 ASSESSMENT and DIAGNOSTIC

EXAMS
 Soraida B.Basallaje, RN.MN.
 ASSESSMENT

 MENTAL STATUS EXAM

 Psychiatric practice; history and
examination
 a structured way of observing and
describing a patient’s current state of
mind under the domains:
◦ Orientation: knowing where he is and date
◦ Attention: concentrate on a mental task
(simple subtractions)
◦ Registration: listen and repeat back a few
words
 ◦ recall : remember words a few minutes
later
◦ Language.
◦ Constructional or visuospatial :copy or
draw an object or diagram
◦ abstract thinking: explain the meaning of
a proverb, or to explain the difference
between two objects

 GLASGOW COMA SCALE

 MOTOR RESPONSE
◦ Obeys simple command 6
◦ Localizes painful stimuli 5
◦ Withdrawal 4
◦ Abnormal flexion 3
◦ Abnormal extension 2
◦ No motor response to pain 1
 VERBAL RESPONSE
 ◦ Oriented 5
◦ Confused 4
◦ Inappropriate words 3
◦ Incomprehensible words 2
◦ None 1
 EYE-OPENING
◦ Spontaneous 4
◦ Sound 3
◦ Pain 2
◦ None 1
 Motor System assessment
 Muscle size:
◦ Severe atrophy suggests denervation of a
muscle (Lower Motor Neuron damage)

 Muscle tone:
 Rigidity - parkinsons disease
  Spasticity – upper motor neuron
damage

 Strength
 ROMBERGS TEST
 Ask the subject to stand erect
with feet together and eyes
closed

 A positive Romberg test

suggests that ATAXIA is sensory
in nature. A negative Romberg
test suggests that ataxia is
cerebellar in nature
 REFLEXES
 BABINSKI
 ◦ Dorsiflexion of the ankle and great
toe with fanning of the other toes
◦ Indictes an upper motor neuron
damage

 CORNEAL
◦ Loss of blink reflex; Cranial nerve V
dysfunction

 GAG
◦ Loss of gag reflex; Cranial nerve IX
and X
 SPECIAL NEURO ASSESSMENT
 Brudzinski’s sign
◦ Flexion of the head causes flexion of
both thigh at the hips and knee
flexion
 Kernig’s sign
◦ Flexion of the thigh and knee to
right angles when the limbs are
extended, it causes spasm of the
hamstring and pain

 SPECIAL NEURO ASSESSMENT

 Lhermitte’s sign
◦ an electrical sensation that runs
down the back and into the limbs,
and is produced by bending the neck
forward and/or backward
◦ Multiple sclerosis or herniation of
cervical disk

 Uhtoff’s Phenomenon
 ◦ visual problems that occur in
persons with Multiple Sclerosis
brought on during periods of
increased body temperature
◦ reflect areas of impaired but still
functioning myelin that breaks down
in transmitting electrical impulses
when the surrounding fluid heats up.
 DIAGNOSTIC EXAMINATIONS
 NON-invasive
 SKULL and SPINAL RADIOGRAPHY
 SKULL: Reveal the size and the
shape of the skull bones, suture
separation in infants, fractures
or bony defects or calcifications
 SPINAL: identify fractures,
dislocation, compression,
curvature, erosion, narrowed
spinal cord and degenerative
processes

 SKULL and SPINAL RADIOGRAPHY

 PREPROCEDURE
 ◦ Maintain immobilization of the neck
if spinal fracture is suspected
◦ Remove metal items from body parts
◦ Document if the patient has thick
and heavy hair because it may affect
the interpretation of the Xray film

 POSTPROCEDURE
◦ Maintain immobilization until the
results are known

 Identify: Male or Female

 Identify: Male or Female
 Radiology of the Pelvis
 Male
 Female
 COMPUTED TOMOGRAPHY SCAN
 A type of brain scanning that
may or may not require an
injection of a dye
 Detect intracranial bleeding,
lesions, edema, infarctions,
hydrocephalus and cerebral
atrophy

 CT SCAN
 PREPROCEDURE
◦ Informed consent if with dye
 (+) hot, flushed and metallic taste in
the mouth
 ◦ Assess for allergies and
claustrophobia
◦ Instruct to lie still and flat during the
test
◦ Remove objects from the head
◦ Inform of the possible mechanical
noises

