cranial nerve examination report normal patient

Documentation of a basic, normal neuro exam should look something along the lines of the following: The patient is alert and oriented to person, place, and time with normal speech. No motor deficits are noted, with muscle strength 5/5 bilaterally.

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How to test all 12 cranial nerves?

Cranial nerve examination frequently appears in OSCEs. You’ll be expected to assess a subset of the twelve cranial nerves and identify abnormalities using your clinical skills. This cranial nerve examination OSCE guide provides a clear step-by-step approach to examining the cranial nerves, with an included video demonstration.

What are the 12 cranial nerve tests?

Nystagmus secondary to BPPV has the following nearly pathognomic characteristics:

• A latency period of 5 to 10 sec
• Usually, vertical (upward-beating) nystagmus when the eyes are turned away from the affected ear and rotary nystagmus when the eyes are turned toward the affected ear
• Nystagmus that fatigues when the Dix-Hallpike maneuver is repeated

Which cranial nerves are usually evaluated during the examination of the eyes?

During a complete neurological exam, most of these nerves are evaluated to help determine the functioning of the brain: Cranial nerve I (olfactory nerve). This is the nerve of smell. The patient may be asked to identify different smells with his or her eyes closed. Cranial nerve II (optic nerve).

How to conduct a cranial nerve examination?

• Ask patient to turn head to one side and push against examiners hand or ask to flex head against resistance, palpate and evaluate strength of sternocleidomastoid muscle. • Evaluate both right and left side, compare for symmetry. CRANIAL NERVES 39 40.

What is a normal neurological examination?

The neurologic examination is typically divided into eight components: mental status; skull, spine and meninges; cranial nerves; motor examination; sensory examination; coordination; reflexes; and gait and station. The mental status is an extremely important part of the neurologic examination that is often overlooked.

How do you document normal Graphesthesia?

Slowly draw a number, letter, or shape using your finger or blunt instrument. Have the patient identify the stimulus. The procedure is repeated 3-5 times or until you are able to determine whether the patient has intact or impaired sensation. Document findings.

What does the cranial nerve examination indicate?

CRANIAL NERVES The cranial nerve examination may reveal signs of sensory or motor dysfunction that could affect gait. Decreased visual acuity, visual field deficits, or visual neglect may cause a patient to adopt a cautious gait pattern and may contribute to falls.

How do you test for CN 12's function and what is considered normal findings?

Cranial Nerve XII – Hypoglossal Ask 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.

What is stereognosis and graphesthesia?

Graphesthesia is the recognition of movements drawn on the skin, while stereognosis is the recognition of solid objects through touch. Loss of stereognosis also indicates a problem with the somatosensory cortex. It's known as astereognosis and can be diagnosed during a neurological exam.

What does a pronator drift indicates?

Pronator drift indicates abnormal function of the corticospinal tract in the contralateral hemisphere. In some patients, the arm may remain supinated but drop lower than the unaffected arm, and the fingers and elbow might flex.

How do you document cranial nerve assessment?

Documentation of a basic, normal neuro exam should look something along the lines of the following: The patient is alert and oriented to person, place, and time with normal speech. No motor deficits are noted, with muscle strength 5/5 bilaterally. Sensation is intact bilaterally.

How do you present the cranial nerve exam?

CN IX and CN X nerves can be assessed together:Ask the patient to cough (assessing CN X)Ask the patient to open the mouth wide and say 'ah', using a tongue depressor to visual the palate and posterior pharyngeal wall (assessing CN IX and X) The soft palate should move upwards centrally.

What does CN II XII grossly intact mean?

The term "grossly intact" usually means that a cranial nerve exam was not done, but the patient's facial function is symmetric.

How do you assess CN VII?

Cranial nerve VII controls facial movements and expression. Assess the patient for facial symmetry. Have him wrinkle his forehead, close his eyes, smile, pucker his lips, show his teeth, and puff out his cheeks. Both sides of the face should move the same way.

How do you test for CN 3?

