Adult Health 3 - exam 3 cranial nerves

VIII-VESTIBULOCOCHLEAR OR ACOUSTIC Whisper Test

Stand 1-2 feet behind patient and instruct patient to place one finger on tragus to obscure sound. Whisper 3 two syllable words into ear and ask patient to repeat back, i.e., baseball, football

VIII-VESTIBULOCOCHLEAR OR ACOUSTIC 3 Tests for Acoustic Nerve

Whisper test Rinne Test Weber test

3/4/6- eyes can do tricks.

oculomotor/trochlear/abducens -motor eye movement Examines pupils for size, shape and equality.

XI-SPINAL ACCESSORY -motor

Shoulder Elevation & Head Turning Examines the sternocleidomastoid and trapezius muscles

Optic nerve 2 Ophthalmoscope

examines retina

-Cover Test

-Cover patient's eye with cardboard or a sheet of paper and wait a minute. Observe for any deviations or movement while eye is covered then repeat after uncovering eye. Looking for Strabismus, Nystagmus, and Ptosis

-6 Cardinal Gazes

-Holding finger 12 inches from patient while holding the patient's chin, ask patient to follow finger movements with eyes only. Start in the center and move finger up and to the right, then return to center, then laterally to the right, then back to center, and lastly down and to the right and back to center. Repeat on left side

2-Optic neve

-sensory -Vision-examines visual fields

PERRL-A

Ask patient to look at a distance, use penlight to shine light obliquely onto each pupil. The pupils should constrict in response to light. The eye that has the penlight shining on it is directly constricting and the opposite eye is consensually constricting. PUPILS should be EQUAL, ROUND, REACTIVE TO LIGHT (PERRL). ACCOMMODATION is tested asking the patient to look at an object in the distance, eyes should dilate with a far gaze. Next hold finger in front of patient about 12 inches from patient's eyes, ask him/her to follow the finger as it moves towards the patients nose, pupils should constrict and converge. and ask

XI-SPINAL ACCESSORY motor test

Ask patient to shrug their shoulders and turn their head to the left and right side with and without resistance.

XII-HYPOGLOSSAL motor-test

Ask patient to stick their tongue straight out looking for fassiculations (tongue twitches) and curving to a side. Test tongue strength by asking patient to poke the inside of their cheek with their tongue while feeling or administering counter-pressure on the outside of their cheek.

VII Facial Nerve Motor test -cranial nerve number 7 make funny faces

Ask patient to wrinkle the brow, show teeth, frown, close eyes tightly, purse lips and puff cheeks

V Trigeminal Nerve -motor sensory

Ask the patient to tightly clench teeth, palpate over jaw for master muscle symmetry. Ask patient to clench teeth while pulling down on chin

VII Facial Nerve Both sensory and motor

Facial Expression Examines the muscles of facial expression and taste sensation

V Trigeminal Nerve both sensory/motor

Facial Sensation Examines facial sensation

VIII -vestibulocochlear or acoustic -Sensory

Hearing & Balance Examines the transmission of sound and equilibrium (balance) from the inner ear to the brain

Confrontation (optic nerve 2)

Note HCP must have peripheral vision to test patient. The paint should cover their right eye with their right hand (vice versa when testing the opposite eye) With the examiner seated directly across from the patient (unless same height, then both can stand) The patient should direct their gaze to the corresponding eye examiner's The testing is performed using moving targets (examiner's fingers) moving target should start outside the usual 180 degree visual field, then move slowly to a more central position until the patient confirms visualization of the target. All 4 quadrants (upper and lower, temporal and nasal) should be tested

The 3 tests for optic Nerve -2 optic

Ophthalmoscope (examines retina) Snellen chart Confrontation

IX/X-GLOSSOPHARYNGEAL/VAGUS Both Sensory/Motor

Oral Sensation, Taste & Salivation, Swallowing, Gag Reflex Examines the elevation of the pharynx during swallowing and speech, taste and gag reflex

Test Cranial Nerve III/IV/VI together-3 Tests -PERRLA-

PERRL/Accommodation 6-Cardinal Gazes Cover Test

VIII-VESTIBULOCOCHLEAR OR ACOUSTIC -Weber Test

Place a vibrating tuning fork on top of the head equal distance from each ear and in contact with skull. Ask patient where they hear the sound, they should reply equally on both ears.

Test Cranial Nerves IX & X together Sensory Test- Motor-

Place sour or bitter liquid in the posterior 1/3 of the tongue Ask patient to open mouth and use tongue blade to depress tongue and observe uvula and soft palate rise should be midline. Test Gag Reflex

VII Facial Nerve Sensory test

Place sweet, sour or bitter liquid in the anterior 2/3 of the tongue

VIII-VESTIBULOCOCHLEAR OR ACOUSTIC -Rinne test

Place vibrating tuning fork against patient's mastoid bone and ask patient to tell you when sound is no longer heard. Once they signal they can't hear it, quickly position the still vibrating tuning fork 1-2cm from the auditory canal, and ask patient when they stop hearing it. Air conduction should be twice as long as bone conduction.

1. Olfactory (sensory) -examines smell

The smell from each nostril is tested individually with coffee, almond oil or rubbing alcohol, after consideration of airflow Check for potency

XII-HYPOGLOSSAL motor

Tongue Movement Examines tongue movements required for speech and swallowing

V Trigeminal Nerve -sensory test

ask patient to close eyes then using a cotton swab or broken tongue blade and ask the patient to identify sharp or dull sensations when they feel the sensation

Snellen chart

chart containing symbols that is used in the testing of visual acuity -ask patient to stand 20 feet from the chart while covering one eye and read lowest line on chart. normal is 20/20