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186 PHYSICAL EXAMINATION

Anterior communicating artery

Posterior inferior cerebellar artery

Anterior spinal artery

C-2

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UNIT 2

Posterior column

The posterior column carries position, vibration and ne-touch sensations. The nerve impulse enters the spinal cord and travels upwards to the medulla, where a synapse with a second sensory neurone occurs. The neurone decussates to the opposite side of the medulla and continues on to the thalamus and sensory cortex.

Blood supply

Blood is supplied to the brain by two pairs of arteries: the internal carotid arteries (anterior circulation) and the vertebral arteries (posterior circulation). At the base of the brain lies the circle of Willis, an arterial anastomosis that links the anterior and posterior blood supplies (

Figure 7.6).

Anterior cerebral artery

Middle cerebral artery

Circle of Willis

C-2

C-3

C-4

T-2 T-3

C-5

T-2

C-7

T-1

Umbilicus

T-4 T-5 T-6

C-6

T-7 T-8 T-9

T-10

T-11

C-8

T-12

L-2 S-3

S-5

L-1

S-4

L-2

L-3

L-5

L-4

S-1

FIGURE 7.7 Anterior and posterior

dermatomal distributions

Internal carotid arteries

Posterior communicating artery

Posterior cerebral artery

Superior cerebellar artery

Basilar artery

Anterior inferior cerebellar artery

C-2

C-4

C-5

T-2

T-3 T-4 T-5 T-6 T-7 T-8 T-9 T-10 T-11 T-12

C-6

T-2

C-7

T-1

L-1

C-8

L-2

FIGURE 7.6 Major arteries of the brain

Peripheral nervous system

The peripheral nervous system consists of nervous tissue found outside the CNS,

Vertebral artery

including the spinal nerves, the cranial nerves and the autonomic nervous system.

S-3

S-2

Spinal nerves

The 31 pairs of spinal nerves include 8 cervical, 12 thoracic, 5 lumbar, 5 sacral and 1 coccygeal. Each spinal nerve is made up of a dorsal (afferent) root and a ventral (efferent) root. Each afferent spinal nerve root innervates a specic area of the skin, called a dermatome, for supercial cutaneous sensations. Figure 7.7 illustrates both

L-4

L-5

the anterior and the posterior dermatomal distributions. Spinal nerves leaving the right side of the cord supply the right side of the body, and those leaving the left side supply the left side.

Each of the eight cervical nerves exits above its corresponding vertebra. Each of

S-1

the spinal nerves below the cervical portion exits below its corresponding vertebra. The spinal cord is not as long as the vertebral column, so the lumbar and sacral nerves are comparatively long. These longer roots are called the cauda equina, meaning ‘horse’s tail’ (see Figure 7.3B).

MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 187

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Cranial nerves

There are 12 pairs of cranial nerves. They are designated with Roman numerals ItoXII in order of their position. Some cranial nerves have purely motor functions and some have only sensory functions. Others have mixed sensory and motor functions. givesa mnemonic to remember them.

TABLE 7.1 The 12 cranial nerves and their functions

NAME AND NUMBER FUNCTION

Olfactory (I) Smell

Optic (II) Visual acuity, visual elds, fundoscopic examination

Oculomotor (III) Cardinal elds of gaze (EOM movement), eyelid elevation, pupil reaction,

Trochlear (IV) EOM movement

Trigeminal (V) Motor: strength of temporalis and masseter muscles

Abducens (VI) EOM movement

Table 7.1 summarises the functions of the cranial nerves, and Table 7.2

doll’s eyes phenomenon

Sensory: light touch, supercial pain and temperature to face, corneal reex

CHAPTER 7

Facial (VII) Motor: facial movements

Sensory: taste anterior two-thirds of tongue

Parasympathetic: tears and saliva secretion*

Acoustic (VIII) Cochlear: gross hearing, Weber and

Vestibular: vertigo, equilibrium, nystagmus

Glossopharyngeal (IX) Motor: soft palate and uvula movement, gag reex, swallowing, guttural

and palatal sounds

Sensory: taste posterior one-third of tongue

Parasympathetic: carotid reex, chemoreceptors*

Vagus (X) Motor and sensory: same as CN IX

Parasympathetic: carotid reex, stomach and intestinal secretions, peristalsis, involuntary control of bronchi, heart innervation*

Spinal accessory (XI) Sternocleidomastoid and trapezius muscle movements

Hypoglossal (XII) Tongue movement, lingual sounds

*Cannot be directly assessed. EOM = extraocular muscle; CN = cranial nerve.

