5: Trigeminal - Facial sensation, corneal reflex, mastication
7: Facial - Symmetry of facial expression and muscle movement in upper and lower face, salivation and tearing, taste, sensation in the ear
9: Glossopharyngeal - Taste, sensation in pharynx and tongue, pharyngeal muscles, swallowing
10: Vagus - Muscles of pharynx, larynx, and soft palate; sensation in external ear, pharynx, larynx, thoracic and abdominal viscera; parasympathetic innervation of thoracic and abdominal organs
- Tremor, rigidity, bradykinesia, postural instability, depression and other psychiatric changes, dementia, autonomic symptoms, sleep disturbances
- The 4 cardinal signs: Tremors, rigidity, bradykinesia (slowness of movement), & postural instability (pt must have at least 2/4 of these to get diagnosed w/ Parksinson's)
Classic S/S = tremors, shuffling gate (short steps), mask-like face
Collect Objective Data!!
- Vital Signs
- Mental Status: Assessed to test Cerebral function. Can also assess cerebral fxn by assessing intellectual function... thought content, emotional status, perception, motor ability, and language ability
- Glascow Coma Scale: 15 = best. Anything below 5 = brain death
- Cranial Nerves
- Motor and Cerebellar systems: posture, gait, muscle tone and strength, coordination and balance, Romberg test
- Sensory System: tactile sensation, superficial pain, vibration and position sense (proprioception)
- Reflexes: Plantar/Babinski: Toes fan out = positive. BAD. DTRs, abdominal reflex.
REMEMBER TO ASSESS AND COMPARE ONE SIDE OF THE BODY TO THE OTHER
- are often characterized by a brief loss of consciousness followed by a lucid interval in which the patient is awake and conversant. During this lucid interval, compensation for the expanding hematoma takes place by rapid absorption of CSF and decreased intravascular volume, both of which help to maintain the ICP within normal limits. When these mechanisms can no longer compensate, even a small increase in the volume of the blood clot produces a marked elevation in ICP. The patient then becomes increasingly restless, agitated, and confused as the condition progresses to coma. Then, often suddenly, signs of herniation appear (usually deterioration of consciousness and signs of focal neurologic deficits, such as dilation and fixation of a pupil or paralysis of an extremity), and the patient's condition deteriorates rapidly.
- An epidural hematoma is considered an extreme emergency; marked neurologic deficit or even respiratory arrest can occur within minutes. Treatment consists of making openings through the skull (burr holes; see Fig. 66-8 in Chapter 66) to decrease ICP emergently, remove the clot, and control the bleeding. A craniotomy may be required to remove the clot and control the bleeding. A drain is usually inserted after creation of burr holes or a craniotomy to prevent reaccumulation of blood.
7th EditionJulie S Snyder, Linda Lilley, Shelly Collins
20th EditionClem Thompson, R T Floyd
9th EditionDonna F Gauwitz
15th EditionEllie Whitney, Frances Sizer