Assessment Flashcards
Assessment for CN II Optic
***Ask pt. if they normally wear glasses or contacts and have them wear them for the test if possible.
Visual acuity: One eye at a time, done with eye chart 14 inches from face “hold eye chart at comfortable distance for you”. Have them recite the line with the smallest letters that they can read.
Visual field:
*have patient focus on your nose
Hold up both hands superiorly and inferiorly and ask the patient if they can see both hands and do they look symmetric.
Then wiggle fingers in the four quadrants of the visual field and ask the patient to point to the hand when a finger wiggles
Use a cotton tip applicator and Test one eye at a time ask the patient to say “now” as soon as they see the applicator come into their side vision as they focus on the examiner’s nose
Pupillary light reflex:
Shine light into one eye, then shine it into the other- the eyes should adjust together/dilate equally
Assessment CN III Occulomotor
Check the shape and size of pupils, alignment of eyes, and presence of eyelid droop.
Pupillary light reflex
Versions: Have the patient follow a target (finger) in an H pattern with both eyes
Ductions: Test each eye separately by asking pt. to cover one eye and follow the H pattern
Convergence: move finger toward pt’s nose
OTHER:
Note eye deviation
Ask about double vision
Note nystagmus.
Assessment for CN IV Trochlear
Complete versions, ductions, and convergence
Patient may complain of double vision when looking to the down and outward position
Assessment CN V Trigeminal
Check for light touch (cotton swab) and painful touch (pointed object) in the three areas of sensation –Ask pt. if they feel touch equally on both sides
Corneal reflex: light touch on eyeball (w/ cotton swab)
Lack of eye blink indicates damage to ophthalmic branch
Ask pt. to open & close their mouth
Ask pt. to bite down & feel masseter and temporalis muscles
Ask pt. to wiggle jaw from side to side
Ask pt. to resist jaw closure
Ask pt. to resist jaw opening
Ask pt. to resist lateral pressure on both sides of jaw
Jaw jerk (a stretch reflex): Have patient slightly open mouth then place your finger on their chin and strike your finger with a reflex hammer.
If there is a jaw jerk it is said to be positive and this indicates an upper motor neuron lesion
Assessment CN VI Abducens
Complete versions, ductions, and convergence
Inability to abduct eye (eye gets stuck inward)
Unilateral-affected eye turns inward
Bilateral- both eyes turn inward
Double vision occurs when looking to affected side or straight ahead
Assessment CN VII Facial
Have pt close eyes adnation of sugar, salt, sour, or sweet tastes to protruded tongue both sides of tongue
nod yes or no if they taste something- BEFORE tongue is withdrawn into mouth
If pt. nods yes- ask them to indicate what the taste was
Motor: Ask pt. to shut eyes as tightly as possible and press down and pull up on eyebrows smile & show teeth pucker lips (say i-u-i-u) inflate cheeks, and tap each cheek. strain neck (frog face)
Assessment CN VIII Vestibulocochlear
Test balance by asking patient to walk, turn, and walk back- watching for gait and coordination irregularities
Romberg: Ask pt. to stand up, place arms straight out to the side, and close eyes, then ask them to touch their nose with each finger
Auditory acuity: Rub fingers together 18” away from patient’s ear and ask them to respond when they hear the rubbing
Rinne’s: Place vibrating fork on mastoid process. Ask pt. to tell you when they stop hearing the sound. When pt. can no longer hear it on mastoid process, immediately move fork in front of patient’s ear and ask if they can hear the tone. can’t hear when put near ear
Weber’s: using a tuning fork, place vibrating fork on midline of pt.’s forehead and ask where they hear the sound.
Assessment CN IX Glossalpharyngeal
Ask them if they have had any heart/breathing problems.
Ask them to dry swallow and note laryngeal elevation
Ask them to cough and grunt (coup de glotte)
Ask pt. if they previously had a gag reflex
Use a tongue depressor to elicit gag reflex by stroking BOTH faucial pillars
Ask pt. to open mouth and say “ah” looking for palatal elevation & symmetry and uvula deviation
Listen for vocal quality
Ask patient to say “kuh, kuh, kuh” looking for nasal emission (w/ nasal mirror/finger)- indicating damage to pharyngeal branch
–For all tests, ask if that is what normal for them… i.e. is that how you normally cough/swallow? Have you always had a gag reflex? Did you have one before?
Assessment CN X Vegas
Same as CN IX
Ask them if they have had any heart/breathing problems.
Ask them to dry swallow and note laryngeal elevation
Ask them to cough and grunt (coup de glotte)
Ask pt. if they previously had a gag reflex
Use a tongue depressor to elicit gag reflex by stroking BOTH faucial pillars
Ask pt. to open mouth and say “ah” looking for palatal elevation & symmetry and uvula deviation
Listen for vocal quality
Ask patient to say “kuh, kuh, kuh” looking for nasal emission (w/ nasal mirror/finger)- indicating damage to pharyngeal branch
–For all tests, ask if that is what normal for them… i.e. is that how you normally cough/swallow? Have you always had a gag reflex? Did you have one before?
Assessment CN XI: Accessory
Ask patient to raise shoulders while you press down
Ask patient to resist when I try to turn their head left and right.
Assessment CN XII Hypoglossal
Ask patient to protrude tongue, raise it, and move it side to side to demonstrate muscle strength.
Examine tongue for fibrillations, fasciculations, asymmetry and atrophy Ask patient to push tongue into one cheek while resisting pressure and switch sides
Push against both sides of protruded tongue with tongue depressor
**WHEN YOU SHOW TONGUE, MAKE SURE IT LOOKS LIKE ITS OBVIOUSLY DEVIATING.
Assessment for CN 1
Ask pt. if they currently have a cold
Ask pt. if they smoke
Ask pt. if exposed to chemicals
Ask pt. if been in recent accident/trauma
Test each nostril by having client Close eyes and plug one nostril:
Place a vile of a well-known scent under nose
Ask pt. do you smell anything, yes or no?
If yes, what do you smell?
Unilateral: pt. can’t smell on one side; lesion located on ipsilateral side
Bilateral: pt. can’t smell from either nostril
Hypersensitivity: smell everything, refer on to ENT or neurologist but no nerve damage,
