Assessment questions (neurological)

  1. I have to come up with an assessment for my on-line transitions class and I am having some difficulty following some of it. 1. what is pupil consensuality, and pupil convergence (on a neurological assessment form) and what do I put in the blank. Then it says "Gaze: (presence of nystagmus)" what would you put there? Or Attention span/ Calcualtion:___ I hate that they give us these forms that no one has seen before and expect us to figure it out on our own and it is due by MN tomorrow! I will be sooo glad when this class is over!
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  2. 3 Comments

  3. by   augigi
    Try google, like I did:
    "Both eyes will accommodate and dilate to the same extent (referred to as consensuality), even when presented with different stimuli (typically the dominate eye will control the accommodation and dilation)."

    convergence
    n 1: the occurrence of two or more things coming together

    gaze nystagmus
    - Nystagmus that occurs when the eyes gaze or fixate upon an object or
    image. Usually caused by a disruption of the nervous system.
    What you would write depends on the form structure. If it's asking yes/no, put yes/no. If it's asking attention span, depends what test you're using. The point of giving you forms noone has seen before is to see if you can research and use critical thinking to come up with an answer.
  4. by   Daytonite
    if you will check out the many weblinks that are listed within the posts to this thread i am certain you will find help with your assessment assignments.

    http://allnurses.com/forums/f205/hea...ms-145091.html - health assessment resources, techniques, and forms (in nursing student assistance forum)

    here are a couple of sites that have very good physical assessment information. they should be listed on the thread above, but i will post them here for you as well.

    http://www.meddean.luc.edu/lumen/med...d/contents.htm - the physical exam - this site is set up for medical students, but nursing students can learn from it as well. this link takes you to a page of links to the various parts of the body to be examined. when you link into a body part you will find an explanation of the method to examine that site and what is normal, a button at the bottom labeled "abnormal" will bring up information about abnormal findings during examination of that site. there are also some photographs with some of the pages. the "knowledge" button gives you a little outline breakdown of the pathophysiology going on. a fourth button, "self eval" is a list of test questions--remember these are designed for medical students, so don't feel badly if you miss a few. this is from loyola university medical school.

    http://medicine.ucsd.edu/clinicalmed/introduction.htm - a very nice site to help with doing physical assessments of patients from the university of california, san diego. explains how to examine the various parts of the body and has lots of photographs showing abnormal conditions and how to assess for them.
  5. by   Wave
    [quote=lpn181;1921739]1. what is pupil consensuality, and pupil convergence (on a neurological assessment form) and what do I put in the blank. Then it says "Gaze: (presence of nystagmus)" what would you put there?

    Well, for starters, I can't help you much with the second half, but eyes have been my bread and butter for 17 years. The links mentioned by Daytonite are great links and you REALLY need to check them out. They are a gold mine of info.

    Regardless of whatever form has been thrown at you, some things don't change or change very little. Across the board, almost all doctors use the acronym "P.E.R.R.L." or "P.E.R.R.L.A" It is used to indicate important neurological information: P= pupils, E= equal (are they the same size?), R= round (are they round or have they had an accident and one is not), RL= React to Light (when you shine the light into the eye, is there a reaction?) and the A (if used)= accomodate (when your pt looks at a near object, to both eyes turn in equally). This assessment is done using the "swinging flashlight test".
    For the part about being direct/ consensual: If I shine a light in your right eye (O.D.), that pupil should constrict -that's direct; at the same time, the left eye (O.S.) should ALSO constrict -even though the light is going only in the right -and that is consenual. Now change to the left eye, shine the light only in that eye. It should constrict, just as the right eye did, and should be the same size as the right eye was when the light was shining in it. Again, this is direct. At the same time, the right eye should change size to match the left even though there is no light shining in it at the moment. It is important that as you change from one side to the other that you keep the timing equal. A "non-consensual" pupil (response where the pupil doesn't: A) constrict as much as the other eye, B) doesn't change at all, or C) can actually get larger) is called either a "Marcus-Gunn pupil" or an "A.P.D."= afferent pupillary defect. This would result from a decreased/ poorer signal being sent (by the parasympathetic nerve pathways) to the brain. When light is shone into the "defective" eye, it should be noted that neither eye will respond as well as when light was in the "good" eye. See also the tread on Horner's syndrome. (I posted there, too.)

    Your [pupil] exam would go like this: light to right (watch to constrict) [pause] light to left (watch to constrict) that was direct. Now back to the right 1-2-3 and change to the left 1-2-3 (watch the left reaction), change back to the right 1-2-3 (watch the right reaction).

    Last is to checK the gaze. Here you're looking to see if there is an eye that turns in (or out or up or down). If a patient has nystagmus, even when they look straight ahead, instead of their eyesbeing steady and non-moving, they have a sort of rhythmic, fast "tic-toc" movement to their eyes(usually it's side-to-side). You would use the "cover/ uncover test"and the "alternate cover/uncover test".
    Hope that helps!

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