Sudden brain damage involv-

SECTION IV: ROLE PLAY

G. Sudden brain damage involv-

ing the may

produce a , which

in its course is .

refers to a defect in the

control of the speech .

begin with

body movements, impair-

ment of , or .

Observe the for the

of the , the

of the , and

of the .

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CHAPTER 20 THE NERVOUS SYSTEM 97

List the cranial nerves.

List the warning signs of stroke.

Activity B MATCHING

Match the level of consciousness with the defi nition.

Answer Level of Consciousness Defi nition

Alertness A. Arouses from sleep only after painful stimuli.

Verbal responses are slow or even absent.

Lethargy B. Opens the eyes and looks at you, but responds slowly and is somewhat confused Obtundation C. Unarousable with eyes closed

Stupor D. Opens the eyes, looks at you, and responds fully and appropriately

Coma E. Appears drowsy but opens the eyes and looks at you, responds to questions, and then falls asleep

Match the disorder of muscle tone with the location of the lesion.

Answer Disorder of Muscle Tone Location of Lesion

Spasticity A. Lower motor neuron system at any point from the anterior horn cell to the peripheral nerves

Rigidity B. Both hemispheres, usually in the frontal lobes Flaccidity C. Upper motor neuron of the corticospinal

tract at any point from the cortex to the spinal cord

Paratonia D. Basal ganglia system

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Match the gait/posture to its description.

Answer Gait/posture Description

Spastic hemiparesis A. Patients appear to be walking through water.

Steppage gait B. Gait is unsteady and wide based. Patients throw their feet for- ward and outward and bring them down, fi rst on the heels and then on the toes, with a double tapping sound.

Parkinsonian gait C. Gait is staggering, unsteady, and wide based, with exaggerated diffi culty on turns.

Scissors gait D. Poor control of fl exor muscles during swing phase

Cerebellar ataxia E. Posture is stooped, with fl exion of head, arms, hips, and knees.

Patients are slow getting started.

Sensory ataxia F. Patients either drag the feet or lift them high, with knees fl exed, and bring them down with a slap onto the fl oor, thus appearing to be walking up stairs.

12.

Which cranial nerve controls pupillary constriction?

Optic

Oculomotor

Trochlear

Trigeminal

13.

Where do the cell bodies of the lower motor neurons lie?

Anterior roots

Neuromuscular junction

Motor strip

Anterior horn cells

14.

When assessing your patient you note brady- kinesia. You would know that this abnormal- ity is caused by damage to what?

Basal ganglia system

Medulla

Cerebellar system

Brainstem

15.

What are attributed to sensory impulses?

Cessation of cough refl ex

Stimulation of sneezing

Help regulate internal autonomic func- tions

Body position in space

Conscious sensation

Activity C SHORT ANSWER

Explain nystagmus.

Discuss the disorders of speech.

Discuss peripheral nerves.

10.

Discuss the spinal cord.

Activity D NCLEX STYLE QUESTIONS

11.

Which of the following are types of diabetic neuropathies? (Mark all that apply.)

Diabetic amyotrophy

Autonomic dysfunction

Mononeuritis multiplex

Orthostatic hypotension

Gastroparesis

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CHAPTER 20 THE NERVOUS SYSTEM 99

16.

Mr. Clyde presents at the clinic with a com- plaint of weakness that is made worse with repeated effort and improves with rest. What would you suspect is wrong with Mr. Clyde?

Multiple sclerosis

Lyme disease

Myasthenia gravis

Parkinson disease

17.

You are admitting a patient new to the clinic who has a chief complaint of “My face feels funny.” When you assess the patient you fi nd isolated facial sensory loss to pain and no neurologic defi cits in his extremities. What would you expect this patient to be diag- nosed with?

Stroke

Horner syndrome

Bell palsy

Trigeminal neuralgia

18.

You are assessing your patient’s coordination and you fi nd that her movements are clumsy, unsteady, and inappropriately varying in their speed, force, and direction. You note the patient has dysmetria. What would you know this patient has?

Cerebellar disease

Cerebral disease

Brainstem disease

Basal ganglia disease

19.

Your patient is diagnosed with a peripheral neuropathy. You know that often the fi rst sensation lost in a peripheral neuropathy is what?

Light touch

Pain

Vibration

Temperature

20.

What important questions guide the approach to this challenging clinical area?

(Mark all that apply.)

Where does the lesion lie?

Is the central nervous system intact?

Is the mental status intact?

Is the peripheral nervous system intact?

Are right-sided and left-sided examination fi ndings symmetric?

SECTION III: CASE STUDY

Activity E

Margaret Blankenship, 76 years old, has fallen down her front steps. She is brought to the emer- gency department by ambulance with a large bruise on her right temple. EMTs report that vital signs are: HR 120; BP 109/77; RR 16; T 37.5°C;

and pain 4/10.

Document a brief neurologic exam on this patient.

What diagnostic tests would be completed on this patient?

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SECTION IV: DOCUMENTATION

FORM FOR USE IN PRACTICE

THE NEUROLOGIC SYSTEM

Patient Name Date/Time

Overview.

Identifying Data Source and Reliability

Common or Concerning Symptoms Headache

Dizziness or vertigo

Generalized, proximal, or distal weakness Numbness, abnormal or loss of sensations Loss of consciousness, syncope, or near syncope Seizures

Tremors or involuntary movements Onset

Location Duration

Characteristic symptoms Associated manifestations Relieving factors

Treatment History

Medications (current) Medications (past) Neurologic disease (present) Neurologic disease (past) Family History

Neurologic disease Genetic testing Lifestyle Habits Alcohol Tobacco Physical activity Physical Examination Mental Status Exam Level of alertness

Appropriateness of responses Orientation to date and place Cranial Nerves

Visual acuity Pupillary light refl ex Eye movements Hearing

Facial strength—smile, eye closure Motor System

Strength—shoulder abduction, elbow extension, wrist extension, fi nger abduction, hip fl exion, knee fl exion, ankle dorsifl exion

Gait—casual, tandem

Coordination—fi ne fi nger movements, fi nger-to-nose Sensory System

One modality at toes—can be light touch, pain/temperature, or proprioception Refl exes

Deep tendon refl exes—biceps, patellar, Achilles Plantar responses

Health Promotion Topics

Preventing stroke or transient ischemic attack (TIA) Reducing risk of peripheral neuropathy

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101

SECTION I: LEARNING OBJECTIVES

Learning Objectives The student will:

Describe the anatomy and physiology of the female and male reproductive systems.

Conduct a focused interview to obtain patient history pertinent to the reproductive system.

Explain appropriate technique in inspecting and palpating external reproductive struc- tures.

Discuss factors related to developmental, psy- chosocial, cultural, and environmental areas that affect the reproductive systems.

Differentiate between normal and abnormal fi ndings in the reproductive system.

Accurately document subjective and objective data fi ndings related to the reproductive sys- tem using the appropriate terminology.

SECTION II: STUDY GUIDE

Activity A FILL IN THE BLANK 1.

Complete the following statements:

When detected early,

Dalam dokumen Student Laboratory Manual for Bates’ Nursing Guide to Physical Examination and History Taking (Halaman 104-109)