Lecture 4 Chapter 15 Nancy Sanderson MSN RN Concept Overview Intracranial regulation Mechanisms that facilitate or impair neurologic function Interrelationships Brain requires oxygenation ID: 240086
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NRS 103 Neurological SystemLecture 4 Chapter 15
Nancy Sanderson MSN, RNSlide2
Concept Overview
Intracranial regulation:Mechanisms that facilitate or impair neurologic function.Interrelationships: Brain requires oxygenation.
Respiratory and cardiovascular systems impacted by neurologic control.
Extensions of neurologic function:
Sensory perception.Tactile perception.
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
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Anatomy and Physiology
Nervous system controls body functions through voluntary and autonomic responses to external and internal stimuli.
Structural divisions of nervous system are:
Central nervous system (CNS), which consists of brain and spinal cord
Peripheral nervous systemAutonomic nervous system
Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
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Copyright © 2013 by Mosby, an imprint of Elsevier Inc.
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Cranial Nerve I – Old Factory
Not routinely testedTest with:
Report of smell
Head trauma
Abnormal mental status
Suspected intracranial lesion (tumor)Sensory function:
With eyes closed occlude nares and present aromatic substance
Patient able to correctly identify aromatic substanceSlide6
Cranial Nerve II – Optic nerve
Sensory Function-:Visual Acuity: Snellen Chart-
L-20/20, R 20/15, B 20/15.
Visual fields
: intact, PERRLAAssess optic disc: color, shape:
optic disc creamy yellow, round with distinct margins.Slide7
Cranial nerve iii,iv,vi Motor Function
CNVI-
abducens
- innervates the lateral rectus muscle for lateral movement. Abducts the eye.
CNVI-trochlear- innervates the superior oblique muscles moving the eye down and in. CNIII- ocular motor- innervates all the rest of the eye moving superior, inferior, medial, rectus and the inferior oblique muscles.Slide8
Cranial Nerve v:trigeminal
Motor Function: Palpate temporal and masseter muscles as patient clenches teeth.
Try to separate jaw by pushing down on chin.
Jaw strength equal bilaterally.Sensory
Function Test light sensation with cotton ball over: forehead (ophthalmic); Cheeks (maxillary); Chin ( mandibular).
Sensation intact and equal bilaterally.Slide9
Cranial Nerve vii
Motor Function:Smile, frown, puff cheeks, smile, show teeth.
Facial muscles intact & symmetrical.
Sensory Function:
Not tested routinely- tested only is suspect facial nerve damage.
Taste on anterior 2/3 tongue with cotton applicator with salt, sugar, and lemon Sweet, sour, bitter.
Patient able to identify sweet, sour and bitter.Slide10Slide11
Cranial Nerve vii
Corneal Reflex:
Only perform if patient is unconscious or with abnormal facial sensation or movement.
Remove contact lenses if in place.
Lightly touch cornea with wisp of cotton from side, the lids of both eyes blink when the cornea is touched. This test the sensory of reception of the ophthalmic (afferent) branch CNV & the motor branch (efferent) of CNVII which creates the blink.
Corneal Reflex intact.Slide12
Cranial Nerve vii acoustic
AKA: Vestibulocochlear NerveSensory function
Assess hearing acuity: Ability to hear normal conversation
Whisper voice test – Whisper words heard bilaterally
Weber tuning fork test- tone heard midline equally in both ears
Rinne test is to assess hearing by comparing air conduction(AC) of sound to bone conduction(BC) of sound. AC>BC,\.
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Cranial Nerve ix and x
CN IX GlossopharyngealCH X Vagus
Motor function:
Swallow-
swallowing intactDepress with tongue blade & note pharyngeal movement as patient says, “
ahhh”. Uvula rises and falls midline with phonation.
Touch posterior wall to illicit gag reflex.
Gag reflex intact.
Note sound of voice.
Sensory function Taste posterior 1/3 of tongue : not routinely tested.Slide14
Cranial Nerve xi - Spinal accessory
Motor Function:Rotate head against resistance
Shrug shoulders against resistance
Shoulder shrug and head intact and equal bilaterally.Slide15
Cranial nerve xii – hypoglossal
Motor functionHave patient protrude u\observe tongue for tremors and wasting
Is tongue midline
Tongue protrudes midline without tremors.Say light tight dynamite
Note if the words are clear and distinct. Light, tight and dynamite are clear and distinct.