NurseReview.Org - Reflexes

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Information about NurseReview.Org - Reflexes

Published on April 30, 2008

Author: nclexvideos

Source: slideshare.net

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Neurology System Reflexes

Reflex Arch Spinal nerves have sensory (Afferent) & motor (Efferent) portions Control DTRs & superficial reflexes Simple reflex arch needs a sensory & motor neuron Ex. Of normal reflex arch = knee-jerk/patellar reflex

Spinal nerves have sensory (Afferent) & motor (Efferent) portions

Control DTRs & superficial reflexes

Simple reflex arch needs a sensory & motor neuron

Ex. Of normal reflex arch = knee-jerk/patellar reflex

Reflex Arch Reflexes= basic defense mechanisms of the nervous system Involuntary Unconscious Allow quick reaction to painful/damaging situations Maintain balance Appropriate muscle tone

Reflexes= basic defense mechanisms of the nervous system

Involuntary

Unconscious

Allow quick reaction to painful/damaging situations

Maintain balance

Appropriate muscle tone

Four Types of Reflexes Deep tendon Patellar or knee jerk Superficial Corneal abdominal Visceral Pupillary reflex to light and accommodation Pathologic Babinski Extensor plantar reflex

Deep tendon

Patellar or knee jerk

Superficial

Corneal

abdominal

Visceral

Pupillary reflex to light and accommodation

Pathologic

Babinski

Extensor plantar reflex

Deep Tendon Response Briskly tap the tendon of a partially stretched muscle For the reflex to fire, all components of the reflex arch must be intact Sensory nerve fibers Spinal cord synapse Motor nerve fibers Neuromuscular junction Muscle fibers

Briskly tap the tendon of a partially stretched muscle

For the reflex to fire, all components of the reflex arch must be intact

Sensory nerve fibers

Spinal cord synapse

Motor nerve fibers

Neuromuscular junction

Muscle fibers

Deep Tendon Response Tapping the tendon activates special sensory fibers in the partially stretched muscle, triggering a sensory impulse that travels to the spinal cord via peripheral nerve the stimulated sensory fiber synapses directly with the anterior horn cell innervating the same muscle.

Tapping the tendon activates special sensory fibers in the partially stretched muscle, triggering a sensory impulse that travels to the spinal cord via peripheral nerve

the stimulated sensory fiber synapses directly with the anterior horn cell innervating the same muscle.

Deep Tendon Response When the impulse crosses the neuromuscular junction, the muscle suddenly contracts, completing the reflex arch.

When the impulse crosses the neuromuscular junction, the muscle suddenly contracts, completing the reflex arch.

Deep Tendon Response Each deep tendon reflex involves specific spinal segments Abnormal reflex help locate an a pathologic lesion

Each deep tendon reflex involves specific spinal segments

Abnormal reflex help locate an a pathologic lesion

The Plantar Response Normally flexion of toes Dorsiflexion of the big toe & fanning of the other toes = Babinski Response Indicative of CNS lesion in corticospinal tract Babinski may also be seen in unconscious states due to drug or alcohol intoxication or postictal period

Normally flexion of toes

Dorsiflexion of the big toe & fanning of the other toes = Babinski Response

Indicative of CNS lesion in corticospinal tract

Babinski may also be seen in unconscious states due to drug or alcohol intoxication or postictal period

Grading Reflex Response Compare Right and Left Sides Graded on a 4 point scale 4+ very brisk,hyperactive with clonus 3+ brisker than average 2+ average, normal 1+ diminished, low normal 0 No response

Compare Right and Left Sides

Graded on a 4 point scale

4+ very brisk,hyperactive with clonus

3+ brisker than average

2+ average, normal

1+ diminished, low normal

0 No response

4 point scale Subjective No standard exists Wide range of normal Advise to assess DTRs only as part of the complete neurologic exam

Subjective

No standard exists

Wide range of normal

Advise to assess DTRs only as part of the complete neurologic exam

Abnormal Findings Clonus Short jerking contractions of the same muscle Hyperreflexia Exaggerated reflex Monosynaptic reflex arch from higher cortical levels Brain attack

Clonus

Short jerking contractions of the same muscle

Hyperreflexia

Exaggerated reflex

Monosynaptic reflex arch from higher cortical levels

Brain attack

Hyporeflexia Absence of reflex Lower motor neuron problem Spinal cord injury

Hyporeflexia

Absence of reflex

Lower motor neuron problem

Spinal cord injury

Reinforcement Reflex response fails Vary position Increase the strength Reinforcement Technique Relaxes muscles Enhances response Isometric exercise in muscle group away from the one being tested

Reflex response fails

Vary position

Increase the strength

Reinforcement Technique

Relaxes muscles

Enhances response

Isometric exercise in muscle group away from the one being tested

sample multiple choice During a neurologic examination, the tendon reflex fails to appear. Before striking the tendon again, the examiner might use the technique of:

