brain_tumor_case_study.

Assessment & Reasoning Neurologic System Peter Simpson, 55 years old © 2019 Keith Rischer/www.KeithRN.com • Cranial nerves • Gait, balance, coordination Head: • Tongue-midline? • Symmetry in facial features • Grimace-big smile to assess facial droop • Sensation each side face • Pupils • Eyes: conjugate vs. disconjugate/extra ocular eye movements/visual fields ***Assess cranial nerve II (Optic) – Check PERRLA and visual fields • Evaluate posture, gait, balance, involuntary movements. • Assess light touch (to face and extremities), pain to extremities. • Fine motor coordination UPPER: finger to nose w/eyes closed (sobriety test) ***finger to nose then touch nurse’s finger ***fingers to thumb same hand in sequence • Fine motor coordination LOWER: Rub heel on opposite shin/calf downwards • Gross motor UPPER: bilateral hand grasp/pronator drift • Gross motor LOWER: dorsi/plantar flexion, bilateral leg lift, Babinski Inspection: Musculoskeletal • Observe posture – standing with feet together • Observe gait – weight-bearing, foot position, stride and length (and equality of stride), arm swing symmetry, and posture • Palpate muscles and joints for edema, heat, tenderness or crepitus • Assess muscle strength (0 to 5 scale) and joint range of motion FOCUSED/Frequent Neuro Assessment: Signs/symptoms: • Pupil changes of any kind (sluggish/change in size-EARLY ICP) • Assess LOC, orientation/new confusion, seizures, lethargic/unresponsive (LATE ICP) • Headache, nausea, vomiting VS changes: increased blood pressure, decreased HR, RR, Assessment & Reasoning Neurologic System Peter Simpson, 55 years old © 2019 Keith Rischer/www.KeithRN.com • Cranial nerves • Gait, balance, coordination Head: • Tongue-midline? • Symmetry in facial features • Grimace-big smile to assess facial droop • Sensation each side face • Pupils • Eyes: conjugate vs. disconjugate/extra ocular eye movements/visual fields ***Assess cranial nerve II (Optic) – Check PERRLA and visual fields • Evaluate posture, gait, balance, involuntary movements. • Assess light touch (to face and extremities), pain to extremities. • Fine motor coordination UPPER: finger to nose w/eyes closed (sobriety test) ***finger to nose then touch nurse’s finger ***fingers to thumb same hand in sequence • Fine motor coordination LOWER: Rub heel on opposite shin/calf downwards • Gross motor UPPER: bilateral hand grasp/pronator drift • Gross motor LOWER: dorsi/plantar flexion, bilateral leg lift, Babinski Inspection: Musculoskeletal • Observe posture – standing with feet together • Observe gait – weight-bearing, foot position, stride and length (and equality of stride), arm swing symmetry, and posture • Palpate muscles and joints for edema, heat, tenderness or crepitus • Assess muscle strength (0 to 5 scale) and joint range of motion FOCUSED/Frequent Neuro Assessment: Signs/symptoms: • Pupil changes of any kind (sluggish/change in size-EARLY ICP) • Assess LOC, orientation/new confusion, seizures, lethargic/unresponsive (LATE ICP) • Headache, nausea, vomiting VS changes: increased blood pressure, decreased HR, RR,