NSE 13A/B- Final Exam Guide - Comprehensive Notes for the exam ( 164 pages long!)

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29 Mar 2018
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Ryerson
NSE 13A/B
Final EXAM
STUDY GUIDE
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NSE 13: WEEK 1 READINGS
Weekly Objectives:
1. Self-review anatomy and physiology including the central nervous system, reflex arc,
cranial and spinal nerves.
2. Distinguish between techniques used to assess impulses carried in the spinothalamic tract
and the posterior/dorsal columns
3. Outline the developmental changes, cultural considerations and health promotion
strategies
4. Assess overall Level of Consciousness (LOC) and General Survey
5. Outline/practice subjective questions and identify critical findings
6. Identify guidelines for preparation of objective data collection
7. For each of the 12 cranial nerves: Identify function and purpose of testing; and
demonstrate mode of testing (do NOT test corneal reflex)
8. Inspect and palpate the motor system
9. Assess the sensory system
10. Test reflexes, practice reinforcement and grade reflex responses
11. Discuss and practice the neurological recheck
12. Practice using the Glasgow coma scale and the Canadian Neurological Scale
13. Verbally report and document subjective and objective findings
Required Readings
Jarvis, ch. 25
pgs. 98-99 and 152-153
TECHNIQUES TO ASSESS IMPULSES CARRIED IN THE SPINOTHALAMIC TRACT
AND POSTERIOR/DORSAL COLUMNS
Spinothalamic Tract
Pain:
- tested by pt ability to feel a pinprick
1 Break a tongue blade lengthwise, sharp end and dull end
2 Lightly apply the sharp point or the dull end to pt body at random, unpredictable order
3 Ask pt to say sharp or dul depending on sensation
4 Sharp edge(pain) dull(test pt responses)
5 Let 2 secs elapse after each stimulus to avoid summation
Abnormal Findings
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- Hyperalgesia: decreased pain sensation
- Analgesia: absence of pain sensation
- Hyperalgesia: increased pain sensation
Temperature:
- Test only when pain sensation is abnormal
1. Fill two test tubes- one with hot water, one with cold
2. Apply bottom ends to pt skin at random
3. Ask pt to tell what temperature is felt
4. Alt: Flat side of tuning fork on the skin, metal is always cool
Light Touch
1. Apply a wisp of cotton to skin
2. Stretch cotton ball and brush over skin in random order/sites/intervals
3. Ask pt to say ‘now” or “yes” when sensation is felt
Posterior Column Tract
Vibration
- Test pt ability to feel vibrations of a tuning fork over bony prominences
- Use a low pitch tuning fork because its vibration has a slower delay
- Ask pt to indicate when the vibration starts and stops
1. Strike on heel of your hand, hold the base on a bony surface of pt fingers and great toe
2. If pt feels the normal vibration on the distal areas, assume proximal spots are normal too
3. If no vibrations, proceed to ulnar processes, ankles, patellae and iliac crests
4. Do both sides
5. If deficit is found, note gradual or abrupt
Abnormal Findings
- Inability to feel vibration(alcoholism, diabetes)
- Peripheral neuropathy is the worst at the feet and sensation gradually improves up the leg
Position
- Assess ability for pt to move passive mvmts of extremities
1. Move a finger or big toe up and down, ask pt to tell you the direction of mvmt
2. Ensure pt eyes are shut
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