NUR 302 EXAM 3 (CRANIAL NERVES)

I Olfactory

Sensory - smell - Have patient identify a familiar scent with eyes closed (usually deferred).

I Optic

Sensory - vision (acuity and field of vision); pupil reactivity to light and accommodation (afferent impulse) - Have patient read from a card or newspaper, one eye at a time. Test visual fields by having patient cover one eye, focus on your nose, and identify the number of fingers you're holding up in each of four visual quadrants.

X Vagus

Both - gagging and swallowing (motor); speech (phonation) - Assess gag and swallowing with CN IX. Assess vocal quality.

XI Glossopharyngeal

Both - gagging and swallowing (sensory); taste - Touch back of throat with sterile tongue depressor or cotton-tipped applicator. Have patient swallow. POSTERIOR

V Trigeminal

Both - chewing; facial and mouth sensation; corneal reflex (sensory) - ask patient to hold the mouth open while you try to close it and to move the jaw laterally against your hand. With patient's eyes closed, touch her face with cotton and have her identify the area touched. In comatose patients, brush the cornea with a wisp of cotton; the patient should blink.

VII Facial

Both - facial expression; taste; corneal reflex (motor); eyelid and lip closure - Ask patient to smile, raise eyebrows, and keep eyes and lips closed while you try to open them. Have patient identify salt or sugar placed on the tongue (usually deferred). ANTERIOR

IV Trochlear

Motor - EOM (turns eye downward and laterally) - have patient look down and in

VI Abducens

Motor - EOM (turns eye laterally) - have patients move the eyes from side to side

III Oculomotor

Motor - eyelid elevation; most EOMs; pupil size and reactivity (efferent impulse) - check pupillary responses by shining a bright light on one pupil; both pupils should constrict. Do the same for the other eye. To check accommodation, move your finger toward the patient's nose; the pupils should constrict and converge. Check EOMs by having patient look up, down, laterally, and diagonally.

XI Spinal Accessory

Motor - shoulder movement; head rotation - Have patient shrug shoulders and turn head from side to side (not routinely tested).

XII Hypoglossal

Motor - tongue movement; speech - Have patient stick out tongue and move it internally from cheek to cheek. Assess articulation.

VII Acoustic

Sensory - hearing; equilibrium - To test hearing, use tuning fork or rub your fingers, place a ticking watch, or whisper near each ear. Equilibrium testing is usually deferred. Rinne & weber; whisper