Rinne tests

REFLECTION IN PRACTICE

Cranial nerve mnemonics

How do you remember this type of detailed information? Mnemonics can assist you in remembering the name of each cranial nerve and whether each nerve has a sensory function, a motor function, or both (see Table 7.2).

188 PHYSICAL EXAMINATION

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TABLE 7.2 Mnemonics to remember cranial nerves

FIRST LETTER OF CRANIAL NERVE NUMBER OF CRANIAL NERVE

UNIT 2

On (Olfactory) I Some

Old (Optic) II Say

Olympus’s (Oculomotor) III Marry

Towering (Trochlear) IV Money

Tops (Trigeminal) V But

A (Abducens) VI My

Finn (Facial) VII Brother

And (Acoustic) VIII Says

German (Glossopharyngeal) IX Bad

Viewed (Vagus) X Business

Some (Spinal accessory) XI Marry

Hops (Hypoglossal) XII Money

For cranial nerve function, S = sensory nerve, M = motor nerve, B = both sensory and motor nerves.

FUNCTION OF CRANIAL NERVE

Autonomic nervous system

The autonomic nervous system (ANS) is divided into two functionally different subdivisions: the sympathetic and the parasympathetic nervous systems. The ANS functions without voluntary control to maintain the body in a state of homeostasis. Most organs that are under the inuence of the ANS have dual innervation of both sympathetic and parasympathetic systems.

The sympathetic nervous system, sometimes called the thoracolumbar system, controls ‘ght or ight’ actions. The parasympathetic nervous system (craniosacral) is responsible for ‘general housekeeping’ of the body. See responses to autonomic stimulation.

Table 7.3 for specic system

TABLE 7.3 Sympathetic versus parasympathetic response

SYSTEM SYMPATHETIC RESPONSE PARASYMPATHETIC RESPONSE

Neurological Pupils dilated Pupils normal size

Heightened awareness

Cardiovascular Increased heart rate

Increased myocardial contractility Decreased myocardial contractility Increased blood pressure

Respiratory Increased respiratory rate Bronchial constriction

Increased respiratory depth Bronchial dilatation

Gastrointestinal Decreased gastric motility Increased gastric motility

Decreased gastric secretions Increased gastric secretions Sphincter contraction Sphincter dilatation Increased glycogenolysis Decreased insulin production

Genitourinary Decreased urine output Normal urine output

Decreased renal blood ow

Decreased heart rate

MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 189

Muscle

neurone

Sensory

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Reexes

A reex action is a specic response to an adequate stimulus and occurs without conscious control. The stimulus can occur in a joint, a muscle or the skin, and is transmitted to the CNS by one or more sensory neurones. The impulse enters the spinal cord through the dorsal root of a spinal nerve, where it synapses. Following synapse in the cord, the anterior motor neurones send an impulse via motor neurones to the endplates of the skeletal muscle, causing the effector muscle to react (Figure 7.8).

A monosynaptic reex, such as the patellar reex, involves two neurones: one sensory and one motor. Polysynaptic reexes involve many neurones in addition tothe sensory and motor limbs of the reex arc. Reexes are classied into three main categories: muscle stretch, or deep tendon reexes (DTR); supercial reexes; and pathological reexes.

ASSESSMENT: TAKING THE CONSUMER’S HEALTH HISTORY

Assessment is the rst phase of the nursing process, and involves collecting subjective information about the consumer’s health status in order to identify consumer problem areas to focus on.

Subjective data is most frequently collected during a health history and serves as the

starting point for the health professional to base the depth of their assessment on.

The sections for the health history include:

> Consumer prole

> Chief complaint (explained systematically using variations of location, quality,

quantity, associated manifestations, aggravating factors, alleviating factors, setting and timing. This is a variation on the OPQRST assessment mnemonic youmay use for other conditions such as pain assessment)

> Past health history (including medical history, surgical history, allergies,

medications, injuries and accidents, special needs and childhood illnesses)

> Family health history

> Social history (including alcohol, tobacco and drug use, sexual practice, work

and home environment, hobbies and leisure activities, stress and culture).

