Maternity Deep Tendon Reflex Check Procedure?

Deep Tendon Reflex (DTR) assessment is a crucial tool in newborn neurological exams, helping to determine the need to start, adjust, or stop magnesium infusion. The perinatal nurse, in collaboration with physicians, can use deep tendon reflexes as a powerful tool in determining the need to start, adjust, or stop magnesium infusion. Hyperactive reflexes, such as those in the patellar and bicep areas, indicate stress in the central nervous system and are at risk for seizures.

Testing deep tendon reflexes is an important part of the newborn neurological exam, but it can be technically difficult. To ensure accurate results, it is essential to use a reflex hammer instead of a finger or a stethoscope. The perinatal nurse and physicians can use deep tendon reflexes to evaluate neurologic diseases affecting afferent nerves, spinal cord synaptic connections, motor nerves, and descending motor pathways.

There are five deep tendon reflexes, and the reflex exam is fundamental to the neurological exam and important to locating upper versus lower motor neuron lesions. Nurses use their judgment to determine who needs DTR assessments, when to perform assessments, and how often to assess. They can also provide practical tips on when to perform assessments and when to discontinue them.

In summary, deep tendon reflex testing is a valuable tool in evaluating neurologic diseases and determining the need for referrals for neurological, neurosurgical, or orthopaedic care.

How do you examine DTR?

Ankle Jerk is a technique used to observe the relaxation phase of the Achilles tendon in patients with suspected thyroid disease. The patient should be seated with one hand underneath their sole and dorsiflex the foot slightly. Tap on the Achilles tendon above its insertion on the calcaneus. If the patient is in bed, flex the knee and invert or evert the foot. If no response is obtained, the patient should face a chair and kneel on it. The Jendrassik maneuver is also useful. DeJong provides a description of other reflexes useful in certain situations.

How do you assess DTR in nursing?

The patient’s elbow should be positioned with the thumb on the biceps tendon, while the brachioradialis tendon is tapped. It is important to observe three potential reflexes: the brachioradialis reflex (flexion and supination of the forearm) and the biceps reflex (flexion of the forearm). A contraction of the biceps tendon should be observed in response to the tap.

What is the normal range for deep tendon reflexes?

The graded deep tendon reflexes, including those of the biceps, triceps, supinator, knee, and ankle, were categorized as absent, present with Jendrassik’s maneuver, trace, present (normal), or brisk (strong muscle contraction).

Why do they check reflexes when pregnant?

The patellar reflex is a common diagnostic tool in obstetric clinical practice, employed to assess patients with preeclampsia and to predict the risk of an eclamptic fit. The latter is thought to be associated with the briskness or augmentation of tendon reflexes.

How do you assess deep tendon reflexes nursing skills?

Reflex assessment is not typically performed by registered nurses in routine neurological assessments of adult patients, but is used in nursing specialty units and advanced practice. Spinal cord injuries, neuromuscular diseases, or lower motor neuron tract diseases can cause weak or absent reflexes. Deep reflex tendon testing involves placing the patient in a seated position and using a reflex hammer to produce an involuntary response. Reflexes are graded from 0 to 4+, with “2+” considered normal. Reflexes can be classified as absent, hypoactive, hyperactive without clonus, or hyperactive with clonus.

What does a 4+ deep tendon reflex mean?

A tap elicits a reflex, which is always abnormal. In a normal person, a muscle tendon contracts due to a two-neuron reflex arc involving the spinal or brainstem segment. The afferent neuron, an alpha motoneuron in the anterior horn of the cord, innervates the muscle or Golgi tendon organ associated with the muscles. The cerebral cortex and brainstem nuclei exert influence over the sensory input of the muscle spindles through gamma motoneurons in the anterior horn.

Hyperporeflexia is an absent or diminished response to tapping, usually indicating a disease involving one or more components of the two-neuron reflex arc. Hyperreflexia refers to hyperactive or repeating reflexes, usually indicating an interruption of corticospinal and other descending pathways that influence the reflex arc due to a suprasegmental lesion above the level of the spinal reflex pathways.

How do you monitor deep tendon reflexes?

The speaker will illustrate the significance of proper positioning, comprehension of the level under examination, and the availability of requisite instrumentation in the execution of deep tendon reflex examinations.

Which do you check when assessing deep tendon reflexes?

The deep tendon reflexes are mediated by the biceps and brachioradialis muscles, with the C5/C6 nerve roots being predominantly involved. The patellar muscles are innervated by the L2-L4 spinal nerves, while the ankle is innervated by the S1 spinal nerve. Superficial reflexes, such as the corneal reflex, involve involuntary blinking in response to corneal stimulation. This is facilitated by the nasociliary branch of the trigeminal nerve, which is the afferent branch.

How do you test for DTRs?

The patient’s forearm should be supported between flexion and extension, either on their thighs or the examiner’s forearm. Place your thumb over the biceps tendon and tap briskly to flex at the elbow. Support the patient’s forearm by cradling it with yours or placing it on the thigh. Identify the triceps tendon at its insertion on the olecranon and tap just above the insertion. The brachioradialis tendon should be supported at the wrist, inserting at the base of the styloid process of the radius. If unsure, ask the patient to hold their arm in a sling, flexing at the elbow and halfway between pronation and supination, and flexing the forearm at the elbow against resistance.

How to assess deep tendon reflexes in pregnancy?

The patient should be supported by the examiner’s forearm, with the arm midway between flexion and extension. The examiner’s thumb should be placed over the biceps tendon, with fingers curled around the elbow. Tap briskly to flex the forearm at the elbow. Tap just above the triceps insertion, extending the forearm. Support the patient’s arm at the elbow and identify the brachioradialis tendon at the wrist.

Place the thumb of the hand supporting the elbow on the biceps tendon and tap the brachioradialis tendon with the other hand. This maneuver will show flexion and supination of the forearm, as well as finger jerk reflex, indicating flexion of the fingers.

Do nurses check deep tendon reflexes?

Preeclampsia is distinguished by hyperactive deep tendon reflexes, which are vital indicators that nurses must monitor and address.