NCM 116 RLE — High-Yield Clinical Study Guide (Condensed) Flashcards

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Neurological Assessment

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A systematic evaluation of the nervous system covering mental status, cranial nerves, motor and sensory functions, reflexes, coordination, and vital signs. It identifies potential neurological problems through observation, patient history, and targeted physical tests. Findings guide further diagnostic or therapeutic actions.

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Mental Status

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Assessment of consciousness, cognition, speech, memory, and higher intellectual functions. It includes orientation, attentiveness, and language evaluation to detect cognitive deficits. Changes may indicate cerebral dysfunction or delirium.

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AVPU

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A rapid scale for consciousness: Alert, responds to Verbal stimuli, responds to Pain stimuli, or Unresponsive. It provides a quick bedside assessment of level of arousal. Useful for triage and ongoing monitoring.

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Glasgow Coma Scale

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A structured scale measuring eye, verbal, and motor responses to assess consciousness level. Scores range to quantify severity of impaired consciousness and track changes over time. It is frequently used in trauma and critical care.

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Cranial Nerves

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Twelve paired nerves that control smell, vision, eye movements, facial sensation and expression, hearing, swallowing, shoulder and tongue movements. Each nerve is examined for specific functions such as pupillary response and extraocular movements. Dysfunction localizes lesions within the brain or brainstem.

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Decerebrate Posturing

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An abnormal body posture with extension and pronation of the arms and legs, indicating severe brainstem dysfunction. It suggests more extensive brain injury and carries a worse prognosis than decorticate posturing. Prompt evaluation and management are required.

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Decorticate Posturing

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A posturing pattern with flexion of the arms and extension of the legs indicating severe cerebral or corticospinal tract damage. It typically suggests damage above the brainstem. Clinical context helps determine prognosis and intervention.

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Motor Strength Grading

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Muscle strength is tested against resistance and graded on a scale from $0$ to $5$, with $0$ indicating no contraction and $5$ indicating normal strength. This provides standardized documentation of weakness severity. It helps localize lesions to upper or lower motor neurons.

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Coordination Tests

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Examinations such as finger-nose-finger, heel-knee-shin, rapid alternating movements, and toe-tapping assess cerebellar and extrapyramidal function. Observers note rhythm, speed, precision, and presence of overshoot or oscillation. Abnormalities suggest cerebellar or proprioceptive pathway dysfunction.

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Romberg Test

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A balance test where the patient stands with feet together and eyes closed to assess proprioceptive and dorsal column function. A positive Romberg (increased sway or loss of balance) suggests sensory ataxia rather than cerebellar disease. It complements other coordination assessments.

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Sensory Modalities

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Evaluation includes superficial sensations (pain, temperature, light touch) and deep sensations (proprioception and vibration). Testing is done with the patient's eyes closed and typically focuses on distal extremities, especially feet. Patterns of loss help localize peripheral nerve, spinal cord, or cortical lesions.

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Deep Tendon Reflexes

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Stretch reflexes assessed to evaluate integrity of the reflex arc and motor neuron pathways. They are graded on a scale from $0$ (absent) to $4+$ (clonus) and help distinguish upper from lower motor neuron lesions. Asymmetric or exaggerated reflexes suggest central nervous system involvement.

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Reflex Grading

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A numeric scale describes reflex responses: $0$ for absent, $1+$ for diminished, $2+$ for normal, $3+$ for brisk, and $4+$ for hyperactive with clonus. This standardization aids serial assessments and comparisons. Abnormal values prompt further neuroanatomical localization.

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Babinski Reflex

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The plantar reflex response elicited by stimulating the lateral sole and moving medially that normally produces toe flexion. An extensor big toe (positive Babinski) indicates corticospinal tract dysfunction in adults. It is an important sign of upper motor neuron lesion.

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Cremasteric Reflex

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A superficial reflex elicited by stroking the inner thigh, causing ipsilateral testicular elevation. Presence or absence provides information about L1-L2 spinal segments and peripheral nerve function. Abnormalities can indicate spinal or peripheral nerve pathology.

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Gait Assessment

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Observation of walking including posture, arm swing symmetry, step length and rhythm, base of gait, steadiness, and turning ability. Tasks such as rising from a chair, walking on toes/heels, tandem gait, running, and hopping further reveal motor and cerebellar function. Documenting gait helps differentiate neurologic from musculoskeletal causes.

