NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Week 9: Assessment of Cognition and the Neurologic System

                NURS 6512-COMPREHENSIVE PHYSICAL EXAMINATION CHECKLIST

The following list will be used to determine the grade for the physical examination demonstration.  It does not constitute a complete list of everything that could be included in a physical examination, but rather a list of those things that should be done at a minimum for every individual having a “complete physical examination”.

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IMPORTANT INSTRUCTIONS: Adjust your camera to show a full view of both you and your patient volunteer, show your government issued photo ID/passport for verification of who you are, scan the room that you are using for verification that notes are not being used or posted, then begin the video. You may not take notes during the examination. Omitting these instructions or obtaining a score of less than 69.5% will result in a failure of the video assignment and the course. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

		PossiblePoints	Score
Skin
2	Inspects all areas of body esp. feet	2
Head & Neck
6	Inspect & Palpates skull	1
	Palpates lymph nodes for adenopathy	2
	Palpates thyroid (with H2O/swallowing)	2
	Palpates tracheal placement	1
Eyes
12	Checks visual acuity  (Snellen chart required)	1
	Checks peripheral fields	2
	Checks EOMs	2
	Checks conjunctiva for pallor	1
	Checks pupillary reaction	1
	Opthalmoscopic exam (opthamoloscope is required)	5
	describes discs, checks for microaneurysms,
	hemorrhages, neovascularization
Ears, Nose,
Sinuses, Mouth	Determines gross hearing/whisper test (Tuning Forks are required. Frequency of 500-1000Hz to be used)	2
8	Otoscopic exam (describes landmarks) (otoscope is required)	2
	Inspect & Assess Nares	1
	Palpate & percuss  sinuses	2
	Examines mouth (hard palate/soft palate, salivary glands, tongue, gag reflex)	1
Chest and Lungs
8	Inspect chest & Observes respiratory movements	1
	Posterior chest	5
	Palpates & percuss respiratory excursion. Assess  tactile fremitus; Thoracic  expansion
	Auscultates breath sounds
	Anterior chest	2
	Palpate & percuss ant chest. Auscultate breath sounds
Breasts	Explanation only –do not demonstrate	1
1	Palpates axillae, inspects breasts
	Palpates axillary lymph nodes
Cardiovascular
8	Inspect & Observes neck veins and measures JVD (two pocket ruler required)	1
	Palpates PMI and precordium	2
	Auscultates cardiac sites (Aortic area, Pulmonic area, Tricuspid area, Mitral Area (Apex) and state sounds	5
	With diaphragm and bell sitting position
	then diaphragm supine/left lateral decubitus
Peripheral Vascular
5	Inspect & Palpates pulses: carotids, radials, tibialis, pedals	2
	Palpates for lower extremity edema	1
	Auscultates for  carotid bruit	2
Abdomen
10	Inspect & Auscultates bowel sounds	1
	Auscultates renal arteries	2
	Percuss liver to determine spanNURS 6512 Week 9: Assessment of Cognition and the Neurologic System	2
	Palpates abdomen for tenderness(light and deep palpation, including McBurney’s point and rebound tenderness)	2
	Check for splenic & liver enlargement	3
Neurological
30	Mental status—MMSE or clock drawing	1
	Cranial nerves:	12
	Olfactory: smell
	Optic: visual acuity, fields
	Oculomotor, trochlear, abduces: EOMs
	Trigeminal: sensation & jaw strength
	Facial: frown, smile, corneal reflex
	Acoustic: gross hearing
	Glossopharyngeal, vagus: gag reflex
	Spinal accessory: shrug shoulders
	Hypoglossal: moves tongue
	Reflexes: all DTRs and Babinski (reflex hammer is required)	5
	Sensory:
	L ight touch/monofilament on feet (Monofilament tool required)	1
	Vibration	1
	Stereognosis or graphesthesia	1
	Motor:
	Strength—upper and lower extremities	2
	Muscle tone	2
	Gait	1
	Cerebellar:
	Test for coordination(any coordination test covered in your text readings)	1
	One test for balance	1
	One test for meningeal irritation	1
	One test for nerve root irritation	1
Musculoskeletal
10	Inspects spine	1
	Palpates spine	2
	Palpates major joints	2
	(Shoulders, Hips, Knees, Elbows)
	Active ROM of spine, knee, shoulders, hips	5
Overall approach	-20 points for every editing/cut/paste in video-20 points using notes or wall notes for each instance-10 points if order is illogical or fragmented-10 points for repeating the video due to not following instructions		–
	-10  points for hesitation or evidence of lack of practice-5 points for not wearing a lab coat AND professional dress attireVideo over 30 mins- video stopped at 30 mins and 10 points deducted in addition to point deductions for systems not covered. Faculty must watch the video to determine if all criteria were met to pass video.		–
	Failure-  not using appropriate equipment;Failure-  to perform a system assessment as this is a complete physical examFailure- not showing photo ID
		Total

• You MUST pass the video with 69.5% or higher or you will fail the course.