(afferent) neurone

Spinal

cord

FIGURE 7.8 Monosynaptic reex arc

Motor (efferent)

Stimulus

CHAPTER 7

HEALTH HISTORY

CONSUMER PROFILE

The mental status and neurological health history provides insight into the link between a consumer’s life and lifestyle, mental status and neurological information and pathology. Diseases that are age-, sex- and race-specic for the neurological system are listed.

AGE Mental status disorders:

> Delirium (any) > Dementia (usually aged 60 and over) > Depression (any) > Acute confusion (any) > Other psychiatric disorders such as schizophrenia, psychosis, anorexia nervosa, bulimia

Neurological:

> Multiple sclerosis (MS) (20–40) > Myasthenia gravis (20–30) > Fibromyalgia (25–50) > Syringomyelia (30) > Huntington’s disease (30–40) > Parkinson’s disease (>50) > Alzheimer’s disease (middle age–old age)

190 PHYSICAL EXAMINATION

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HEALTH HISTORY

SEX FEMALE Alzheimer’s disease, myasthenia gravis, MS, meningiomas, pseudotumor

UNIT 2

cerebri, migraine headaches, bromyalgia

MALE Cervical spine injuries, cluster headache, dyslexia (boys)

CHIEF COMPLAINT

CULTURAL BACKGROUND

Common chief complaints for mental status and the neurological system are dened, and information on the characteristics of each sign or symptom is provided.

1. HEADACHE See Chapter 9

2. SEIZURE A transient disturbance of cerebral function caused by an excessive discharge of neurones

CAUCASIAN Parkinson’s disease, Alzheimer’s disease, multiple sclerosis

ASIAN OR PASIFIKA

LOCATION Body parts involved

QUALITY General or localised

QUANTITY Number of minutes or seconds, weekly, monthly, every few months

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

SETTING Sequence of events: warning (aura) such as headache, abdominal

Intracranial haemorrhage

Incontinence, injury (tongue, cheeks, limbs), memory loss, cyanosis, respiratory arrest, postictal headache, somnolence, confusion

Television viewing, bright lights, sleep deprivation, stress, ashing lights, hyperventilation, fever in children or infants, alcohol (use or withdrawal),

hyperglycaemia, hypoglycaemia

Medications

discomfort, euphoria or depression, visual hallucination Types and phase: Generalised tonic-clonic or generalised motor seizures, absence or generalised non-motor seizures, focal seizures, febrile convulsions, post-ictal phase

TIMING First occurrence, age at onset of seizures, associated trauma or

presumed cause, sleeping hours, rst awakening, menses

3. SYNCOPE Abrupt loss of consciousness of brief duration due to decreased oxygen or glucose supply to the brain

QUALITY Total versus partial loss of consciousness

QUANTITY Duration of seconds, minutes or hours; daily, monthly

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

SETTING Hot, stuffy room; standing still for long periods of time

Nausea, diaphoresis, dimmed vision, increased salivation, gastrointestinal bleeding, dyspnoea, chest pain, palpitations, hemiparesis, transient focaldecits, seizures, migraine headache, associated illness (myocardial infarction, diabetes mellitus type 1)

Injury, intense emotion, carotid occlusion, cardiovascular disorders, exertion, anaemia, hypoglycaemia, insulin peak, crowded space, decreased atmospheric oxygen

Cool air, change in position, oxygen, glucose, medication, volume infusions

MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 191

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HEALTH HISTORY

4. TREMOR Repetitive, often regular, oscillatory movements of a body part caused by contraction of opposing

muscle groups; usually involuntary

LOCATION Voice, face, arms, hands, trunk

QUALITY Postural, intention/essential, rest

CHAPTER 7

AGGRAVATING FACTORS

ALLEVIATING FACTORS

SETTING Head or hands outstretched against gravity; with tasks requiring precision

TIMING Age of onset; intermittent, constant

5. PAIN A sensation of discomfort, distress or suffering

LOCATION Anatomic location (e.g. lower back, head)

QUALITY Aching, stabbing, throbbing, cramping

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

TIMING Minutes to constant; early morning, late day; daily, monthly

6. PARAESTHESIA Abnormal sensations such as numbness, pricking, tingling

Fatigue, anxiety, caffeine, movement; hyperthyroidism, cerebellar disease, MS, Parkinson’s disease; lithium, tricyclic antidepressants

Rest, propranolol, benzodiazepines, L-dopa, primidone, alcohol intake

or ne motor grasp

Crying, hysteria, muscular tenseness, depression, shortness of breath, diaphoresis, splinting or protective behaviours, focal decits, limited range of motion, sleep disturbance

