HA 9-11

need to know angles for movements (flexion etc) + scoliosis markers

CN 1

olfactory

symmetrical recognition of smells

CN 2

optic

visual acuity, vision. snellen and rosenbaum charts.

CN 3

oculomotor. paired 3, 4, and 6

extraocular movements. open eyelids. pupil constriction, lens shape. 6 cardinal positions of gaze/ Diagnostic Positions Test. PERRLA

CN 4

trochlear

down and inward eye movement. 6 cardinal positions of gaze / Diagnostic Positions Test

CN 5

trigeminal

sensation of face, scalp, comea, nose, and mouth mucous membranes. mastication muscles. 3 nerve spots (above eyes, cheeks, and chin). teeth clench test

CN 6

abducens

lateral eye movement. 6 cardinal positions of gaze / Diagnostic Positions Test

CN 7

facial

taste (anterior 2/3 of tongue). facial muscles, close eyes, labial speech (with lips), close mouth, saliva and tear secretion. smile, frown, close eyes, lift brows, show teeth, puff cheeks, check for symmetry.

CN 8

vestibulocochlear or acoustic

hearing and equilibrium/balance. whispered voice test

CN 9

glossopharyngeal. 9 and 10 paired.

posterior 1/3 of tongue. gag reflex. pharynx (phonation and swallowing), parotid gland, carotid reflex. use tongue depressor and see uvula rise on “aah”

CN 10

vagus

sensation of carotid body, sinus, pharynx, and viscera. larynx (talking). carotid reflex. trigger gag reflex, test for smooth voice.

CN 11

spinal accessory

trapezius and sternomastoid muscle movement. rotate head against resistance applied to side of chin. shrug shoulders against resistance

CN 12

hypoglossal

tongue movement. move tongue forward, wiggle side to side. “light, tight, and dynamite” for proper tongue movement

ear anatomy

inspection of ears

size and shape, skin condition, tenderness, external auditory meatus. use otoscope to few inside

abnormal signs of ears

abnormal is cysts, battle signs, low set ears, and cancer. ear angle is >10 degrees.

subjective data with ears in adults

ear pain, infections, discharge, hearing loss, environmental noise, tinnitus, medications, vertigo, cleansing habits

subjective data with ears in children

ear pains, infections, surgeries (tubes, tonsils), discharge, childcare outside of home (bottlefeeding), environmental noises, school health, speech, contact sports

otoscope for adults

pull pinna up and back

otoscope for children

pull pinna down and back

air conduction

most efficient pathway of hearing. sound waves go thru external ear canal, tympanic membrane vibrates (inner ear and cochlea), CN8 interpretation

test using conversation, whispered voice, and audiometry

bone conduction

less efficient pathway of hearing. sounds travel thru bones of skull, causing skull vibration directly on cochlea

test using tuning fork, weber and rinne

presbycusis

gradual sensorineural hearing loss with age. affects 50% of people over 60 and 80% of people over 85.

hearing loss in inner ear

consider social isolation, diminished quality of life, cognitive impairment, and depression. consider hearing aids.

also caused by trauma, bone fracture, tumor, noise, medication ototoxicity, and age

hearing leaves through cochlea hair loss, change of blood vessels, high tone frequency loss, consonant (s, z, cg, sh, f) loss. require shouting. sound localization difficulty.

conductive hearing loss

hearing loss in the outer ear. caused by foreign body, cerumen (wax), otitis externa, perforated tympanic membrane.

hearing loss in outer and middle ear

tuning fork test

for bone conduction test. do not hold vibrating prongs. distinguishes if patient prefers to hear via air conduction or bone conduction. AC should be 2x as long as BC for how long the patient can hear it before they can no longer.

test using weber and rinne

weber - put fork on patient’s head and ask if they hear it equally biliterally

rinne - ask patient when they stop hearing sound behind their ear, then place in front of their ear

audiometry test

for air conduction test. headphones that play different frequencies

whispered voice test

for air conduction. stand 1-2 feet behind patient, cover other ear, whisper words and have patient repeat

sensorineural hearing loss

presbycusis

ROS

range of sight

subjective data for eyes

ask patient difficulty with vision (acuity, blurring, blind spots), eye pain, diplopia (double vision), redness, swelling, watering, discharge, glaucoma, cataracts, strabismus (lazy eye).