Comments:

A 63-year-old woman comes to your office because she’s been forgetting things…a young mother comes in concerned because her baby fails to make eye contact and is unresponsive to touch…a teenager comes in and a parent complains that the teen obsessively washes his hands.

An array of neurological conditions could be causing the above symptoms. When assessing the neurologic system, it is vital to formulate an accurate diagnosis as early as possible to prevent continued damage and deterioration of a patient’s quality of life. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

This week, you will explore methods for assessing the cognition and the neurologic system.

Learning Objectives – Week 9: Assessment of Cognition and the Neurologic System

Students will:

• Evaluate abnormal neurological symptoms
• Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for cognition and the neurologic system

Photo Credit: Kurt Drubbel/E+/Getty Images

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Learning Resources – Week 9: Assessment of Cognition and the Neurologic System

Note: To access this week’s required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.

Required Readings

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 5, “Mental Status” (64-78)This chapter revolves around the mental status evaluation of an individual’s overall cognitive state. The chapter includes a list of mental abnormalities and their symptoms.

• Chapter 22, “Neurologic System” (pp. 544-580)The authors of this chapter explore the anatomy and physiology of the neurologic system. The authors also describe neurological examinations and potential findings.

Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

• Chapter 4, “Affective Changes” (pp. 33-46)This chapter outlines how to identify the potential cause of affective changes in a patient. The authors provide a suggested approach to the evaluation of this type of change, and they include specific tools that can be used as part of the diagnosis.

• Chapter 9, “Confusion in Older Adults” (pp. 97-109)This chapter focuses on causes of confusion in older adults, with an emphasis on dementia. The authors include suggested questions for taking a focused history, as well as what to look for in a physical examination.

• Chapter 13, “Dizziness” (pp. 148-157)Dizziness can be a symptom of many underlying conditions. This chapter outlines the questions to ask a patient in taking a focused history and different tests to use in a physical examination.

• Chapter 19, “Headache” (pp. 221-234)The focus of this chapter is the identification of the causes of headaches. The first step is to ensure that the headache is not a life-threatening condition. The authors give suggestions for taking a thorough history and performing a physical exam. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System.
• Chapter 28, “Sleep Problems” (pp. 345–355)In this chapter, the authors highlight the main causes of sleep problems. They also provide possible questions to use in taking the patient’s history, things to look for when performing a physical exam, and possible laboratory and diagnostic studies that might be useful in making the diagnosis.

Sullivan, D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia, PA: F. A. Davis.

• Chapter 2, “The Comprehensive History and Physical Exam” (“Cranial Nerves and Their Function” and “Grading Reflexes”; p. 29)

• Chapter 4, “Pediatric Preventative Care Visits” (” Neurological Reflexes That Should Be Tested During Infancy”; (p. 108)
• Chapter 9, “Prescription Writing and Electronic Prescribing” (pp. 195-206)

Note: Download and review these Adult Examination Checklists and Physical Exam Summary to use during your practice neurological examination.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for mental assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Mental Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for neurologic assessment. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. This Adult Examination Checklist: Guide for Neurologic Assessment was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Neurologic system. In Mosby’s guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby. This Neurologic System Physical Exam Summary was published as a companion to Seidel’s guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Bearden, S. T., & Nay, L. B. (2011). Utility of EEG in differential diagnosis of adults with unexplained acute alteration of mental status. American Journal of Electroneurodiagnostic Technology, 51(2), 92–104. This article reviews the use of electrocenographs (EEG) to assist in differential diagnoses. The authors provide differential diagnostic scenarios in which the EEG was useful. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Athilingam, P., Visovsky, C., & Elliott, A. F. (2015). Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice. American Journal of Alzheimer’s Disease & Other Dementias, 30(6), 547–558. doi:10.1177/1533317515577127. Retrieved from the Walden Library Databases.

Sinclair, A. J., Gadsby, R., Hillson, R., Forbes, A., & Bayer, A. J. (2013). Brief report: Use of the Mini-Cog as a screening tool for cognitive impairment in diabetes in primary care. Diabetes Research and Clinical Practice, 100(1), e23–e25. doi:10.1016/j.diabres.2013.01.001

Retrieved from the Walden Library Databases.