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Visual Field Screening

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A bedside test using a finger-wiggling technique in each temporal quadrant to detect visual field deficits. If an abnormality is noted, each quadrant is tested individually to map the defect. Findings can localize lesions along the visual pathways.

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Fine Motor Movements

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Tests like finger and toe tapping evaluate rhythm, speed, and precision reflecting pyramidal and extrapyramidal tract function. Slowness or irregularity may indicate motor pathway or basal ganglia dysfunction. These tests are sensitive for early motor impairment.

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Plantar Reflex Testing

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Assessment of the plantar response by stroking the lateral foot to observe toe movement. A normal plantar response is toe flexion, while extension suggests corticospinal tract involvement. It is part of reflex examination for upper motor neuron signs.

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Meningeal Signs

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Clinical indicators of meningeal irritation such as neck stiffness and positive Brudzinski's or Kernig's signs. These findings raise suspicion for meningitis or subarachnoid hemorrhage and warrant urgent evaluation. They are assessed carefully because sensitivity varies.

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Brudzinski's Sign

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A meningeal sign where passive neck flexion causes involuntary flexion of the hips and knees. It suggests meningeal irritation often seen in meningitis. Lack of the sign does not exclude meningitis.

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Kernig's Sign

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A meningeal sign elicited when hip flexion followed by knee extension causes pain or resistance. A positive Kernig's sign indicates possible meningeal irritation and may be seen in meningitis or subarachnoid hemorrhage. It complements other meningeal assessments.

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Pediatric Neurological Exam

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A child-focused assessment including observation of attention, limb use, language development, head circumference, tone, and reflex maturation. Important primitive reflexes include Moro and rooting, which should be present in neonates and integrate with age. Growth and developmental milestones guide interpretations.

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Seizure Classification

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Seizures are categorized as focal (originating in one hemisphere) or generalized (involving both hemispheres). Focal seizures may be with preserved awareness or with impaired awareness, while generalized seizures include tonic-clonic and absence types. Classification guides management and prognosis.

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Tonic-Clonic Seizure

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A generalized seizure characterized by an initial tonic phase with sustained muscle stiffening followed by a clonic phase of rhythmic jerking. It often involves loss of consciousness and postictal confusion. Safety measures and airway protection are priorities during management.

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Absence Seizure

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A brief generalized seizure with sudden, transient loss of awareness often lasting seconds and accompanied by subtle motor signs like eyelid fluttering. It is more common in children and may be mistaken for inattention. Diagnosis and treatment differ from focal or tonic-clonic seizures.

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Seizure Nursing Assessment

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Collect a history of seizure onset, triggers, description of events, duration, and postictal behavior, plus medication use and comorbidities. Observations during and after an event inform diagnosis and immediate care. Documentation should be precise and timely.

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Seizure Nursing Interventions

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Prioritize preventing injury, maintaining airway patency, and ensuring a safe environment during seizures. Use appropriate seizure precautions, have resuscitation equipment available, and provide postictal support and documentation. Communication with the patient and family is essential.

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Cast Types

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Casts immobilize fractures and deformities and include short-arm, long-arm, short-leg, long-leg, body, and hip spica casts. Type selection depends on injury location and required immobilization. Proper cast care prevents complications and promotes healing.

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Cast Complications

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Potential problems include compartment syndrome, pressure ulcers, infection, and disuse syndrome with muscle atrophy. Frequent neurovascular checks and monitoring for pain, paresthesia, pallor, pulselessness, and swelling are essential. Early detection allows timely intervention.

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Traction

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A treatment using continuous pulling forces to align fractures, reduce deformities, or relieve muscle spasm. Types include skin traction for short-term alignment and skeletal traction for more sustained and stronger pull. Nursing care focuses on alignment, skin integrity, and neurovascular status.

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Crutch Walking

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Technique for ambulation with crutches requiring proper measurement, upper body strength, and coordination. Gait patterns include four-point, three-point, and two-point techniques, with special instructions for sitting, standing, and stairs. Training reduces fall risk and promotes independence.

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Enema Types

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Enemas are classified as cleansing, carminative, retention, and return-flow, each serving purposes like stool removal, gas relief, medication retention, or colon clearance. Choice depends on clinical goal and patient condition. Proper technique minimizes complications.

