Cranial Nerves Assessment 2009. Sheeba Jacob R.N., B.S.N., Victoria Kim RN B.S.N. Goals. Goal: 1 .Students will be able to identify the 12 cranial nerves by name and assess the function of each (knowledge).
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Sheeba Jacob R.N., B.S.N.,
Victoria Kim RN B.S.N.
Goal:1 .Students will be able to identify the 12 cranial nerves by name and assess the function of each (knowledge).
2. The student will be able to comprehend the anatomical significance of the assessment. (Comprehension)
2. . Anatomy of Brain-http://www.righthealth.com/search/Picture_Of_Labeled_Brain/overview/google_imagesearch?img=3
3. Cranial Nerve http://www.becomehealthynow.com/images/organs/nervous/cranial_nerves_bh.jpg
CN V Trigeminal Sensorimotor muscles of the Jaw
The temperomandibular joint is palpated while the patient clenches jaw, opens and closes mouth, moves jaw side to side and forward against pressure CN V, trigeminal Nerve
CN V is further tested with light touch a wisp of cotton in three areas .Cranial Nerve V
Temporomandibular joint and Massater Muscle
Cranial Nerve V -http://www.fotosearch.com/LIF155/mm103010/
Inspection and Palpation
Cranial Nerves are assessed in this order 5,7,2,3,4,6,8,1,9,10, 11,12
Palpate the Temporomandibular Joint– CN V
Q. Which cranial nerve is further tested with light touch a whisp of cotton in three areas .
Cranial Nerve VII
Q. A test of Cranial VII is?
Definition Cranial Nerve the optic nerve II (vervus opticus), which facilitates sight,
The oculomotor nerve III (n. oculomotorius) stretches from the front edge of the pons to the eye socket. There it connects to four external eye muscles (musculi recti superior, inferior et medialis and musculus obliquus inferior). It also carries parasympathetic nerves for closing the pupil (usculus sphincter pupillae) and the accommodation (musculus ciliaris).
The trochlear nerve IV (nervus trochlearis) runs from the brain to the tendons on the eye muscles in the orbit. It connects an external motor eye muscle (musculus obliquus superior).
The abducens nerve VI (nervus abducens) is a motor nerve which connects to the external optic muscles (musculus rectus lateralis). If this nerve fails, the eyes can become cross-eyed (strabismus convergens).
Assessment – CN III, IV, VI
The cranial nerves of each eye is assessed separately for pupillary reactions to light
cranial nerves III, IV and or VI a further tested by evaluating the extra ocular movements through the six cardinal fields of gaze. This examination allows assessment of each muscle in its primary field of action Video link below
cranial nerves III, IV and VI are further tested by performing the cover- uncover testCranial Nerve III, IV, VIPupillary Function
cranial nerves III, IV and VI are further tested by performing the cover- uncover test
Link http://www.youtube.com/watch?v=PRa7mPx2XVsCranial Nerve III, IV, VI
Part TEN –Cranial Nerve VIII, Hearing performing the cover- uncover test
Definition The vestibulocochlear nerve VIII (n. vestibulocochlearis) is a sensory nerve branch which comes from the pons in the brain. It reaches to the inner ear and serves to carry hearing and balance senses.
Assessment - cranial nerve eight is tested using this screening hearing test or the whisper tests
Cranial nerve eight is also tested by performing the Weber and Rinne testsPart 10-Cranial Nerve VIII Hearing
2. External Ear --Both outer ears are deliberately and thoroughly inspected and palpated http://medicalimages.allrefer.com/large/medical-findings-based-on-ear-anatomy.jpg
Mask the hearing in the other ear by having the patient place a finger in the ear canal and gently move it rapidly up-and-down.
Stand to the side of the patient at a consistent distance best for you, about 1 to 2 feet away from the ear being tested, and out of the patients line of vision
Whisper a combination of three letters and numbers very softly and ask the patient to repeat the words heard
Normal findings .
The patient should hear softly whispered words in each ear at that distance of about 1 to 2 feet, responding correctly more than 50% of the timePerforming the Whisper Test
Perform the Weber test by placing the base of the vibrating tuning fork on the midline vertex of the patients head
Ask the patient if the sound is heard equally in both ears or is better in one ear
Normal finding lateralization of sound. Is their lateralization of sound?
