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NU 325 Exam 4 Study Exam Graded A+ 2025. NU 325 Exam 4 Study Exam Graded A+ 2025.
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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
-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
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
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?
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
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
how to remember the cranial nerves (song): - ANSWERS-http://youtu.be/IBuPzn_8UTc