Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
58 Cards in this Set
- Front
- Back
|
List the Cranial Nerves in Order:
|
Olfactory, Optic, Oculomotor, trochlear, trigeminal, abducens, facial, acoustic, glossopharyngeal, vagus, spinal accessory, hypoglossal
|
|
|
How do you assess cranial nerve I?
|
After determining that both nostrils are patent, ask the patient to close one nostril and identify easy to recognize odors (coffee, alcohol wipe). Do the same for the other. Chronic rhinitis, sinusitis, and heavy smoking may decrease sensation.
|
|
|
How do you assess cranial nerve II?
|
(optic) Assess visual fields and acuity. Examine each eye independently. Position yourself opposite the patient and ask him or her to look directly at the bridge of your nose and indicate when an object presented from the periphery of each of the visual field is seen. Test visual acuity with Snellen or Rosenbaum chart. Should wear glasses during exam. |
|
|
What 3 nerves are assessed together using EOM? |
Cranial nerves III, IV, VI Hold target back about 12 inches and flow through each position returning to center. If eyes do not move together- disconjugate gaze. Fine, rapid, jerking movements of the eyes= nystagmus
|
|
|
In addition to EOM, what are other functions of CN III?
|
pupillary constriction, convergence, and accommodation (pupils constricting with near vision). Shine light in pupil and note ipsilateral and contralateral constriction. Note the shape and size of the pupils. If oculomotor nerve is compressed the pupil remains dilated. Chart as PERRLA. or PERRL if unconscious because accommodation cannot be assessed. Another function of the oculomotor nerve is to keep the eyelid open. Damage may cause ptosis.
|
|
|
What does cranial nerve IV do?
|
eyes in and down
|
|
|
What does cranial nerve VI do?
|
eyes outward/ lateral eye movement
|
|
|
How do you assess cranial nerve V?
|
Sensory: eyes closed, identify light touch and pinprick in each of the 3 divisions (ophthalmic, maxillary, and mandibular) on both sides of the face Motor: clench the teeth and palpate the masseter muscles |
|
|
What should you know about the corneal reflex?
|
Evaluates CN V and VII simultaneously and should never be done on a conscious patient. If they can blink they have a corneal reflex. AKA blink to threat. Sensation of threat= ophthalmic division of CN V. Motor eye blink= facial CN VII
|
|
|
How do you asses cranial nerve VII?
|
Facial Expression: raise the eyebrows, close the eyes tightly, purse the lips, draw back the corners of the mouth in an exaggerated smile, and frown. Note any asymmetry. Taste discrimination of salt and sugar in the anterior two-thirds of the tongue is also a function of this nerve but is not usually tested unless lesion is suspected.
|
|
|
How do you assess cranial nerve VIII?
|
Acoustic/vestibulocochlear Have the patient close the eyes and indicate when he or she hears the rustling of the examiner's fingertips. Weber and Rinne tests or audiometer. The vestibular portion is not usually assessed. In the unconscious patient the oculocephalic reflex (movement of the eyes when the head is briskly turned to the side) may be assessed, |
|
|
Why and how are cranial nerves IX and X assessed together?
|
Glossopharyngeal and vagus nerves. Because they both innervate the pharynx. Test the gag reflex by touching the sides of the posterior pharynx or soft palate with a tongue blade. Glosspharyngeal= bitter and sour on posterior tongue and gag reflex. Vagus= ah and gag If weak or absent the patient is in danger of aspirating foods or secretions. Also have the patient phonate "ah" and note bilateral symmetry of elevation of the soft palate. If ET in place, suction catheter contact with carina elicits cough reflex. |
|
|
How do you assess cranial nerve XI?
|
Ask the patient to shrug the shoulders and to turn the head to either side against resistance. Turn head left to right against resistance.
|
|
|
How do you assess cranial nerve XII?
|
Ask the patient to protrude the tongue: it should protrude midline. Move the tongue up and down and side to side. Should also be able to push the tongue to either side against the resistance of a tongue blade. Note any asymmetry, atrophy, or fasciculation.
|
|
|
How do you test the motor system?
|
Assessment of strength, tone, coordination, and symmetry of the major muscle groups. Push and pull against resistance of arms. Abnormal tone is hypotonia (flaccid) or hypertonia (spasticity). Test CEREBELLAR function by assessing balance and coordination. Observe stature (posture while standing) and gait. Finger to nose test, heel to toe or heel to shin test. Pronation and supination of hands. Shallow knee bend. Note dysarthia or slurred speech because it is a sign of incoordination of the speech muscle. |
|
|
How do you test the sensory system?
|
Patient's eyes closed and avoid providing the patient with clues. Light touch using a cotton wisp or light pin prick. Test pain by alternately touching skin with sharp and dull end of the pin. Extinction is assess by simultaneously touching both sides of the body symmetrically. Temperature is only to be tested when the response to deep pain is abnormal. Tubes of warm and cold water to skin. Vibration: tuning fork to nails moving proximally. Ask when felt and when ceases. Position sense: (proprioception) pace finger and thumb on either side of patient finger or toe. Gently move and ask patient to describe position. Romberg test: stand feet together, eyes closed. |
|
|
How do you test cortical sensory function/ parietal lobe?
|
2-point discrimination. Graphesthesia (writing on hand) and stereognosis (ability to perceive the form and nature of objects).
