Cranial Nerve Assessment Flashcards
CN I what is it?
Function?
Examined by?
Olfactory
Smell
Having patient occlude one nostril and identify a common scent (coffee, peppermint or cinnamon) placed under the other nostril
CN II what is it?
tests what?
Optic
Visual acuity
visual fields
funduscopic exam
pupillary light reflex
CN II
visual acuity is examined by?
having patient cover one eye placing snellen card appox 14” away.
have the patient read the letters on the card
examine each eye separately
patient should wear corrective lenses
CN II
Visual fields are examined by?
standing facing the patinet from 2 arms lengths away
close your righ eye while the patient closes their left eye
ask the patient to count 1 or 2 fingers presented in each of the four quadrants
CN II
funduscopic exam is performed how?
turn off lights in room
examint pt’s R eye by holding the opthalmoscope to your R eye in your R hand and vice versa
ask patient to look straight ahead and shine the beam of light on the pupil and look for the red reflex move closer to patients pupil staying focused on the red reflex.
locate optic disc and retinal vessels
CN III what is it?
What are its functions?
Oculomotor
eye movments
eye lid elevation
accommodation
pupillary light relfex
CN III
Eye movements: examine the eye for?
Have the patient do what?
ptosis
fixate on your finger held about 2 ft away
examine movements of eyes through the 6 cardinal points of gaze
CN III
Accommodation: ask the patient to?
look at a distant object and then at your finger
the pupils should constrict when the eye focuses on the near object
CN III
Pupillary light reflex
Shine a light on each pupil examining for both direct constriction of the pupil
the same size in addition to consensual reaction
CN IV what is it?
What are its functions?
Trochlear
Eye movement inward and down
CN IV
Eye movement inward and down is examined by?
having the pt fixate on your finger while you move it from a distant position to the patients nose
CN V what is it?
What are its functions?
Facial sensation
Muscles of Mastication
corneal reflex
CN V
Facial Sensation
Lightly touch both sides of the patients forehead, cheek and chin.
Ask if the stimuli felt the same
CN V
Muscles of Mastication
Ask the pt to clench teetch.
Palpate jaw muslces for tone and strength
CN V
Corneal Reflex
Typically not neccessary in the awake, alert patient
CN VI what is it?
What are its functions?
Abducens
Eye movement - lateral
CN VI
Eye movement - lateral
examine lateral eye movement
CN VII what is it?
what are its functions?
Facial
Facial movement
taste on anterior tongue
CN VII
Facial Movement
inspect symmetry of facial features with various expressions
eyelid closing
smile
frown
puffed cheeks
wrinkle forehead
CN VII
Taste
typically not tested
CN VIII What is it?
What are its functions?
Acoustic
Hearing and balance
CN VIII
Hearing
Face the pt hold your fingers out near each ear
rub your fingers together softly asking the pt to identify the side they hear the rubbing.
CN VIII
Hearing: Weber test
place the base of a vibrating tuning fork on midline of patients head
ask pt if sound is heard equally in both ears
CN VIII
Hearing: Rinne
Place base of vibrating tuning fork against pt mastoid bone
ask the pt when the sound is no longer heard
position the still vibrating tines 1-2 cm from auditory canal
Air conduction should be > Bone conduction
CN VIII
Balance
Not typically tested. Can perform Romberg test if c/o vertigo
CN IX what is it?
What are its functions?
Glossopharyngeal
taste
sensation posterior tongue
sensation posterior oropharynx
palate movement
CN XI
Palate movement
ask pt to swallow
CN XI
Gag reflex
stimulate back of throat on each side
CN X what is it?
what are its functions?
Vagus
Uvula and soft palate movement
muscles of larynx and pharynx
CN X
Uvula and soft palate movement
ask the pt to say “Ah”
Examine the soft palate and uvula for symmetry
observe for swallowing difficulty
CN X
Muscles of larynx and pharynx
Evaluate quality of speech
CN XI what is it?
what are its functions?
Spinal Accessory
Sternocleidomastoid and Trapezius muscles
CN XI
Sternocleidomastoid and Trapezius muscles
Evaluate head turning and shoulder shrug
CN XII what is it?
What are its functions?
Hypoglossal
tongue movement
CN XII
Tongue Movement
Ask pt to protrude tongue and move it side to side
Neuro assessment of stuporous or comatose pts includes?
LOC
Brainstem Reflexes
Motor Response
Neuro assessment of stuporous or comatose pts
LOC
Describe pts spontaneous behavior and responses to stimuli
Neuro assessment of stuporous or comatose pts
Arousability
Awake, alert, oriented
arousable to voice or pain
Neuro assessment of stuporous or comatose pts
CNs
Pupils
Eye movements
Cough
Gag
Neuro assessment of stuporous or comatose pts
CN Pupils
fixed
dilated
anisocoric
papilledema
Neuro assessment of stuporous or comatose pts
CN Eye movements
eye position, deviation gaze roving
dolls eyes
cold caloric response
corneal reflexes
Neuro assessment of stuporous or comatose pts
Motor Exam
Spontaneous movement, is it purposeful?
Localize
Withdrawal
Posturing (decorticate, decerebrate)
Myoclonus
Neuro assessment of stuporous or comatose pts
Motor Exam
Decorticate indicates dysfunction at what level?
cerebral cortex level or below
Neuro assessment of stuporous or comatose pts
Motor Exam
Decerebrate indicates dysfunction w/n what?
brainstem
GCS
Eye opening
Opens eyes spontaneously?
Opens eyes in response to speech?
Opens eyes in response to painful stimuli?
Does not open eyes?
4
3
2
1
GSC
Motor response
Follows commands?
Localizes in response to painful stimuli?
Withdrawal to painful stimuli?
Flexion to pain?
Extension to pain?
No motor response?
6
5
4
3
2
1
GSC
Best Verbal response
Oriented?
Confused?
Inappropriate words?
Incomprehensible sounds?
No verbal response?
5
4
3
2
1