Roalf, D. R., Moberg, P. J., Xei, S. X., Wolk, D. A., Moelter, S. T., & Arnold, S. E. (2013). Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimer’s & Dementia, 9(5), 529–537. doi:10.1016/j.jalz.2012.10.001 Retrieved from http://www.alzheimersanddementia.com/article/S1552-5260(12)02463-6/abstract

University of Virginia. (n.d.). Introduction to radiology: An online interactive tutorial. Retrieved from http://www.med-ed.virginia.edu/courses/rad/index.html

This website provides an introduction to radiology and imaging. For this week, focus on head CTs in neuroradiology.

Required Media

Online media for Seidel’s Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel’s Guide to Physical Examination. Focus on the videos and animations in Chapters 5 and 22 that relate to the assessment of cognition and the neurologic system. Refer to the Week 4 Learning Resources area for access instructions.

Optional Resources

LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

• Chapter 14, “The Neurologic Examination” (pp. 683–765)This chapter provides an overview of the nervous system. The authors also explain the basics of neurological exams.
• Chapter 15, “Mental Status, Psychiatric, and Social Evaluations” (pp. 766–786)In this chapter, the authors provide a list of common psychiatric syndromes. The authors also explain the mental, psychiatric, and social evaluation process.

Mahlknecht, P., Hotter, A., Hussl, A., Esterhammer, R., Schockey, M., & Seppi, K. (2010). Significance of MRI in diagnosis and differential diagnosis of Parkinson’s disease. Neurodegenerative Diseases, 7(5), 300–318. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

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Discussion: Assessing Neurological Symptoms

Imagine not being able to form new memories. This is the reality patients with anterograde amnesia face. Although this form of amnesia is rare, it can result from severe brain trauma. Anterograde amnesia demonstrates just how impactful brain disorders can be to a patient’s quality of living. Accurately assessing neurological symptoms is a complex process that involves the analysis of many factors.

In this Discussion, you will consider case studies that describe abnormal findings in patients seen in a clinical setting.

Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Case 1: Headaches

A 20-year-old male complains of experiencing intermittent headaches. The headaches diffuse all over the head, but the greatest intensity and pressure occurs above the eyes and spreads through the nose, cheekbones, and jaw.

Case 2: Numbness and Pain

A 47-year-old obese female complains of pain in her right wrist, with tingling and numbness in the thumb and index and middle fingers for the past 2 weeks. She has been frustrated because the pain causes her to drop her hair-styling tools.

Case 3: Drooping of Face

A 33-year-old female comes to your clinic alarmed about sudden “drooping” on the right side of the face that began this morning. She complains of excessive tearing and drooling on her right side as well.

To prepare:

With regard to the case study you were assigned:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Note: Before you submit your initial post, replace the subject line (“Discussion – Week 9”) with “Review of Case Study ___.” Fill in the blank with the number of the case study you were assigned.

By Day 3

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

Read a selection of your colleagues’ responses.

By Day 6

Respond to at least two of your colleagues on two different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 9 Discussion Rubric

Post by Day 3 and Respond by Day 6

To participate in this Discussion:

Week 9 Discussion

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Assignment (Optional): Practice Assessment: Neurological Examination

Short of opening a patient’s cranium or requesting a brain scan, what can an advanced practice nurse do to determine the cause of neurological symptoms? A multitude of techniques can be used to generate a neurological diagnosis.

In preparation for the Head-to-Toe Physical Assessment Video due in Week 10, it is recommended that you practice performing a neurological examination this week.

Note: This is an optional practice physical assessment. You do not have to capture a video of this assessment, as no submission is required.

To prepare:

• Arrange an appropriate time and setting with your volunteer “patient” to perform a neurological examination.
• Download and review the Neurological Checklist provided in this week’s Learning Resources.
• Ensure that you have a plexor (reflex hammer) to perform the examination.

To complete:

• Perform the neurological examination. Be sure to cover all of the areas listed in the checklist and to use the plexor appropriately.

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Looking Ahead: Head-to-Toe Physical Assessment Video

In Week 10, you will videotape yourself conducting a head-to-toe physical assessment.

By Day 7 of Week 10

This video is due. Refer to Week 10 for additional guidance.

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Week in Review

This week, you properly applied the assessment techniques and diagnoses for cognition and the neurological system. In addition, you evaluated abnormal neurological symptoms and explained which physical exams and diagnostic tests would render the appropriate results needed to make a diagnosis.

Next week, you will explore how to assess problems with the breasts, genitalia, rectum, and prostate while making the patient feel safe, listened to and cared about using a non-invasive approach. NURS 6512 Week 9: Assessment of Cognition and the Neurologic System