|
|
|
higher cognitive function, memory retention, voluntary eye movements, voluntary motor movements, and speech in broca's area (motor speech)
|
Frontal lobe
|
|
|
Somatic, visual, and auditory data and Wernicke's speech area (meaning of words)
|
Temporal lobe
|
|
|
Interprets spatial information and contains the sensory cortex
|
Parietal lobe
|
|
|
Processing of sight
|
occipital lobe
|
|
|
initiation, execution, and completion of voluntary movements associated with skeletal muscle activity
|
basal ganglia
|
|
|
major relay center for afferent inputs
|
thalamus
|
|
|
regulates the ANS and endocrine system
|
hypothalamus
|
|
|
concerned with emotion, aggression, feeding behabvior, and sexual response
|
limbic system
|
|
|
vital centers concerned with respiratory, vasomotor, and cardiac function
|
medulla
|
|
|
Relaying sensory information, influencing excitatory and inhibitory control of spinal motor neurons, and controlling vasomotor, and respiratory activity, Regulates arousal and sleep wake transitions. Centers for sneezing, coughing, hiccupping, vomiting, sucking, and swallowing.
|
Reticular activating system
|
|
|
Coordinates voluntary movement and maintains trunk stability and equilibrium
|
cerebellum
|
|
|
Decorticate posturing
|
Flexion response, protecting your core, arms flexed legs extended
|
|
|
coordination=
|
cerebellum
|
|
|
Decerebrate
|
not protecting. Worst! significant global cerebral injury. extension.
|
|
|
Heel to shin
|
abnormal= jerky movements, missing shin. Tests coordination and function of cerebellum. Test bilaterally. May indicate stroke.
|
|
|
Heel to toe
|
coordination. Don't look at feet. Imagine a straight line. Forward on toes back on heels. Cerebellum. Observe gait
|
|
|
Romberg
|
Balance, cerebellum
|
|
|
Shallow need bends
|
balance/coordination. cerebellum
|
|
|
Upper extremity coordination
|
cerebellum and vestibular apparatus function Finger to nose, opposition of fingers, rapid alternating movements (patty cake) figure 8 in air (test bilaterally) |
|
|
Cheyne stokes respirations
|
metabolic conditions, midpons injury, bilateral cerebral hemisphere stroke. apneic leading into fast deep breathing slowing back down to apneic. Monitor pulse ox and ABGs
|
|
|
Apneustic respirations
|
extensive brainstem damage (agonal) breath in apnea breath out apnea
|
|
|
Central neurogenic respirations
|
>24 deep rapid. Mid pons brain stem injury
|
|
|
Graphesthesia
|
tests parietal lobe, peripheral sensation. close eyes, write on hands, guess what wrote (test bilaterally)
|
|
|
Rhinne's test
|
Bone conduction first then air conduction should be air 2:1 cone. Tests CN 8.
|
|
|
What does cranial nerve testing indicate?
|
brainstem function
|
|
|
Biceps reflex
|
find biceps tendon. stretch with thumb. tap thumb. look for flexion reflex. tests Cervical 5-6 reflex arc.
|
|
|
Stereognosis:
|
hold object in hand. Tests peripheral sensation, parietal lobe, discrimination
|
|
|
Confrontation:
|
checks CN 2, peripheral vision, get face to face and cover one eye. Wiggle fingers upper, lower, bilaterally. When leaving your field of vision should enter the patient's. hemianopsia= blind in one eye. Quadrianopsia= blind in one field
|
|
|
Vibration
|
peripheral sensation. Tuning fork to peripheral distal joints or nail beds and then move proximally. Ask what they feel and where. Ask to tell you when it stops or if anything has changed.
|
|
|
Accommodation:
|
pen moves towards eyes. Tests CN 3 oculomotor.
|
|
|
3 branches of trigeminal nerve:
|
CN 5. Clench teeth (masseter muscle) hard and soft (sharp and dull) forehead, cheek, jawline. Only check corneal reflex on unconscious patient, pry open eye take cotton wisp and gently touch corner.
|
|
|
Describe the distribution of the vertebrae:
|
7 cervical 12 thoracic 5 lumbar |
|
|
How many pairs of cervical spinal nerves are there?
|
8
|
|
|
Achilles tendon reflex:
|
Look for plantar flexion, kneel on chair. May be absent with injury L5-S2 (originates S1-S2). ASK MARGIE ABOUT THIS!!!
|
|
|
Patellar reflex:
|
L2-L4. Support leg, relax muscle, tap with flat side. Normal= extension of legs, contraction of quadriceps. Checks upper motor neurons and integrity of the reflex arc.
|
|
|
Weber test
|
Bone conduction. CN 8 acoustic. Tuning fork on top of head. Should hear equally on both sides.
|
|
|
EOM
|
CN 3 oculomotor, 4 trochlear, and 6 abducens
|
|
|
Triceps reflex:
|
Cervical 6-8tests reflex arc. Alecranon process. hold weight of arm and let dangle.
|
|
|
Romberg test:
|
Close eyes, feet together. Balance=cerebellum. Negative is normal for this.
|
|
|
Babinski test:
|
stroke outer lateral edge of foot and across balls of toes. If big toes dorsiflex and toes fan= positive= abnormal unless under age 2. If curl in= negative= normal unless under age 2. L4-S2
|
|
|
Proprioception=
|
sensation, elderly stroke patient common. Peripheral discrimination. parietal lobe.
|
