulders against resistance -These movements should feel equally strong on both sides -Abnormal - stroke (opposite side of lesion) Cranial Nerve 12 - ANSWERS-Hypoglossal Nerve Motor
Judgment - Ask them about future plans - daily or lifelong goals (is response logical?) Mood - overall mood - if suspect anxiety, depression, suicidal thoughts screen more in depth how to test motor - ANSWERS-Balance Tests
- Gait (normal and tandem)
- Romberg Test - 20 seconds. State results how to test sensory - ANSWERS-Peripheral Pain:
- Sharp/dull extremities
- Abnormal: peripheral neuropathy (diabetes, peripheral arterial disease) how to test reflexes - ANSWERS-Reflexes: basic defense mechanisms of nervous system -Involuntary below level of conscious control permitting quick reaction to potentially painful or damaging situations Four types of reflexes:
- Deep tendon reflexes (myotatic), e.g., knee jerk . - Superficial, e.g., corneal reflex, abdominal reflex
- Visceral, e.g., pupillary response to light
- Pathologic (abnormal), e.g., Babinski's reflex or extensor plantar reflex Recognize the normal primitive reflexes seen in the infant - ANSWERS-Have
primitive reflexes resolved at normal time?Rooting - brush cheek (birth to 3 - 4 months) Sucking - birth to 10 - 12 months Palmar grasp - birth to 3 - 4 months Babinski reflex - toes fan (positive Babinski) birth to about 2 years Tonic neck Moro Reflex Placing and Stepping Reflex Know how to assess LOC and the importance of doing such - ANSWERS-Level of consciousness (change is earliest and most sensitive index of change in neurologic status), Orientation, Motor function - strength extremities (follow commands), facial movement, arm drift; Pupillary Response (PERRLAC); Vital Signs, including Glasgow Coma Scale importance: Spasticity - ANSWERS-types of increased resistance that occur with central weakness Paralysis - ANSWERS-loss of ability to move and sometimes feel Flaccidity - ANSWERS-decreased muscle tone; muscle feels limp/soft/flabby Rest tremor - ANSWERS-when a person's hands/legs shake when they are at rest; often only affects hands Intention tremor - ANSWERS-increases as an extremity approaches the endpoint of deliberate and visually guided movement (like when someone cannot feed themselves because their hand shakes so much upon completion of moving a spoon to their mouth)
achilles plantar/babinski Paraplegia - ANSWERS-symmetric paralysis (two extremities) Quadriplegia - ANSWERS-paralysis of all four extremities What is the primary purpose of the Glascow Coma Scale? - ANSWERS-Used to asses a pt's level of consciousness and assess functional state of the brain as a whole •Monitor LOC over time (improving or deteriorating) What is the highest and lowest score you can receive on the Glascow Coma Scale?
- ANSWERS-•Total Numeric value: highest 15, lowest 3, less than 7 coma How do we get the Glascow Coma Scale score? - ANSWERS-• Eye Opening: 1 - 4
- Motor Response: 1 - 6
- Verbal Response: 1 - 5 Appearance - ANSWERS-posture, dress, grooming and hygiene, body movements Behavior (include what is affect and what is considered a flat affect) - ANSWERS- LOC, facial expression, speech, mood and affect. (Flat affect: lack of emotional expression) Orientation - ANSWERS-Orientation of person, place and time (1st), attention span, recent/remote memory, new learning (4 unrelated words test) Recent memory - ANSWERS-able to recall recent events in memory (what they had for breakfast, etc.) Remote memory - ANSWERS-able to recall passed events in memory (recall health history, first job, birthday, anniversary)
Reasoning - ANSWERS-abstract thinking and judgment What does the finger to nose test allow assessment of? - ANSWERS-assesses coordinated, smooth, skilled movement and fine motor function the interview process - ANSWERS-an abbreviated mental status examination is generally conducted during when? Deep tendon reflexes - ANSWERS-- Reveals intactness of reflex arc at specific spinal levels
- Limb should be relaxed and muscle partially stretched
- Stimulate reflex by directing short, snappy blow of reflex hammer onto muscle's insertion tendon
- Compare right and left sides: responses should be equal Reflex response graded on 4-point scale 4 = very brisk, hyperactive with clonus, indicative of disease 3 = brisker than average, may indicate disease 2 = Average, normal 1 = diminished, low normal, or occurs with reinforcement 0 = no response bicep reflexes - ANSWERS-contraction of biceps muscle and flexion of forearm tricep reflexes - ANSWERS-extension of forearm Brachoradialis reflexes - ANSWERS-flexion and supination of forearm Patellar or Quadriceps reflex - ANSWERS-extension of lower leg Achilles reflex - ANSWERS-foot plantar against hand
Sensory Function -(NOT DOING) Verbalize - sense of taste posterior third of tongue -Abnormal: Stroke, risk for aspiration what are the 12 cranial nerves (number and name) - ANSWERS-I. olfactory II. optic III. occulomotor IV. trochlear V. trigeminal VI. abducens VII. facial VIII. acoustic IX. glossopharyngeal X. vagus XI. spinal accessory XII. hypoglossal Negative Romberg test - ANSWERS-pt has normal balance and posture Positive Romberg test - ANSWERS-pt had loss of balance/posture What is the expected response seen with each reflex if it is a normal response? - ANSWERS-contraction of biceps muscle and flexion of forearm what is the expected response seen with the triceps reflex - ANSWERS-extension of forearm what is the expected response seen with the brachioradialis reflex - ANSWERS- flexion and supination of forearm
what is the expected response seen with the patellar reflex - ANSWERS-extension of lower leg what is the expected response seen with the plantar/babinski reflex - ANSWERS- plantar flexion of toes and inversion/flexion of forefoot (toes curl inward for adults but fan out for infants) what is the expected response seen with the achilles reflex - ANSWERS-foot plantar against hand infants/children and mental status - ANSWERS-emotional and cognitive functions develop over time aging adults and mental status - ANSWERS-no decrease in general knowledge/vocab; response time may be slower; recent memory decreased by remote memory not; some sensory loss what is the Four Unrelated Words test and why is it used? - ANSWERS-tests a pt's ability to lay down new memories; highly sensitive and valid memory test; used for alzheimer dementia pts, anxiety pts, and depression risk factors for suicide and how to determine if a pt is serious - ANSWERS-previous risk; giving away valuables; risk of hurting themselves; feelings of hopelessness, despair, etc. why would a mini-status exam be used? - ANSWERS-screens for cognitive function only and detects organic disease; useful for initial and serial measurement of cognition over time what are organic diseases - ANSWERS-mental diseases that develop over time instead of a psychiatric illness; delirium, dementia, Alzheimer's, intoxication, withdrawl psychiatric illness - ANSWERS-anxiety, Schizophrenia, manic depression, OCD
- With increasing age, there is no decrease in general knowledge but people have a slower response time, recent memory is decreased, remote memory is usually not affected. There may also be some vision and hearing impairments that can
how to remember the cranial nerves (song): - ANSWERS-http://youtu.be/IBuPzn_8UTc
