Transcript Slide 1
Chapter 3: Cultural Competence: Cultural Care
The Spinning Woman Illusion
--Nobuyuki Kayahara
J Carley MSN, MA, RN, CNE
Fall, 2009
JARVIS , C. (2008)
Physical Examination & Health Assessment
Chapter
232004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.
Elsevier items and derived
items © 2008,
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Unit Objectives
•1. Describe the anatomic structures of the central
nervous system and brain.
•2. Identify the 12 cranial nerves and their function
•3. Complete the Glasgow Coma scale, the Rancho Los
Amigos scale, and the mini mental state exam as
appropriate for case studies.
4. Explain how to prepare the client for a neurological
examination
5. Discuss the appropriate equipment necessary for
examining the neurological system.
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23-2
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23-3
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23-4
Peripheral nerves go from spinal cord
to arms, hands, legs, and feet
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23-5
Autonomic nerves go to the stomach,
intestines, and other parts of the
digestive system
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23-6
Cranial nerves go from brain to
eyes, mouth, ears, and other parts of
head (and others…e.g., Vagus)
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23-7
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23-8
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23-9
Central Nervous System
(CNS)
Cerebral cortex Hypothalamus
- Frontal lobe
Cerebellum
- Parietal lobe
- Occipital lobe
Brainstem
- Wernicke’s area
- Broca’s area
Basal ganglia
Thalamus
- Midbrain
- Pons
- Medulla
Spinal cord
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Cerebral Cortex
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[PRODUCTION NOTE: Please insert Figure 23-2 (from Jarvis Physical
Examination and Health Assessment, 5e, ISBN: 978-1-4160-3243-4)]
CNS
© Pat Thomas,
2006.
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I
Olfactory
II
Optic
III
Oculomotor
IV
Trochlear,
VI
Abducens
V
Trigeminal
VII
Cranial
Nerves
Facial
VIII Acoustic (vestibulocochlear)
IX
Glossopharyngeal
X
Vagus
XI
Spinal accessory
XII
Hypoglossal
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Cranial Nerves - Introduction
Interactive quiz to identify the cranial nerve function.
Olfactory I
Optic II
Oculomotor III
Trochlear IV
Trigeminal V
Abducens VI
Facial VII
Auditory (vestibulocochlear) VIII
Glossopharyngeal IX
Vagus X
Spinal Accessory XI
Hypoglossal XII
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CNS Pathways
Sensory pathways
- Spinothalamic tract
- Posterior (dorsal) column
Motor pathways
- Corticospinal or pyramidal
tract
- Extrapyramidal tracts
- Cerebellar system
Upper motor neurons
Lower motor neurons
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Sensory Pathways
© Pat Thomas, 2006.
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Motor Pathways
© Pat Thomas, 2006.
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Reflex Arc
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Subjective Data
Headache
Head injury
Dizziness or Vertigo
Seizures
Tremors
Weakness
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Subjective Data
In-coordination / “uncoordinated”
Numbness or tingling
Difficulty swallowing
Difficulty speaking (Dysphasia)
Environmental/occupational hazards
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Objective Data
Equipment needed
- Penlight
- Tongue blade
- Toothpick
- Cotton swab / Cotton ball
- Tuning fork (128 or 256 Hz)
- Percussion hammer
- Familiar aromatic substance
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Motor System
Muscles
- Size
- Strength
- Tone
- Involuntary movements
Cerebellar function
- Balance tests
- Coordination
- Skilled movements
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Romberg Test
Proprioceptive pathway
Negative
- ve
Positive
+ ve
Normal
Abnormal
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Ambulation
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Describe…
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Abnormal Ambulation
Asymmetrical Spastic Diplegia
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Neuro Check (Crani Check)
Level Of Consciousness (LOC)
Person
Place
Time
Oriented x
3
Motor function
Pupillary response
Vital signs
Glasgow Coma Scale (GCS)
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IntraCranial Pressure = ICP
Pressure within the cranial cavity influenced by brain mass,
the circulatory system, CSF dynamics, and skull rigidity
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Increased
ICP (IICP)
Critical event / Life threatening
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CT scan showing intracranial
hemorrhage with cerebral
edema, midline shift, and
increased intracranial pressure
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Glasgow Coma Scale
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The GCS is the most
widely used method of
defining a patient's level
of consciousness (LOC)
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Expanded
Neuro
Assessment
Tool
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Mini-Mental Status Exam
Rancho Los Amigos Scale
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EARLY Signs of
↑ ICP
The most important
neurologic “vital sign”
!!!!!!!!!!!!!!!!!!!!!!!!!
