STUDY - Technical - New Dacian's Medicine
Nuchal
rigidity (Classical / Allopathic Medicine)
Commonly an early
sign of meningeal irritation, nuchal rigidity refers to the
stiffness of the neck that prevents flexion. This sign may
herald life-threatening subarachnoid hemorrhage or meningitis,
and may also be a late sign of cervical arthritis, in which
joint mobility is gradually lost.
ALERT:
After eliciting nuchal rigidity:
- attempt to elicit Kernig's and Brudzinski's signs and evaluate the level of consciousness (LOC)
- assess the patient for signs of increased intracranial pressure
- institute emergency treatment, if necessary.
If the patient's condition permits, perform a focused assessment.
After eliciting nuchal rigidity:
- attempt to elicit Kernig's and Brudzinski's signs and evaluate the level of consciousness (LOC)
- assess the patient for signs of increased intracranial pressure
- institute emergency treatment, if necessary.
If the patient's condition permits, perform a focused assessment.
HISTORY:
Ask the patient about the onset and duration of neck stiffness. (Ask the patient's family for information if an altered LOC prevents the patient from responding.)
Ask the patient about associated signs and symptoms, such as headache, fever, nausea and vomiting, and motor and sensory changes. If the patient has no other signs of meningeal irritation, ask about a history of arthritis or neck trauma.
Review the patient's medical history, noting especially hypertension, head trauma, cerebral aneurysm or arteriovenous malformation, endocarditis, recent infection (such as sinusitis or pneumonia), and recent dental work.
Ask the patient if he can recall pulling a muscle in his neck.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Ask the patient about the onset and duration of neck stiffness. (Ask the patient's family for information if an altered LOC prevents the patient from responding.)
Ask the patient about associated signs and symptoms, such as headache, fever, nausea and vomiting, and motor and sensory changes. If the patient has no other signs of meningeal irritation, ask about a history of arthritis or neck trauma.
Review the patient's medical history, noting especially hypertension, head trauma, cerebral aneurysm or arteriovenous malformation, endocarditis, recent infection (such as sinusitis or pneumonia), and recent dental work.
Ask the patient if he can recall pulling a muscle in his neck.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Testing for nuchal
rigidity
To test for nuchal rigidity, place your hands behind the patient's neck and touch her chin to her chest, as shown here. Pain and muscle spasms will result if nuchal rigidity is present.
PHYSICAL ASSESSMENT:
To elicit nuchal rigidity, attempt to passively flex the patient's neck and touch his chin to his chest. (See Testing for nuchal rigidity.) If nuchal rigidity is present, this maneuver triggers pain and muscle spasms.
To test for nuchal rigidity, place your hands behind the patient's neck and touch her chin to her chest, as shown here. Pain and muscle spasms will result if nuchal rigidity is present.
PHYSICAL ASSESSMENT:
To elicit nuchal rigidity, attempt to passively flex the patient's neck and touch his chin to his chest. (See Testing for nuchal rigidity.) If nuchal rigidity is present, this maneuver triggers pain and muscle spasms.
ALERT:
Before testing for nuchal rigidity, make sure that no cervical spinal misalignment, such as a fracture or dislocation, exists. Severe spinal cord damage could result.
Inspect the hands for swollen, tender joints, and palpate the neck for pain or tenderness.
Before testing for nuchal rigidity, make sure that no cervical spinal misalignment, such as a fracture or dislocation, exists. Severe spinal cord damage could result.
Inspect the hands for swollen, tender joints, and palpate the neck for pain or tenderness.
SPECIAL
CONSIDERATIONS:
If meningeal irritation is present, monitor vital signs, intake and output, and neurologic status closely.
If meningeal irritation is present, monitor vital signs, intake and output, and neurologic status closely.
PEDIATRIC
POINTERS:
Nuchal rigidity reliably indicates meningeal irritation in children, unless they are paralyzed or comatose.
Nuchal rigidity reliably indicates meningeal irritation in children, unless they are paralyzed or comatose.
PATIENT
COUNSELING:
Instruct the patient on what to expect from diagnostic testing, which may include magnetic resonance imaging, computed tomography scan, and cervical spinal X-rays.
Instruct the patient on what to expect from diagnostic testing, which may include magnetic resonance imaging, computed tomography scan, and cervical spinal X-rays.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.