Inability to follow and object in direction of CN III (the quickest test is to observe upward gaze which is all CN III; the eye on the affected side does not look upward) Inability to open the eyelid. CN III dysfunction causes the eyelid on the affected side to become "droopy".

How do you test cranial nerve 8?

2:065:39Vestibulocochlear nerve examination | Eighth cranial nerve - YouTubeYouTubeStart of suggested clipEnd of suggested clipNow we test the auditory component of the eighth cranial nerve a simple but crude method of gettingMoreNow we test the auditory component of the eighth cranial nerve a simple but crude method of getting an initial impression of the patient's hearing is to wrap your fingers. Together from some distance

What is the direct pupillary reflex?

Assess the direct pupillary reflex: Shine the light from your pen torch into the patient’s pupil and observe for pupillary restriction in the ipsilateral eye. A normal direct pupillary reflex involves constriction of the pupil that the light is being shone into.

How many efferent limbs are there in the pupillary reflex?

Each afferent limb of the pupillary reflex has two efferent limbs, one ipsilateral and one contralateral. The afferent limb functions as follows: Sensory input (e.g. light being shone into the eye) is transmitted from the retina, along the optic nerve to the ipsilateral pretectal nucleus in the midbrain.

What does strabismus mean in a patient?

Strabismus: may indicate oculomotor, trochlear or abducens nerve palsy. Limbs: pay attention to the patient’s arms and legs as they enter the room and take a seat noting any abnormalities (e.g. spasticity, weakness, wasting, tremor, fasciculation) which may suggest the presence of a neurological syndrome).

What does it mean when a pupil is pronounced in bright light?

If the pupil is more pronounced in bright light this would suggest that the larger pupil is the abnormal pupil, if more pronounced in dark this would suggest the smaller pupil is abnormal. Examples of asymmetry include a large pupil in oculomotor nerve palsy and a small and reactive pupil in Horner’s syndrome.

What causes anosmia in the nose?

There are many potential causes of anosmia including: Mucous blockage of the nose: preventing odours from reaching the olfactory nerve receptors. Head trauma: can result in shearing of the olfactory nerve fibres leading to anosmia. Genetics: some individuals have congenital anosmia.

Where does motor output come from?

Motor output is transmitted from the pretectal nucleus to the Edinger-Westphal nuclei on both sides of the brain (ipsilateral and contralateral). Each Edinger-Westphal nucleus gives rise to efferent nerve fibres which travel in the oculomotor nerve to innervate the ciliary sphincter and enable pupillary constriction.

Which nerve is involved in the afferent branch of the corneal reflex?

The afferent branch of the corneal reflex involves V1 of the trigeminal nerve whereas the efferent branch is mediated by the temporal and zygomatic branches of the facial nerve. To assess the corneal reflex: 1. Clearly explain what the procedure will involve to the patient and gain consent to proceed. 2.

How many cranial nerves are there in the nervous system?

Assessment of the cranial nerves provides insightful and vital information about the patient’s nervous system. There are 12 cranial nerves that are often forgotten by nurses, so with that in mind, here’s a free assessment form that you can use!

How to test light sensation?

(same as above) (same as above) To test deep sensation, use alternating blunt and sharp ends of an object. Determine sensation to warm and cold object by asking client to identify warmth and coldness. (same as above)

What should a client be able to do?

Client should be able to smile, raise eyebrows, and puff out cheeks and close eyes without any difficulty. The client should also be able to distinguish different tastes. Client performed various facial expressions without any difficulty and able to distinguish varied tastes.

How to use a penlight?

Hold a penlight 1 ft. in front of the client’s eyes. Ask the client to follow the movements of the penlight with the eyes only. Move the penlight upward, downward, sideward and diagonally. Client’s eyes should be able to follow the penlight as it moves. Both eyes are able to move as necessary.

What reflex should a client have to respond to light and deep sensation?

While the client looks upward, lightly touch the lateral sclera of eye to elicit blink reflex. Client should have a (+) corneal reflex, able to respond to light and deep sensation and able to differentiate hot from cold. Client was able to elicit corneal reflex, sensitive to pain stimuli and distinguish hot from cold.