1. LOC changes ******MOST IMPORTANT****
2. Pupils sluggish / Impaired eye movement
3. Limb strength changes
4. Headache
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Pupils
LATE Signs of
.
ICP
.
“Call the
neurosurgeon”
1. Further decreased LOC
2. Cushing’s Triad
3. Abnormal respiration patterns
anisicoria
“fixed & dilated
4. Pupils asymmetrical / Dilated
5. Projectile vomiting
“Call the
chaplain.”
6. Hemiplegia / decorticate or decerebrate posturing
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Late Sign of IICP
Cushing’s “Triad”
Blood Pressure
(Widening Pulse Pressure)
Temperature
Pulse
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Abnormal Postures
Flaccid quadriplegia
Decorticate rigidity
Decerebrate rigidity
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“Toward the Core”
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Pupil Responses
Dilated ?
Consenusal ?
Shape ?
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Rapidly Alternating
Movement (RAM) Evaluation
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Finger to Nose Test
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Heel to Shin Coordination Test
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Test Deep Tendon Reflexes
Technique
Grading
Babinski’s sign
Biceps reflex
Triceps reflex
Brachioradialis reflex
Quadriceps reflex
Achilles reflex (“ankle jerk”)
Abdominal reflexes
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Reflexes
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Babinski Reflex
Negative
- ve
Normal
Positive
+ ve
Abnormal
A normal response, B Babinski reflex
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Testing the DTR’s provides
data about the
INTACTNESS of the
REFLEX ARC at specific
levels in the spinal cord.
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Abnormalities in Muscle Movement
Paralysis
Fasciculations
Flaccidity
Ataxia
Rest tremor
Intention
tremor
Paresthesia
Coma
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Sensory System
Alert, cooperative, and comfortable
Spinothalamic tract
- Pain
- Temperature
- Light touch
Posterior column tract
- Vibration
- Position (kinesthesia)
- Tactile discrimination
(stereognosis,
graphesthesia)
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Aged – “Less” is Normal
- Walk slower
- More careful walking
- Decreased tactile sensation
- Lose ability to feel vibration
at ankles
- Decreased ability to smell
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Cultural Considerations
“Epilepsy”
Uganda: contagious, untreatable
Greece: source of family shame
Mexican-American: evidence of physical
imbalance
Hutterites: having endured a trial by God
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Narrative Charting
Denies any of the following: frequent or severe headaches; history of head
injury, dizziness, or vertigo. Denies weakness, numbness, or tingling; no
difficulty swallowing or speaking. No past history of stroke, meningitis, spinal
cord injury, or alcoholism.
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Narrative Charting
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Jarvis Page 679
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Neuro Assessments
Neuro Assessment Practice:
http://icarus.med.utoronto.ca/NeuroExam/
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Which area of the brain is most likely
affected if the patient is having trouble
with the finger-to-nose test?
A.
B.
C.
D.
Cerebellum
Cerebrum
Hypothalmus
Brain stem
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Vibratory sense is most
frequently affected in cases of?
A.
B.
C.
D.
Heart disease
Crohns’ disease
Lung Cancer
Diabetes
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Brain Teasers
http://brainconnection.positscience.com/teasers/
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The Hermann Grid Illusion
This phenomena demonstrates a very important principle of perception: we don't
always see what's really there. Our perceptions depend upon how our visual system
responds to environmental stimuli and how our brain then interprets this
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information.1
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1
Bach, M. (n.d.). Grid illusions. http://www.michaelbach.de/ot/lum_herGrid/index.html
The Zollner Illusion
This illusion presents a series of oblique lines crossed with overlapping short lines. The oblique
lines look as if they are crooked and will diverge. In reality, all of the oblique lines are
parallel.This optical illusion demonstrates how the background of an image can distort the
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appearance of straight lines.
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The
End
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