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Acute Care I > Cranial Nerve Assessment > Flashcards

Cranial Nerve Assessment Flashcards

1
Q

CN I what is it?
Function?
Examined by?

A

Olfactory
Smell
Having patient occlude one nostril and identify a common scent (coffee, peppermint or cinnamon) placed under the other nostril

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2
Q

CN II what is it?
tests what?

A

Optic
Visual acuity
visual fields
funduscopic exam
pupillary light reflex

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3
Q

CN II
visual acuity is examined by?

A

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

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4
Q

CN II
Visual fields are examined by?

A

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

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5
Q

CN II
funduscopic exam is performed how?

A

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

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6
Q

CN III what is it?
What are its functions?

A

Oculomotor
eye movments
eye lid elevation
accommodation
pupillary light relfex

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7
Q

CN III
Eye movements: examine the eye for?
Have the patient do what?

A

ptosis
fixate on your finger held about 2 ft away
examine movements of eyes through the 6 cardinal points of gaze

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8
Q

CN III
Accommodation: ask the patient to?

A

look at a distant object and then at your finger
the pupils should constrict when the eye focuses on the near object

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9
Q

CN III
Pupillary light reflex

A

Shine a light on each pupil examining for both direct constriction of the pupil
the same size in addition to consensual reaction

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10
Q

CN IV what is it?
What are its functions?

A

Trochlear
Eye movement inward and down

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11
Q

CN IV
Eye movement inward and down is examined by?

A

having the pt fixate on your finger while you move it from a distant position to the patients nose

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12
Q

CN V what is it?
What are its functions?

A

Facial sensation
Muscles of Mastication
corneal reflex

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13
Q

CN V
Facial Sensation

A

Lightly touch both sides of the patients forehead, cheek and chin.
Ask if the stimuli felt the same

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14
Q

CN V
Muscles of Mastication

A

Ask the pt to clench teetch.
Palpate jaw muslces for tone and strength

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15
Q

CN V
Corneal Reflex

A

Typically not neccessary in the awake, alert patient

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16
Q

CN VI what is it?
What are its functions?

A

Abducens
Eye movement - lateral

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17
Q

CN VI
Eye movement - lateral

A

examine lateral eye movement

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18
Q

CN VII what is it?
what are its functions?

A

Facial
Facial movement
taste on anterior tongue

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19
Q

CN VII
Facial Movement

A

inspect symmetry of facial features with various expressions
eyelid closing
smile
frown
puffed cheeks
wrinkle forehead

20
Q

CN VII
Taste

A

typically not tested

21
Q

CN VIII What is it?
What are its functions?

A

Acoustic
Hearing and balance

22
Q

CN VIII
Hearing

A

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.

23
Q

CN VIII
Hearing: Weber test

A

place the base of a vibrating tuning fork on midline of patients head
ask pt if sound is heard equally in both ears

24
Q

CN VIII
Hearing: Rinne

A

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

25
Q

CN VIII
Balance

A

Not typically tested. Can perform Romberg test if c/o vertigo

26
Q

CN IX what is it?
What are its functions?

A

Glossopharyngeal
taste
sensation posterior tongue
sensation posterior oropharynx
palate movement

27
Q

CN XI
Palate movement

A

ask pt to swallow

28
Q

CN XI
Gag reflex

A

stimulate back of throat on each side

29
Q

CN X what is it?
what are its functions?

A

Vagus
Uvula and soft palate movement
muscles of larynx and pharynx

30
Q

CN X
Uvula and soft palate movement

A

ask the pt to say “Ah”
Examine the soft palate and uvula for symmetry
observe for swallowing difficulty

31
Q

CN X
Muscles of larynx and pharynx

A

Evaluate quality of speech

32
Q

CN XI what is it?
what are its functions?

A

Spinal Accessory
Sternocleidomastoid and Trapezius muscles

33
Q

CN XI
Sternocleidomastoid and Trapezius muscles

A

Evaluate head turning and shoulder shrug

34
Q

CN XII what is it?
What are its functions?

A

Hypoglossal
tongue movement

35
Q

CN XII
Tongue Movement

A

Ask pt to protrude tongue and move it side to side

36
Q

Neuro assessment of stuporous or comatose pts includes?

A

LOC
Brainstem Reflexes
Motor Response

37
Q

Neuro assessment of stuporous or comatose pts
LOC

A

Describe pts spontaneous behavior and responses to stimuli

38
Q

Neuro assessment of stuporous or comatose pts
Arousability

A

Awake, alert, oriented
arousable to voice or pain

39
Q

Neuro assessment of stuporous or comatose pts
CNs

A

Pupils
Eye movements
Cough
Gag

40
Q

Neuro assessment of stuporous or comatose pts
CN Pupils

A

fixed
dilated
anisocoric
papilledema

41
Q

Neuro assessment of stuporous or comatose pts
CN Eye movements

A

eye position, deviation gaze roving
dolls eyes
cold caloric response
corneal reflexes

42
Q

Neuro assessment of stuporous or comatose pts
Motor Exam

A

Spontaneous movement, is it purposeful?
Localize
Withdrawal
Posturing (decorticate, decerebrate)
Myoclonus

43
Q

Neuro assessment of stuporous or comatose pts
Motor Exam
Decorticate indicates dysfunction at what level?

A

cerebral cortex level or below

44
Q

Neuro assessment of stuporous or comatose pts
Motor Exam
Decerebrate indicates dysfunction w/n what?

A

brainstem

45
Q

GCS
Eye opening
Opens eyes spontaneously?
Opens eyes in response to speech?
Opens eyes in response to painful stimuli?
Does not open eyes?

A

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46
Q

GSC
Motor response
Follows commands?
Localizes in response to painful stimuli?
Withdrawal to painful stimuli?
Flexion to pain?
Extension to pain?
No motor response?

A

6
5
4
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2
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47
Q

GSC
Best Verbal response
Oriented?
Confused?
Inappropriate words?
Incomprehensible sounds?
No verbal response?

A

5
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Acute Care I (24 decks)

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