Stress, excessive exercise, lifting, coughing or sneezing, posture changes, trauma, illness, extreme temperatures, humidity

Medications, heat, cold, distraction, physical therapy

7. DISTURBANCES IN GAIT

LOCATION Anatomic location (e.g. arms, hands, legs, feet)

QUALITY Aching, stabbing, pins and needles, numbness

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

Abnormal way of moving on foot, walking or running

QUALITY Ataxic, spastic hemiplegia, hemiplegic, scissors, festinating, steppage,

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

SETTING Level ground versus uneven terrain, stroke, neuromuscular pathology

Pain, stiffness, changes in gait, pulseless extremities, pallor, injury, ulcers, muscle wasting, traumatic injury

Activity, extreme cold, diabetes mellitus

Medication, warmth, position changes

antalgic, apraxic, Trendelenburg

Vertigo, visual impairments, blackouts, stroke, focal weakness, muscle wasting, abnormal movements or posture, spasticity, falling

Fatigue, alcohol ingestion, vitamin D deciency

Rest, supportive equipment

192 PHYSICAL EXAMINATION

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HEALTH HISTORY

8. VISUAL

UNIT 2

CHANGES

9. VERTIGO The sensation of moving in space or objects moving around the person; also may be referred to

Changes in visual acuity, visual elds, colour perception, depth perception

QUALITY Blindness in particular eld of vision; scotoma; perception of ashing,

bright lights; blurriness

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

TIMING Abrupt, gradual, constant, intermittent, morning, evening

as dizziness, light-headedness

QUALITY Spinning sensations, dizziness or light-headedness

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

Vertigo, dizziness, nausea, weakness, headache

Darkness, fatigue, bright lights, reading, alcohol ingestion, medication

Rest, medication, glasses

Nausea, vomiting, headache, tinnitus, deafness, discharge from ear, cranial nerve palsies, hemiparesis, seizure, loss of consciousness, chest pain, palpitations, falling

Motion, movement of head, changes in atmospheric pressure (weather), heights, amusement rides, anxiety, alcohol ingestion, pain, medications

Medications, lying down, maintaining a still posture

10. MEMORY

DISORDERS

11. DIFFICULTY

WITH SWALLOWING OR SPEECH

SETTING Amusement rides, glassed-in elevators, rising from a seated or

supine position

TIMING Sudden, gradual; seconds, minutes, days, months; constant, intermittent

Change in ability to remember events or facts

QUALITY Recent or remote (long-term) memory loss

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

ALLEVIATING FACTORS

SETTING Unfamiliar environment

TIMING Night-time, upon awakening

Inability to swallow food or drink, choking, or aspiration; changes in enunciation of words, speed and volume of speech, content of speech, or comprehension of written or verbal language, word salad, making up of new words

ASSOCIATED MANIFESTATIONS

Irritability, anxiety, agitation, confabulation, associated trauma, depression, fearfulness

Distraction, anxiety, medications, alcohol ingestion, drug abuse, unfamiliar environment, sleep deprivation, anaesthesia, hypoxia, electrolyte imbalance, high altitude

Visual or auditory cues, familiarity with environment, oxygen, electrolyte replacement, narcotic reversal, detoxication

Excessive drooling and saliva, paresis, dysarthria, weight loss, dehydration, irritability, depression, disease or damage to the CNS such as stroke or cerebral palsy, confusion

AGGRAVATING FACTORS

Fatigue, position, prolonged tracheal intubation, alcohol intake, stress levels

MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 193

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HEALTH HISTORY

12. SUICIDAL IDEATION

ALLEVIATING FACTORS

SETTING Loud, chaotic environment; after a prolonged intubation, at times of crisis

Describes thoughts of life not being worth living. May range from eeting thoughts to concrete plans engaging in behaviour intended to end one’s life. May have preoccupation with distressing thoughts to end one’s life, may feel like they are a burden to others. May report feelings of helplessness and hopelessness, negative outlook on life, may feel like they are a burden to others and that life is not worth living and expressing regret about being alive or ever having been born

