Cranial Nerves

Cranial Nerve I Olfactory

Function Smell reception and interpretation Visual acuity and fields

Method Ask client to close eyes and identify different mild aromas such alcohol, powder and vinegar. Ask client to read newsprint and determine objects about 20 ft. away Assess ocular movements and pupil reaction

Normal Findings Client should be able to distinguish different smells

II

Optic

Client should be able to read newsprint and determine far objects

III

Oculomotor

IV V

Trochlear Trigeminal

Extraocular eye movements, lid elevation, papillary constrictions lens shape Downward and inward eye movement Sensation of face, scalp, cornea, and oral and nasal mucous membranes. Chewing movements of the jaw

Client should be able to exhibit normal EOM and normal reaction of pupils to light and accommodation Client should be able to move eyeballs obliquely Client blinks whenever sclera is lightly touched; able to feel the wisp of cotton over the area touched; able to discriminate blunt and sharp stimuli

Ask client to move eyeballs obliquely Elicit blink reflex by lightly touching lateral sclera; to test sensation, wipe a wisp of cotton over clients forehead for light sensation and use alternating blunt and sharp ends of safety pin to test deep sensation

Assess skin sensation as of ophthalmic branch above

Ask client to clench teeth

Client is able to sense and distinguish different stimuli Client should be able to clench teeth Client should be able to move eyeballs laterally Client should be able to do different facial expressions

VI VII

Abducens Facial

Lateral eye movement Taste on anterior 2/3 of

Ask client to move eyeball laterally Ask client to do different facial expressions such

the tongue Facial movement, eye closure, labial speech VIII Acoustic Hearing and balance Taste on posterior 1/3 of tongue, pharyngeal gag reflex, sensation from the eardrum and ear canal. Swallowing and phonation muscles of the pharynx Sensation from pharynx, viscera, carotid body and carotid sinus Trapezius and sternocledoma stoid muscle movement Tongue movement for speech, sound articulation and swallowing

IX

Glossophary ngeal

as smiling, frowning and raising of eyebrows; ask client to identify various tastes placed on the tip and sides of the mouth: sugar, salt and coffee Assess clients ability to hear loud and soft spoken words; do the watch tick test Apply taste on posterior tongue for identification (sugar, salt and coffee); ask client to move tongue from side to side and up and down; ask client to swallow and elicit gag reflex through sticking a clean tongue depressor into clients mouth Ask client to swallow; assess clients speech for hoarseness Ask client to shrug shoulders and turn head from side to side against resistance from nurses hands Ask client to protrude tongue at midline, then move it side to side

such as smiling, frowning and raising of eyebrows; able to identify different tastes such as sweet, salty and bitter taste Client should be able to hear loud and soft spoken words; able to hear ticking of watch on both ears Client should be able to identify different tastes such as sweet, salty and bitter taste; able to move tongue from side to side and up and down; able to swallow without difficulty, with (+) gag reflex

Vagus

Client should be able to swallow without difficulty; has absence of hoarseness in speech Client should be able to shrug shoulders and turn head from side to side against resistance from nurses hands Client should be able to protrude tongue at midline and move it side to side

XI

Spinal accessory

XII

Hypoglossal

Painful Stimuli If your patient does not respond to tactile stimuli, you will have to resort to painful stimuli. These are acceptable and unacceptable ways to elicit a response to pain. Never perform a nipple twist. Avoid using a pin or needle, because if the skin breaks, you risk infection. Also remember to rotate sites- repeated stimulation at the same site may cause bruising. Painful stimuli may be central or peripheral. Central painful stimuli includes: 1. Trapezius squeeze- pinch 1 to 2 inches of the trapezius muscle and twist.

2. Sterna rub- with the knuckles or the palm of your dominant hand, apply pressure in a grinding motion to the sternum. Do not use this site repeatedly because it will cause bruising. 3. Supraorbital pressure- apply firm pressure with your thumbs at the notch at the center of the orbital rim below the eyebrows. Because a never runs in the notch, pressure to this area will cause sinus pain. Use this stimulus carefully to avoid damage to the eyes. 4. Mandibular pressure- with your index and middle finger, apply inward and upward pressure at the angle of the jaw. Peripheral Painful Stimuli: 1. Nail pressure- apply pressure over the moon of the nail with a pen or pencil. 2. Achilles tendon squeeze- squeeze the Achilles tendon between your thumb and your index finger.

The stimulus should be applied for 15 to 30 seconds. Language and Copying- Listen to patients rate and ease of speech, including enunciation. Spontaneous Speech Show patient a picture and have him or her describe what he or she sees.

Motor Speech Have patient repeat, do, ray, me, fa, so, la, ti, do. Automatic Speech Have patient say something that is committed to memory, such as days of week or months of year.

Sound Recognition have patient close eyes and identify familiar sound such as clapping sounds.

Auditory-Visual Comprehension have patient to follow simple directions or explain meaning of a series of words.