During a neurologic examination, the tendon reflex fails to appear. Before striking the tendon again, the examiner might use the technique of:

Two-point discrimination Reinforcement vibration graphesthesia

Two-point discrimination

Reinforcement

vibration

graphesthesia

Complete Neurologic Exam Mental Status Cranial Nerves II - XII Motor System – muscle size, strength, tone, gait, and balance, RAMs Sensory System – superficial pain, light touch and vibration, position sense, stereognosis, graphesthesia, 2 point discrimination Reflexes – DTRs, biceps, triceps, brachioradialis, patellar, Achilles Superficial – abdomonal , Plantar

Mental Status

Cranial Nerves II - XII

Motor System – muscle size, strength, tone, gait, and balance, RAMs

Sensory System – superficial pain, light touch and vibration, position sense, stereognosis, graphesthesia, 2 point discrimination

Reflexes – DTRs, biceps, triceps, brachioradialis, patellar, Achilles

Superficial – abdomonal , Plantar

Neurologic Screening Exam Mental Status Cranial Nerves II Optic III, IV, VI Extraocular muscles V Trigeminal VII Facial Mobility Motor Function- gait & balance, Knee flexion (hop or shallow knee bend)

Mental Status

Cranial Nerves

II Optic

III, IV, VI Extraocular muscles

V Trigeminal

VII Facial Mobility

Motor Function- gait & balance, Knee flexion (hop or shallow knee bend)

Screening Sensory function – superficial pain & light touch (arms & legs) Vibration – arms & legs Reflexes Biceps Triceps Patellar Achilles

Sensory function – superficial pain & light touch (arms & legs)

Vibration – arms & legs

Reflexes

Biceps

Triceps

Patellar

Achilles

Neurologic Recheck In house patients with head trauma or neurologic deficit due to systemic disease process must be monitored closely for change in status or signs of  ICP. Use this shortened form of the neurologic exam: LOC Motor function Pupillary Response Vital Signs

In house patients with head trauma or neurologic deficit due to systemic disease process must be monitored closely for change in status or signs of  ICP. Use this shortened form of the neurologic exam:

LOC

Motor function

Pupillary Response

Vital Signs

LOC A change in the level of consciousness is the single most imp. Factor in this exam. It is the earliest sign. Check arousal, awareness, orientation – person, place & time. A person is fully alert when his eyes open at your approach or spontaneously, orientated x3, follows verbal commands appropriately. If not fully alert increase the amt. Of stimulus used as follows: name called, light touch on arm, vigorous shake of shoulder, pain (Nail bed, sternal rub)

A change in the level of consciousness is the single most imp. Factor in this exam. It is the earliest sign. Check arousal, awareness, orientation – person, place & time.

A person is fully alert when his eyes open at your approach or spontaneously, orientated x3, follows verbal commands appropriately. If not fully alert increase the amt. Of stimulus used as follows: name called, light touch on arm, vigorous shake of shoulder, pain (Nail bed, sternal rub)

Motor Function Check voluntary movement with commands (raise right arm, squeeze fingers) If spontaneous movement occurs in reaction to noxious stimuli = Localizing, documented as a purposeful movement

Check voluntary movement with commands (raise right arm, squeeze fingers)

If spontaneous movement occurs in reaction to noxious stimuli = Localizing, documented as a purposeful movement

Pupillary Response Size, shape, and symmetry of both pupils In a brain injured person – a sudden, unilateral, dilated and nonreactive pupil is ominous. When  ICP pushes the brain stem down (uncal herniation) it put pressure on Cranial nerve III (runs parallel to brain stem) causing pupil dilatation

Size, shape, and symmetry of both pupils

In a brain injured person – a sudden, unilateral, dilated and nonreactive pupil is ominous. When  ICP pushes the brain stem down (uncal herniation) it put pressure on Cranial nerve III (runs parallel to brain stem) causing pupil dilatation

Vital Signs TPR & B/P prn Note pulse & B/P are notoriously unreliable parameters of CNS deficit. Changes are late consequences of  ICP Cushing Reflex = sudden  B/P with widening pulse pressure ; pulse  slow & bounding

TPR & B/P prn

Note pulse & B/P are notoriously unreliable parameters of CNS deficit. Changes are late consequences of  ICP

Cushing Reflex = sudden  B/P with widening pulse pressure ; pulse  slow & bounding

Glascow Coma Scale Objective tool that defines LOC by assigning it a numeric value. Scale divided into 3 areas; Eye opening Verbal response Motor response Alert, normal person scores 15 Score of 7 or < reflects coma

Objective tool that defines LOC by assigning it a numeric value. Scale divided into 3 areas;

Eye opening

Verbal response

Motor response

Alert, normal person scores 15

Score of 7 or < reflects coma

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