To test the reliability of the patient’s response, repeat the procedure while occluding one ear, asking the patient in which hear the sound is best heard. It should be heard best in the occluded ear.Performing Weber test
The Rinne test is performed by placing the base of the vibrating tuning fork against the patient’s mastoid bone
Begin counting or timing the interval with your watch .
Ask the patient to tell you when the sound is no longer heard, noting the number of seconds
Quickly position the still vibrating tines 1cm to 2 cm from the auditory canal, and again ask the patient to tell you when the sound is no longer heard
Continue counting or timing the interval to determine the length of time, the sound is heard by air conductionRinne Test of Hearing
The sense of smell is developed by the mucous membranes in the nose (nasus). Here a small area has a layer of sensory sells, the olfactory epithelium. This picks up smells and sends them to the brain (cerebrum). All information received by the brain from the main sensory organs is called sensory signals.
The nose is inspected and palpated externally .
Inspected internally with the light and speculum of an otoscope
The patency of the nose is also assessed be occluding each nostril.
Test cranial nerve 1 with odor differentiation of each nostrilPart 11-Cranial Nerve I, Smell
Cranial Nerve 1Olfactory
The glossopharyngeal nerve IX (n the nose (. glossopharyngeus) is a motor, sensory and parasympathetic nerve branch which comes from the extended spinal cord (medulla oblongata). Its branches connect to the tongue, the pharyngeal muscles, the ear drum, the lower thorangeal skin and the ear wax glands.
The vagus nerve X (n. vagus) comes from the extended spinal cord. It has motor and sensory threads which reachs from the neck to the stomach-intestinal tract. On its path, it connects to numerous muscles in the larynx, thorax, gullet and intestinal tract, but also the glands, glandular organs and the ear canal.
The entire oral cavity is inspected
CN IX and X are tested by
Having the patient swallow
This can be observed during the thyroid assessment
Observing movement of the palate during phonation.
A comment about quality of the patients voice should be noted .
Testing the gag reflex, does not need to be assessed and is usually only tested if neurological impairment is suspected .
The sense of taste on the posterior third of the tongue does not need these testedCranial Nerve IX and X, Swallowing
Cranial Nerve 1Olfactory
The thyroid gland is inspected and palpated before and during swallowing .
The patient is provided a couple water to facilitate swallowing during this part of the assessment
The Cervical Vertebrae ( the nose (Vertebrae cervicales)
The cervical vertebral column is the one most capable of movement. The first cervical vertebrae (atlas) and the second cervical vertebrae (axis) deviate significantly from the basic form of the cervical vertebrae. For instance, the atlas does not have the body of the vertebrae or spine of the vertebrae. Instead of that, it has two arches with joint surfaces for the axis and the occipital bone (os occipitale).
The second cervical vertebra has a tooth-like process (dens axis), which connects the front surface of the joint of the atlas and axis. The cervical vertebrae 3-6 are very similar to one another.
The range of motion of the cervical spine is evaluated by having the patient .
- put his or her chin on the chest .
- lift chin to ceiling
-turn chin toward each shoulder
- touch each ear toward corresponding shoulderPart 13-Range of Motion of the Cervical Spine
Shrugged the their shoulders against resistance .
By turning their head against the examiner hand bilaterally
Observe the Sternocleidomastoid and trapeze muscles for equal size
General examination of the patients anterior neckCranial Nerve XI
The carotids are also auscultated bilaterally using the belle of the stethescope while the patient is holding his breath
Note – the thyroid is also auscultated only if it is enlarged
The carotid arteries, which each extend towards the head on either side, branch off in the so-called carotid bifurcation on the level of the upper edge of the larynx into an inner and outer carotid artery (arteria carotis externa et interna). The outer carotid artery supplies blood to the thyroid gland (glandula thyreoidea), larynx (larynx), oral cavity (cavum oris), masticatory muscles and the face; the inner carotid artery supplies blood to the eye (oculus) and to most of the brain (cerebrum).Auscultate the Carotids
The cranial nerves belle of the stethescope while the patient is holding his breath
The appearance of the sternoclidomastoid muscle and the trapezius muscle
Lymph Nodes of the head and neck
Position of the trachea
Start Part 2Summary Part 1