ask about current and past eye problems. ask about contacts or glasses and when last eye test was.

cranial nerves for eyes

CN 2 - peripheral vision screening, far and near central vision screening

CN 3 - external ocular, PERRLA

CN 3, 4, 6 - extra-ocular muscle

snellen test

far vision. on the wall

opaque card or occluder. expectation: 20/20

eye anatomy

limbus

border between cornea and sclera

lateral canthus

palpebral fissure

caruncle

medial canthus

sclera

iris

infant hearing test

test within 24 hrs of birth. expected is normal biliteral heaering. lack of hearing can impact speech abilities

ptosis

CN 3 deficit.

ectropian

outward turning of the eyelids. exposes the inner eyelid to air. causes burning, blurry vision, red eyes, red eyelids, and tearing

entropian

inward turning of eyelids. eyelashes may rub against the eyeball.

PERRLA

pupils equal, round, reactive to light and accommodation

accommodation - put finger in the middle of eyes to see if eyes move inward

superior rectus

superior oblique

medial rectus

lateral rectus

inferior oblique

inferior rectus

optic nerve

corneal light reflex

AKA hirschberg test. NOT PUPIL REFLEX. used to test that the light reflects off of the corneas equally. different positions indicate unequal eye sizes and shapes. use this to test for strabismus (lazy eye)

6 cardinal fields of gaze

AKA diagnostic positions test. check that all eye muscles work

50 superior, 90 temporal, 70 inferior, then 60 nasal on covered eye side

strabismus

lazy eye

lymph nodes

remove foreign substances from body. immune system. lymph system brings fluid to the heart, preventing edema.

large or warm lymph nodes are sign of infection

removing lymph nodes from breasts can cause lymphedema

palpable in kids, especially when sick. not palpable in adults

60-70

number of lymph nodes in neck

lymph node documentation

document location, size, mobility, tenderness, and firmness of lymph nodes

sternomastoid

trapezius

omohyoid

anterior triangle

posterior triangle

cricoid cartilage

thyroid cartilage

thyroid gland

subject data for lymph nodes

neck pain, limitation of motion, lumps, swelling, enlarged or tender LNs, energy level, fatigue, goiter, history of neck surgery, history of throat or neck cancer

lymph node inspection

ROM, symmetry, trachea midline, no swelling or enlargement

lymph node palpation

feel lymph nodes and thyroid on neck for swelling

thyroid palpation

periauricular LN

submandibular LN

submental LN

deep cervical chain LN

posterior auricular LN

occipital LN

tonsillar, retropharyngeal, jugulodigastric LN

posterior cervical LN

supraclavicular LN

visual fields

left visual field is left side of each eye

right visual field is right side of each eye

rosenbaum test

near vision test. handheld, 14 inches from eye. expectation: 20/20.

tests for presbyopia, loss of eyes’ ability to focus on nearby objects

visual acuity test

sharpness of vision

cataracts

progressive loss of vision

glaucoma

peripheral loss of vision

macular degeneration

central loss of vision

diabetic retinopathy

general poor vision

types of muscles

skeletal (voluntary), smooth, cardiac

skeletal muscle movements

flexion, extension, abduction, adduction, pronation, supination, eversion, inversion, protraction, retraction, elevation, depression, rotation, circumduction

subjective data collection for musculoskeletal

joints, muscles, bones, functional assessment (ADL), patient-centered care

musculoskeletal inspection

size and contour of joints. skin and tissues above joint. movement, gait, body alignment, involuntary movements

SEE (skin color, edema, equal)

musculoskeletal palpation

skin temperature, muscles, strength and tone, joints

PEET (pain, edema, equal, temperature)

hypertonia

excess muscle tone

hypotonia

minimal muscle tone

active range of motion

AROM

passive range of motion

PROM

support above and below the joint to be moved

muscle strength

the muscle’s ability to contract and create force in response to resistance

upper body: shoulder flexion, elbow flexion and extension, hand grip strength

lower body: hip extension, knee extension, ankle dorsiflexion and plantarflexion

muscle tone

tension in a muscle at rest

shoulder flexion

180 flexion, 50 extension

elbow flexion and extension

0 extension. 160 flexion

elbow supination and pronation

supination: 90 thumb moves outwards.

pronation: 90 thumb moves inwards

grip strength