Okay, so let's talk about
assessing motor function.
This one is really, really fun
to try on a roommate, okay?
So for accurate assessment, the
patient needs to be awake.
So you can't really test their motor function if
they're not able to be awake and follow commands.
So the idea is you wanna make sure it's
equal on both sides, right and left.
I guess that part of it I need to explain to you that sides
meant right and left but there you go, that's a freebie.
So here's the things you're
gonna ask your patient to do.
You're gonna ask them to flex and extend their
arms against their hand, against your hand.
So you wanna put some pressure on
them to see what their strength is
because you wanna see if
it's equal on both sides.
You can ask them to
squeeze your fingers.
So have them with their palms up, you lay your hand in
theirs and just ask them to just squeeze your hands.
Do both at one time and see if they have any
difference between the right side and the left side.
Now, I sometimes really have a
hard time with my right hand.
If it's particularly stiff, that
is gonna be a little weaker.
So you can talk to
your patients and say,
"Hey, do you have any problems with
your grip? on the right or the left?"
and they should be able
to tell you if they do.
Now you want to put gentle pressure on their thigh and
see what their strength is if they lift the leg
while you're putting that pressure down,
same thing with the right and the left leg.
Have them hold their legs straight and
see that they lift up against gravity,
good for their abs
too, just kidding.
Or you can have them flex and
extend the foot against your hand.
So if they're laying in bed, just put your palms
of your hand against the bottoms of their feet
and have them try flex and extend
their feet against your hands
that way you can see what
their strength is there, too.
Hey, while we're talking about feet, one of my least
favorite parts of the patient's body sometimes.
But remember, if that patient has socks
on, everyone should take those socks off.
Now, there's no telling what you're gonna find,
but a thorough assessment of the patient,
you wanna take those socks off, look at their feet, especially
while you're doing this assessing the motor function,
You wanna check and see if there's any
wounds on their feet, how their feet look,
if there's anything we
need to follow up on.
Because sometimes, we get these little
elderly people that put those socks on
and you know, 1984 and they
haven't taken them off since.
So, you wanna carefully take that off
and assess those feet also for skin
while you're assessing
the motor function.
Okay, what do you do for
an unconscious patient?
Well, we use noxious stimulus and
we look how they respond to it.
It's really not my favorite part because
I wouldn't want this done to me
but we need to figure out what's going on with
their neuro status so that's what you do.
So when we say noxious stimulus, can you
remember what two examples we talked about?
Okay, remember we put pressure on the nailbed, you
can use a pen or you can use the end of a hammer,
you could put it on the
fingers or on their toes.
Another thing we do is you kinda
do this with your knuckles
and you put it right on their
sternum and you press and twist.
Okay, that's another very
noxious form of stimulus.
So two ways, nailbed pressure is
usuallly enough, this is more,
I mean, more noxious than nailbed
pressure, you can also try that.
What you wanna watch for is
any asymmetrical response.
So, do both arms respond the same
way, do both legs respond the same?
Is there anything
Do you notice anything about their muscle
tone or are they just flaccid when yo do that?
Now, the worst case scenario we're talking about
is decorticate posturing or decerebrate posturing.
This looks really bizarre, you're gonna know right away
when your patient does this that this is not a great sign.
Okay, so let's talk about
They have straight arms and legs
or toes are pointed downwards,
they arch their neck and their back
and they do like kind of this thing.
Now, I usually remember this because
they'd do the arms like this looks like,
I kind of think about
But this is caused by a problem with the brainstem,
this is not a cause to celebrate, right?
So you know, I've tried to remember like, they're
celebrating, decerebrate, it's nothing to party about
because once your brainstem is affected, we're
really talking about severe, severe problems.
So decerebrate posture, straight arms and legs, they move
their arms like this but it's a really, really bad sign.
Decorticate posture, arms are stiff and bent, legs
stick out straight but they clench their wrist
and they bend their fingers,
pressed against their chest.
I remember this one by thinking like
- to the cord, it's "decorticate".
Okay, so that's with problems due
to their corticospinal pathways.
I wouldn't want to be doing either one of
these, I wouldn't want somebody I care about
or any patient to be decerebrate or
decorticate posturing, but it happens.
It's important that you as a nurse recognize the difference
between decerebrate posturing, decorticate posturing
and what that really
translates in the meaning.
So I would pause the video for just a minute if
I were you and I would practice that yourself.
Can you mimic what
I would look like?
Put your body in the position of decerebrate
posturing and decorticate posturing
and do that 2 or 3 times, back and forth
to really lay that down in your brain.
That way, if you see it on a
test question, you got it.
And if you see it in a patient more importantly,
you'll know what it means and you know what to do.
Now this is a new assessment on your patient,
this is immediately call the healthcare provider.
If this is continued, then alright,
then we know that's it's just a trend
and it's been going on, we
handle that differently.
But if this is new,
this is a big deal.
This is something you would absolutely
let the healthcare provider know.