ASSOCIATED MANIFESTATIONS

AGGRAVATING FACTORS

Rest, quiet environment, thickened liquids, soft foods, varied communication tools

or high stress

Previous or failed suicide attempts, excessive risky behaviour (e.g.increase in alcohol or drug use, careless driving), self-imposed social isolation, purchasing or acquiring rearms, stockpiling medications or drugs, getting affairs in order or giving away possessions, saying or writing nal ‘goodbyes’ to others, change in mood (depression,anxiety), reports feeling helpless or hopeless, talks about taking revenge or overwhelming feelings of shame, physical agitation or depression, signicant decline in day-to-day activities, may also exhibit no associatedmanifestations

Alcohol/drug intake, social isolation, bullying, situational crisis, crisis of identity, sexuality, gender or personality, family history of suicide, recent suicide in family members or friends, victim of abuse, violence or neglect, fatigue, sleep deprivation, other mental health disorders, breakdown of social or family support systems, owning a rearm, military service, gambling, nancial debt, deterioration in physical health, witness to familyviolence

CHAPTER 7

13. MOOD ALTERATION

ALLEVIATING FACTORS

SETTING Any

Two types of presentations: depression related or mania related. Some conditions will have manifestations of both (e.g. those with bipolar disorder or borderline personality disorder). Depressive-related signs and symptoms: Extreme tiredness and lack of energy, persistent lethargy, crying often or for long periods of time, indifference to others or for normal interests/activities, increased sleep, difculty waking in the morning, increased or decreased appetite, weight gain or loss, feelings of worthlessness or guilt, inability to concentrate, indecisive, anxiety, irritability, suicidal thoughts, decreased libido, headaches, body aches, pains,cramps or digestive problems. Mania-related signs and symptoms: Elevated mood – feeling extremely energised, creative, feels ‘interesting’; rapid thinking and speech, physical agitation, weight loss, decreased sleep, recklessness – risk-taking behaviours not usually exhibited; increased sexual desire, irritability, grandiose plans and beliefs, lack of insight, inability to concentrate.

ASSOCIATED MANIFESTATIONS

Psychosocial support, crisis support referrals, counselling, medication, further psychiatric assessment to rule out other mental health disorders

Relationship breakdown, loss of job/ability to work, decreased ability in managing self and relationships, nancial stress (e.g. mania can cause people to spend all their savings in short period of time, whereas those who are depressed have reduced ability to earn money). In some cases of severe depression, presence of psychotic symptoms can be identied such as hallucinations (seeing, hearing, smelling, tasting or sensing things that are not apparent to others) or delusions (false beliefs that are rmly held, despite evidence opposite to the belief).

194 PHYSICAL EXAMINATION

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HEALTH HISTORY

UNIT 2

PAST HEALTH HISTORY

AGGRAVATING FACTORS

ALLEVIATING FACTORS

SETTING Seasonal Affective Disorder (SAD) is related to season and length

The various components of the past health history are linked to neurological pathology and neurology-related information.

MEDICAL HISTORY

SURGICAL HISTORY

NEUROLOGIC SPECIFIC

NON-NEUROLOGIC SPECIFIC

Craniotomy, laminectomy, carotid endarterectomy, transsphenoidal hypophysectomy, cordotomy, aneurysm repair (surgical or radiological)

This is dependent on cause. Situational crisis, change in sleep patterns, season (winter or summer), alcohol or drug use, genetic predisposition, hormone changes (in line with menstrual cycle, menopause and andropause, thyroid disorders), illness, onset of other disorders such as dementia, schizophrenia and attention decit hyperactivity disorder. Borderline personality disorder more common in women, onset early 20s and intensity may lessen with age.

This is dependent on cause. For example, if seasonally related, then a change in season or exposure to light. If related to changes in hormone levels or other diagnosed disorders, adherence to medication regimen.

of days. Winter and autumn onset, more common in locations with signicantly shortened days. Summer onset, more common in locations that have long hot days.

Amyotrophic lateral sclerosis (ALS), MS, tumours, Guillain-Barré syndrome, cerebral aneurysm, arteriovenous malformations (AVM), stroke, migraines, Alzheimer’s disease, myasthenia gravis, congenital defects, metabolic disorders, childhood seizures, TBI, neuropathies, peripheral vascular disease, Parkinson’s disease

Hypertension, heart disease, cardiac surgery, invasive procedures, diabetes mellitus, leukaemia, hypoglycaemia

MEDICATIONS Antidepressants, antiseizure medications, narcotics, antianxiety medications, antipsychotic medications

COMMUNICABLE DISEASES

INJURIES AND ACCIDENTS

FAMILY HEALTH HISTORY

SOCIAL HISTORY The components of the social history are linked to neurological factors and pathology.

