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When performing a comprehensive neurological exam, examiners may assess the functioning of the cranial nerves. When performing these tests, examiners compare responses of opposite sides of the face and neck. Instructions for assessing each cranial nerve are provided below. Cranial Nerve I – OlfactoryAsk the patient to identify a common odor, such as coffee or peppermint, with their eyes closed. See Figure 6.11[1] for an image of a nurse performing an olfactory assessment. Figure 6.11 Assessing Cranial Nerve I (Olfactory)Cranial Nerve II – OpticBe sure to provide adequate lighting when performing a vision assessment. Far vision is tested using the Snellen chart. See Figure 6.12[2] for an image of a Snellen chart. The numerator of the fractions on the chart indicate what the individual can see at 20 feet, and the denominator indicates the distance at which someone with normal vision could see this line. For example, a result of 20/40 indicates this individual can see this line at 20 feet but someone with normal vision could see this line at 40 feet. Test far vision by asking the patient to stand 20 feet away from a Snellen chart. Ask the patient to cover one eye and read the letters from the lowest line they can see.[3] Record the corresponding result in the furthermost right-hand column, such as 20/30. Repeat with the other eye. If the patient is wearing glasses or contact lens during this assessment, document the results as “corrected vision.” Repeat with each eye, having the patient cover the opposite eye. Alternative charts are available for children or adults who can’t read letters in English. Figure 6.12 Snellen ChartNear vision is assessed by having a patient read from a prepared card from 14 inches away. See Figure 6.13[4] for a card used to assess near vision. Figure 6.13 Assessing Near VisionCranial Nerve III, IV, and VI – Oculomotor, Trochlear, AbducensCranial nerve III, IV, and VI (oculomotor, trochlear, abducens nerves) are tested together.
Video Review for Assessment of the Cardinal Fields of Gaze[7]Read more details about assessing the Pupillary Light Reflex. Cranial Nerve V – Trigeminal
Cranial Nerve VII – Facial Nerve
Cranial Nerve VIII – Vestibulocochlear
Cranial Nerve IX – GlossopharyngealAsk the patient to open their mouth and say “Ah” and note symmetry of the upper palate. The uvula and tongue should be in a midline position and the uvula should rise symmetrically when the patient says “Ah.” (see Figure 6.22[14]). Figure 6.22 Assessing Glossopharyngeal NerveCranial Nerve X – VagusUse a cotton swab or tongue blade to touch the patient’s posterior pharynx and observe for a gag reflex followed by a swallow. The glossopharyngeal and vagus nerves work together for integration of gag and swallowing. See Figure 6.23[15] for an image of assessing the gag reflex. Figure 6.23 Observing the Gag ReflexCranial Nerve XI – Spinal AccessoryTest the right sternocleidomastoid muscle. Face the patient and place your right palm laterally on the patient’s left cheek. Ask the patient to turn their head to the left while resisting the pressure you are exerting in the opposite direction. At the same time, observe and palpate the right sternocleidomastoid with your left hand. Then reverse the procedure to test the left sternocleidomastoid. Continue to test the sternocleidomastoid by placing your hand on the patient’s forehead and pushing backward as the patient pushes forward. Observe and palpate the sternocleidomastoid muscles. Test the trapezius muscle. Ask the patient to face away from you and observe the shoulder contour for hollowing, displacement, or winging of the scapula and observe for drooping of the shoulder. Place your hands on the patient’s shoulders and press down as the patient elevates or shrugs the shoulders and then retracts the shoulders.[16] See Figure 6.24[17] for an image of assessing the trapezius muscle. Figure 6.24 Assessing Cranial Nerve XICranial Nerve XII – HypoglossalAsk the patient to protrude the tongue. If there is unilateral weakness present, the tongue will point to the affected side due to unopposed action of the normal muscle. An alternative technique is to ask the patient to press their tongue against their cheek while providing resistance with a finger placed on the outside of the cheek. See Figure 6.25[18] for an image of assessing the hypoglossal nerve. Figure 6.25 Assessing the Hypoglossal NerveVideo Review of Cranial Nerve Assessment[19]Expected Versus Unexpected FindingsSee Table 6.5 for a comparison of expected versus unexpected findings when assessing the cranial nerves. Table 6.5 Expected Versus Unexpected Findings of an Adult Cranial Nerve Assessment
Where is the nurse positioned when performing a Romberg test?The implementation is mostly the same. For this second test, the patient has to place his feet in heel-to-toe position, with one foot directly in front of the other. As with the original Romberg test, the assessment is performed first with eyes open and then with eyes closed.
Which clinical indicator is most commonly present in the assessment of a client with a ruptured cerebral aneurysm?A sudden, severe headache is the key symptom of a ruptured aneurysm. This headache is often described as the "worst headache" ever experienced.
Which finding for a client with a head injury indicates increasing intracranial pressure?An MRI or CT scan of the head can usually determine the cause of increased intracranial pressure and confirm the diagnosis.
Which muscle in the given figure turns the eye toward the nose quizlet?The medial rectus is an extraocular muscle that attaches to the side of the eye near the nose. It moves the eye inward toward the nose.
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