 POSTPROCEDURE
◦ Replacement fluids for diuresis
◦ Allergic reactions to dye
◦ Assess dye injection site for
bleeding, hematoma, extremity color
and pulses
 MAGNETIC RESONANCE IMAGING
 Identifies types of tissues,
tumors and vascular
abnormalities
 Similar to CT scan but provides
more detailed pictures
 MRI
 PREPROCEDURE
◦ Remove all metal objects
◦ Containdicated to patients with
pacemakers, implanted defibrillators,
metal implants
◦ Assess for claustrophobia
◦ Determine if contrast agent will be
given
◦ Instruct to remain still during the
procedure
 POSTPROCEDURE
◦ Normal activities; diuresis if with
contrast agent

 ELECTROENCEPHALOGRAPHY
 A graphic recording of electrical
activity of the superficial layers
of the cerebral cortex

 EEG
 PREPROCEDURE
◦ Wash hair
◦ Inform that electrodes are attached
and that electricity DOES NOT enter
◦ Withhold stimulants,
antidepressants, tranquilizers,
 anticonvulsants for 24-48 hours
before the test
◦ Premedicate as prescribed

 POSTPROCEDURE
◦ Wash hair
◦ Maintain safety if patient was
sedated
 POSITRON EMISSION
TOMOGRAPHY
 a test that uses a special type of
camera and a tracer (radioactive
chemical) to look at organs in
the body
◦ Do not smoke or drink caffeine or
alcohol for 24 hours before this test.
 ◦ Do not eat or drink for 8 hours
before this test
◦ The tracer may make you feel warm
and flushed
 CAROTID/ TRANSCRANIAL
DOPPLER
 uses sound frequency to produce
images of the carotid arteries in
the neck on a viewing screen.
 a computer converts the Doppler
sounds into colors that are
overlaid on the image of the
blood vessel.
 gel is applied to the neck area to
provide good contact for the
handheld transducer.
 DIAGNOSTIC EXAMINATIONS
 INVASIVE

 LUMBAR PUNCTURE
 Insertion of a spinal needle
through the L3-L4 interspace
into the lumbar subarachnoid
space to obtain CSF, measure
CSF pressure or instill dye or
medications
 LP
 CONTRAINDICATED: increase ICP
d/t rapid decrease of CSF around
the spinal cord = brain
herniation
 PREPROCEDURE
◦ Informed consent
◦ Empty bladder

 DURING
◦ Lateral recumbent with knees drawn
up to the abdomen and chin onto the
chest
◦ Maintain strict asepsis

 POST PROCEDURE
◦ Monitor VS and NVS
◦ Position flat as prescribed
◦ Monitor I/O, force fluids
 MYELOGRAM
 Injection of dye or air into the
subarachnoid space to detect
abnormalities of the spinal cord
and vertebrae

 MYELOGRAM
 PREPROCEDURE
◦ Obtain informed consent
◦ Assess for allergies of iodine
◦ Premedicate for sedation if
prescribed

 POSTPROCEDURE
◦ Asses VS and NVS
 ◦ Dye: water based elevate head 15-
300; 6-8 hrs
oil based flat for 6-8 hrs
air keep head lower than
trunk 48hrs
◦ Monitor I/O, bladder distention and
vomiting
 CEREBRAL ANGIOGRAPHY
 Injection of a contrast through
the femoral artery into the
carotid arteries to visualize the
cerebral arteries and assess for
lesions
 CEREBRAL ANGIOGRAPHY
 PREPROCEDURE
◦ Informed consent
 ◦ Assess for allergies
◦ NPO status 4-6 hours prior
◦ Obtain baseline neurological
assessment
◦ Mark peripheral pulses

 POSTPROCEDURE
◦ Monitor VS, NVS
◦ Assess for allergic reaction- swelling
of neck or difficulty breathing
◦ Elevate head of bed 15-30 degrees
only if prescribed
◦ Keep bed flat if femoral artery is
used
◦ Assess peripheral pulses
◦ Apply sandbags and pressure
dressing; ice on puncture site
 ELECTROMYOGRAPHY
 test that checks the health of the
muscles and the nerves that control
the muscles; shows impaired muscle
strength

 a very thin needle electrode will be

inserted through the skin into the
muscle and picks up the electrical
activity which will be displayed on an
oscilloscope