NURSING 207 Neurologic System Assessment and Reasoning Case Study- Peter Simpson 55 Years old

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NURSING 207 Neurologic System Assessment and Reasoning Case Study- Peter Simpson 55 Years old/NURSING 207 Neurologic System Assessment and Reasoning Case Study- Peter Simpson 55 Years old Assessment:... General • Mental status: assess speech, orientation, memory, and level of consciousness • Posture, position • Assess behavior, mood, and affect • Assess dress, grooming, hygiene Inspection: Neurological • Level of consciousness, orientation • 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, • Role play or go through the interview/body assessment process – student to student or as a group. • Review the case study as an application exercise in small groups or together as a class. • Depending on your program, some content in the case study may not have been taught. Do not let that prevent you from utilizing this case study! Use it to promote learning by having students identify what they do not yet know and guide where they can find the information in the textbook or on the internet to address knowledge gaps. This is educational best practice and another way to scaffold knowledge! Present Problem: Peter Simpson is a 55-year-old Caucasian male with a past medical history of hypertension and hyperlipidemia who presents to the emergency department for evaluation of a slight right facial droop and slurred speech that began two days ago. Peter states that the right side of his face feels numb like when you go to the dentist. He became more concerned this morning when he began having difficulty walking and noticed that his right arm and hand were weak and had difficulty holding onto a pen when he tried to write a check. What data from the pr......................................................................CONTINUED [Show More]

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