Who is Matt Vera?

Matt Vera, BSN, R.N. Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible.

Why wouldn't cranial nerves work?

Why wouldn’t a cranial nerve “work ”? In many neuro diseases, the neurons that supply a particular nerve is damaged, which makes the nerve not function properly. For example, in multiple sclerosis the myelin sheath of the neurons in the central nervous system are damaged, which leads to some sensory and motor problems.

What nerve causes blurry vision?

Therefore, you can assess this nerve (cranial nerve II) for any type of abnormalities.

Which nerve is responsible for mastication?

Cranial Nerve V. To test Cranial Nerve V…..trigeminal nerve: This nerve is responsible for many functions and mastication is one of them. Have the patient bite down and feel the masseter muscle and temporal muscle. Then have the patient try to open the mouth against resistance.

How far can a patient see with normal vision?

This means the patient can see at 20 feet what a person with normal vision can see at 30 feet.

What is neuro exam?

A neuro exam is one of the more complex body systems to master when it comes to assessment and documentation. Testing the cranial nerves, for example, takes practice. Omitting a small part of the process can mean missing a potentially serious diagnosis.

What is a neurological exam?

The neurological exam consists of a number of components that assess for neurological abnormalities. The level of detail of the neurological exam performed in the clinical setting varies with each patient depending on history and symptoms. Patients presenting with neurological deficits, or symptoms of neurological conditions, for example, ...

Do you need a neurological assessment?

Patients presenting with neurological deficits, or symptoms of neurological conditions, for example, may require a complete neurological assessment. Patients presenting for non-neurological complaints may only require a simple assessment of mental status.

What nerve controls the eyeball?

The fourth cranial nerve, the trochlear nerve, innervates the superior oblique muscle of the eyes. This means it controls the downward movement of the eyeball and prevents it from rolling upward. When there is a fourth nerve palsy, patients will often complain of vertical diplopia and/or tilting of objects.

What nerve controls the movement of the eyelid?

The oculomotor nerve controls the majority of the extraocular muscles. It is primarily responsible for eye movement, eyelid movement, and pupillary constriction. If there is any oculomotor nerve impairment, there will be a pupillary dilation, ptosis ( drooping eyelid ), and outward deviation of the eye – termed abduction. When a patient has diplopia (double vision), it is often due to a unilateral lesion on this cranial nerve. In most cases, third nerve palsy resolves over weeks to months.

How to test cranial nerves II and III?

The pupillary light reflex tests both cranial nerves II and III. First, inspect both pupils and make sure they are equal in size and shape. Then dim the lights if possible and shine a penlight directly into the right eye. Both pupils should constrict and maintain symmetry. Note if they are brisk or sluggish and if they are symmetric. Remove the light source and watch both eyes dilate equally as well. Do the same for the left eye.

Why is cranial nerve assessment important?

The cranial nerve assessment is an important part of the neurologic exam, as cranial nerves can often correlate with serious neurologic pathology. This is important for nurses, nurse practitioners, and other medical professionals to know how to test cranial nerves and what cranial nerve assessment abnormalities may indicate.

What nerves are tested for oculomotor nerves?

To test the oculomotor nerve, you need to assess the EOMs. Testing the EOMs also tests cranial nerves IV and VI, as all three nerves are responsible for eye movement.

What nerve is responsible for the sense of smell?

The olfactory nerve is responsible for the sense of smell. Although rarely tested in practice, alterations in smell can be caused by serious intracranial pathology (brain tumors, strokes, TBI), neurodegenerative diseases like Alzheimer’s, Parkinson’s, or MS, or benign and transient causes such as the common cold.

How to test hypoglossal nerve?

How to test the Hypoglossal Nerve. To test the hypoglossal nerve, ask the patient to stick out their tongue. If the tongue deviates to one side , this indicates hypoglossal nerve dysfunction on the side of deviation. Then ask them to move their tongue from side to side rapidly.