00:01
Now, let's move on when
we're talking about
the neurological system
and talk about coordination.
00:06
Now, this is typically done
if you suspect
some sort of neurological damage,
you may have to test
this in particular,
but just know
this is actually considered
more of a focused assessment.
00:17
So depending on where you work,
this may or may not be appropriate.
00:22
Now, here's a couple of things
that you can do
to test coordination.
00:26
One of those are a
finger-to-nose test.
00:28
And sometimes we'll do this
on a neurological or stroke unit,
for example.
00:32
So all this is here,
as you see in the image,
we're going to ask the patient
to take their finger and say,
"Okay, Mr. Jones,
I want you to touch your nose.
00:41
And then as the provider,
we're going to have our finger out
and have them reach out
and touch your finger.
00:45
Now, we're going to have repeat this
several times from nose to finger.
00:49
And as you see as the provider,
will move the finger around
and have them touch that,
and see what the patients
and assess their coordination here.
00:58
Now, the second way to assess
coordination is what we call
the heel-to-shin test.
01:03
Now, if you're assessing
coordination of patient
and you use the finger-to-nose,
or the heel-to-shin test,
and you notice the patient is just
completely missing their target,
then that may mean they have
neurological damage,
and you want to make sure you
report this to the physician.
01:20
Ask the client to place
their left heel
onto their right shin
just below the knee.
01:25
Ask them to slowly
inaccurately run their heel
down the length of the shin
to the top of the foot,
and then back up again.
01:33
Now, we're gonna ask the patient
to repeat this several times
and then perform the same test
on the other side.
01:40
Some patients have
a lot of illness,
there can be a lot of disease
process and things going on,
that they're so weak,
that they can even
pull up their foot
or their leg up off the bed
to touch their shin.
01:53
This weakness doesn't mean that
there's a coordination issue.
01:57
Now, let's talk about the sensory
piece of the neurological system.
02:01
Now, when we're
talking about sensory
think about sensation and being
able to feel with your patients.
02:08
Meaning certain patients,
such as stroke,
or post-op back procedures,
or trauma patients
can may have a different
or a decrease in sensation
in different parts of their body.
02:19
Now, sometimes,
if they're sensory issues,
we may need to do
a more focused assessment
and can do a complete sensory exam.
02:27
Now, this may include like
pain, or temperature,
or even position, vibration,
and even fine touch.
02:35
Now, if you take a look
at this dermatome map,
just one thing
I want you to keep in mind
and take a look at
this map while we talk.
02:42
Now, each area of our spine
innervate the specific area
of the body.
02:46
So if a specific area of
your spinal cord is injured,
now, you're going to
expect to see those effects
in particular areas of the body.
It all kinds of correlates.
02:57
So for example, if you take a look
at our map here on this image,
now you can imagine that if you
see injuries to the sacral area,
which is here shown in purple,
you're going to expect to see
these problems or symptoms
in the patient's legs.
03:11
Now let's further discuss
this whole topic.
03:14
Now, if someone
is having an epidural, for example.
03:18
This dermatome map is
really helpful to consider.
03:21
So when I say this word epidural,
now this is just when a
medication is put directly
into someone's spine.
03:28
Now, by doing this
at a specific spinal level,
it affects the neurological
status of the entire dermatome.
03:36
So just know that an epidural,
it's important to know where it is.
03:41
So you can tell if the med
is beginning to go up or down
the spinal column.
03:46
Now, here's a great example of this,
like let's say the epidural is put
into the lumbar region of the back.
03:52
Now, you're going to
expect that the patient has
some sensory or motor loss
in the lumbar regions,
because that's expected.
03:59
But what you don't expect
is them to have issues at,
or above the belly button, right?
Now, if this is different,
and if you assess this,
you need to let the provider know
immediately.
04:13
Now, let's talk about a sensation
assessment.
04:16
This can tell us a
lot about the patient
including their ability
to be able to feel or move,
or even acknowledge that there's
a presence of a part of the body.
04:26
Now, the start office
sensation assessment
we're going to explain to the client
that they need to report
when they feel a sensation
on their extremity.
04:35
Then we're going to use
our fingers or tool
and touch the client's extremity
to produce that feeling.
04:42
And then you're going to make sure
you tell the client to report it.
04:45
Now, here's a great little tip,
you can use your finger
or specific tool.
04:49
So a lot of the times in nursing
we can get just a Q-tip on the floor
because you've got a soft end,and
of course you've got the sharp end,
and you can use both for assessment.
05:00
Now, have the client
close their eyes,
and you will ask them
to close their eyes
and we don't want them to be
able to either see, or sense,
or see the movement
of our extremities
when we're assessing the client.
05:12
Now, you're going to use
your fingers, or your tools
or your cotton swab,
and lightly touch the client
without them seeing this.
05:20
Now particularly, what I'll do
is I'll have the blanket
over the clients legs,
I'll have my hands or my Q-tip
or tool underneath the blanket.
05:29
That way my patient can't see
me touch each side and assess.
05:33
So again, we're gonna assess
one side versus the other,
and then maybe both,
and we're gonna keep repeating this
and ask our client to report.
05:41
Now, the whole goal here is to see
if the client can feel the touch
without even being able to see
which parts assessed.
05:49
So this may be like, here's the
client's feet, that covers over it.
05:54
And I may say, "Okay, Mr. Jones,
which side am I touching now?
Tell me if it's right or
left, or both.
06:01
So under the covers with
my hands hidden or my tool,
I'll do right, I'll do left,
I'll do both.
06:07
I may go right again,
right, right, left.
06:11
So I just vary this to see if
the client can report appropriately
what they feel.
06:16
Now, during this time,
you can assess for numbness,
tingling, and any decrease
in sation in the extremity.
06:24
Now let's talk about paralysis.
06:26
There's different types,
meaning some patients
have no ability
to feel or even move
these parts of their body.
06:33
And again, we call this paralysis
and there's different types.
06:37
So all of these, unfortunately,
are going to result
from some kind of injury to
someone's central nervous system.
06:43
So, here's varying degrees of this.
06:46
So, if you take a look at this
one side called hemiplegia.
06:50
As you can see here in the green,
this is the affected part
of the patient's body.
06:54
So as you can see it's hemi,
meaning one side,
this is typically going
to occur in stroke.
07:00
So you see the upper,
the lower side of the body,
the patient's whole side,
they may not be able to feel
or move the side of the body.
07:08
Now when we're talking about
paraplegia, or quadriplegia,
this is usually from some
sort of spine injury.
07:15
Here's something to know,
the higher the injury is
on the patient's spine,
usually everything below it
can be damaged,
meaning they can't move it
or they can't feel it.
07:27
Now when we're talking about
monoplegia
this can happen as course as stroke
or maybe nerve compression,
some sort of inflammation
or some sort of
motor neuron disease.
07:38
So again,
taking a look at the slide.
07:40
As you can see, there are
different types of paralysis
that we need to assess,
and note in our documentation.