HEENT assesments

Bell’s pasly is damage to what? and a CVA (stroke) is damage to what?

CN 7; blood clot in brain

Bell’s palsy is damage to CN 7, how does this happen?

A viral infection

Which condition is this a CVA or Bell’s Palsy?

Lower facial droop (only on cheeks, chin, & mouth) , & wrinkles on forehead when eyebrows raise

stroke

Which conditoon is this? CVA or Bell’s palsy?

Lower & upper facial droop:  where eyebrows & palpebral fissures come down. There are NO present WRINKLES on the forehead (bc patient can’t raise eyebrows) 

bell’s palsy

What are 2 eye test to do on a patient to asses their eyes?

Snellen chart or Rosenbaum, & Hirschberg,

What is the name of this eye assessment? (What is another term for this test when performed at arm's length?)

The patient stands 20 feet away, closes one eye, and reads the smallest line they can. Then, the patient switches to the other eye and reads the same line again. Finally, both eyes are tested together, ensuring there is no squinting, leaning, or tilting of the head.

snellen chart (rosenbaum) 

What is the purpose of the Hirschberg corneal-light reflex test?

To see if your extraocular muscles are intact

What eye assessment is this?

patient stares across the room, nurse shines pen light @ the bridge of nose & BOTH eyes are symmetrical 

Hirschberg test 

if you preform the Hirschberg corneal-light reflex test and ONE eye is not symmetrical with the other, what do you do next?

uncover & cover test

How do you preform the cover & uncover test? (2 steps)

cover one patients eye then uncover it, repeat it

the eye that is MOVING after being uncovered is the weak eye muscle 

What is the ear test we do?  what does entail?

Whisper test- stand behind patient and whisper 4 words to them. Having them repeat them back to you 

In the whisper test, assessing a patient’s hearing, how many words must they recall to indicate hearing is intact? How many do they recall to indicate hearing loss

2 or 3 more = hearing is intact

1 or none = hearing lsos

When assesing the nose what do you look for as a nurse?

Discharge

Clear nasal discharge indicates?

allergies

Yellow or green nasal discharge indicates?

sinus infiection

A bloody nose is also called what? and indicates what?

(apitaxis) tramua or picking it too much

foul smelling discharge indicates?

forgien object in the nose

how do you test patient’s nasal opening?

Have pt occulde one nostril and breathe through it. then repeat for other