Congenital defects such as neural tube defects, hydrocephalus, AVM, headaches, epilepsy, Alzheimer’s disease, Huntington’s chorea, muscular dystrophies, lipid storage diseases, Gaucher’s disease, Niemann-Pick disease. Neurological diseases that are familial are listed.

ALCOHOL USE Consumers suffering from chronic alcoholism may exhibit the following abnormal ndings:

TOBACCO USE Increased risk of stroke

DRUG USE Neurological signs of drug use are listed in Table 7.4

SEXUAL PRACTICE Neurosyphilis; impotence secondary to neuropathies, MS or lower motor neurone lesions

TRAVEL HISTORY Arthropod-borne encephalitis (Japanese B, Murray Valley), malaria

WORK ENVIRONMENT

HOME ENVIRONMENT

Encephalitis, meningitis or poliomyelitis, AIDS, botulism, syphilis, cat scratch fever (Bartonella henselae), rickettsial infections, toxoplasmosis

Closed head injury, chronic subdural haematoma, spinal cord injury, peripheral nerve damage

Korsakoff’s psychosis, polyneuropathy, Wernicke’s encephalopathy, tremor

Exposure to continuous loud noise, performing repetitive-motion tasks, toxic chemical exposure (carbon dioxide, insecticides)

Exposure to toxic chemicals (carbon dioxide, insecticides), lead paint

HOBBIES AND LEISURE ACTIVITIES

STRESS Headaches; migraine headaches, bromyalgia ares, or MS can be exacerbated by stress

Use of protective equipment; participation in contact sports or high-risk activities such as football, soccer, hockey, boxing, race car driving, motorcycling; hobbies involving repetitive motion (needlework)

MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 195

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TABLE 7.4 Neurological signs of drug ingestion

ASSESSMENT PARAMETER

CANNABIS (MARIJUANA)

(NOTE THIS HAS HALLUCINOGENS (E.G., PCP, LSD)

Pupils

Deep tendon reexes Hyperactive Normal Normal Hypoactive Hyperactive

Speech Normal Often normal Normal or dulled Slurred N/A

Coordination Normal Normal Normal or unsteady Ataxia N/A

Sensorium Often clear Usually clear Dulled Confusion May be confused

Sensory perception

Memory

Hallucinations Any type

Delusions Variable Paranoid N/A N/A Paranoid

Dilated Normal Pinpoint Normal Dilated

React to light Fixed React to light

Distorted Distorted Dulled Dulled Heightened

Unchanged Transient loss Unchanged Impaired Unchanged

HALLUCINOGENIC

PROPERTIES TOO)

Rare Rare N/A N/A

NARCOTICS (E.G., HEROIN, MORPHINE, CODEINE)

DRUG

SEDATIVE – HYPNOTICS (E.G., ALCOHOL, BENZODIAZEPINES, BARBITUATES, KETAMINE)

CNS STIMULANTS (COCAINE, MDMC, AMPHETAMINES)

PERSON-CENTRED HEALTH EDUCATION

When conducting a health assessment, opportunities for the provision of person-centred health education will arise. This is a signicant consideration in relation to the assessment process for examination of the person’s mental health and neurological status due to the stigma associated with mental illness, and the associated quality of life limitations that mental illness and neurological disorders have on the person and their families. These occasions are identied as individualised education and may generate further data that can be added to the assessment. All education given should be documented so that in future, health professionals can assess the impact of previous information provided to the consumer. (Refer to Chapter 1 for initiating Health education.) Refer to the following examples.

CHAPTER 7

INDIVIDUALISED HEALTH EDUCATION INTERVENTIONS

This information provides a bridge between the health maintenance activities and neurological function.

Sleep Narcolepsy, insomnia, mindfulness for stress reduction to improve sleep quality

Diet Beriberi (vitamin B

Exercise Increased muscle strength, increased coordination, provides stress relief, and linked to improved sleep and overall wellbeing

Use of safety devices Helmet, seat belt, eye shields and other protective equipment

Health check-ups

PLANNING FOR PHYSICAL EXAMINATION

The planning phase refers to evaluating subjective data to narrow the focus on physical examination, determining what objective data needs to be gathered, as well as considering the environment and equipment that will be required.

), pellagra (niacin), maintaining medication adherence

Developmental milestones review, post TBI or mental health diagnosis may need to have relationship support/referral

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