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Enema Temperatures

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Adult cleansing enemas are usually given at $40$–$43^C$ ($105$–$110^F$) and children at about $37.7^C$ ($100^F$), with some oil retention enemas at $33^C$ ($91^F$). High temperatures can injure bowel mucosa, so solutions must be warmed and checked before administration. Temperature selection is age-appropriate to ensure safety and comfort.

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Enema Volumes

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Volume recommendations vary by age: infants around $50$–$200$ ml, toddlers $200$–$300$ ml, school-age children $300$–$1000$ ml, and adolescents/adults $500$–$1000$ ml. Appropriate volume ensures effectiveness while minimizing discomfort and complications. Clinicians must individualize based on size and clinical need.

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Rectal Tube Sizes

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Rectal tube sizes correspond to patient age: infants/small children #$10$–$12$ Fr, toddlers #$14$–$16$ Fr, school-age #$16$–$18$ Fr, and adults #$22$–$30$ Fr. Correct tube size improves comfort and reduces mucosal trauma. Selection should match patient anatomy and procedure type.

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Enema Purpose

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Enemas stimulate peristalsis, remove feces or flatus, soften stool, lubricate the rectum, prepare bowel for examination or surgery, and prevent contamination. Each enema type targets a specific goal such as cleansing or retention. Proper indication and technique optimize outcomes.

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Enema Equipment

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Typical supplies include an absorbent pad, bath blanket, bedpan or commode, disposable enema unit, lubricant, thermometer, prescribed solution, gloves, and towels. Having all equipment prepared ensures a smooth, efficient procedure. Sterility and cleanliness reduce infection risk.

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Enema Preparation Steps

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Preparation involves assessing bowel history, abdominal status, and contraindications, assembling supplies, lubricating the tube, and expelling air from tubing. Patient identification and privacy are confirmed before starting. Assessment guides safe administration.

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Enema Administration Steps

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Key steps are verifying the patient, washing hands, positioning appropriately, gently inserting the rectal tube following rectal direction, instilling solution slowly, and encouraging retention for the prescribed time. Monitor for discomfort and assist the patient to defecate afterward. Documentation of tolerance and outcomes is necessary.

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Return-Flow Enema

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A specialized enema where fluid is instilled and the container lowered to allow return flow, repeating to help expel flatus and stool. It uses progressive instillation and drainage cycles to stimulate peristalsis. Often used for gas relief or to promote bowel evacuation in constipated patients.

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ECG Conduction System

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The cardiac conduction system includes the sinoatrial (SA) node as the primary pacemaker, the atrioventricular (AV) node as the secondary pacemaker, the Bundle of His, and Purkinje fibers. This system coordinates atrial and ventricular depolarization to produce effective cardiac output. Dysfunction produces dysrhythmias visible on ECG.

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ECG Interpretation Steps

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Systematic interpretation includes assessing rhythm regularity, calculating heart rate, checking for P waves and their relation to QRS complexes, evaluating the PR interval for conduction delays, and analyzing QRS width and morphology. This structured approach identifies arrhythmias and conduction abnormalities. Serial comparison improves diagnostic accuracy.

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Common Dysrhythmias

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Examples include sinus bradycardia, sinus tachycardia, atrial flutter, atrial fibrillation, and premature atrial or ventricular contractions. Each has distinct ECG features and clinical implications ranging from benign to life-threatening. Management depends on rhythm stability and patient condition.

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Shockable Rhythms

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Rhythms considered shockable include ventricular fibrillation and pulseless ventricular tachycardia, which require immediate defibrillation. Early shocks improve chances of return of spontaneous circulation. Basic life support and advanced cardiac life support algorithms prioritize rapid defibrillation for these rhythms.

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Non-shockable Rhythms

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Pulseless electrical activity (PEA) and asystole are non-shockable and are treated with high-quality chest compressions, airway management, and identification of reversible causes. Defibrillation is not indicated for these rhythms. Outcomes depend on rapid recognition and correction of underlying issues.

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Code Blue Causes

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Potential reversible causes include the Hs and Ts: hypovolemia, hypoxia, hydrogen ion (acidosis), hypo-/hyperkalemia, hypothermia, toxins, tamponade, tension pneumothorax, thrombosis (coronary or pulmonary), and others. Identifying and treating these underlying problems is a core part of resuscitation. Systematic evaluation during arrest improves chances of successful resuscitation.