1b Health Assessment

What cranial nerves are important for the eyes?

CN II = optic/vision
CN III = oculomotor
CN IV = trochlear
CN VI = abducens
III, IV, VI control extraocular eye movements.

What is the visual pathway?

Cornea → pupil → lens → retina → optic nerve (CN II) → occipital lobe/visual cortex.

What do rods and cones do?

Retina receptors that convert light into nerve signals.

5 Important abnormal eye symptoms?

Diplopia = double vision
Scotoma = area of vision loss
Strabismus = eye misalignment
Photophobia = light sensitivity
Also: blurred vision, redness, pain, discharge.

3 Major eye disorders to know?

Glaucoma = optic nerve damage, often related to ↑ eye pressure
Cataract = cloudy/opaque lens
Conjunctivitis = inflammation/infection ("pink eye

What should normal pupils look like?

Equal, round, about 3–5 mm.
Difference between pupils should be <1 mm.

What is PERRLA?

Pupils Equal, Round, Reactive to Light, and Accommodation.

Direct vs. consensual light reflex?

Direct = illuminated pupil constricts.
Consensual = opposite pupil also constricts.

What is accommodation?

Eyes adjust from far → near; pupils constrict + eyes converge.

What does the Snellen chart test?

Distance visual acuity.
Patient stands 20 ft away, covers one eye, then the other.

What does the Rosenbaum/Jaeger card test?

Near vision; held about 14 inches from the eyes.

What is presbyopia?

Age-related difficulty seeing objects up close.

What does the confrontation test assess?

Peripheral visual fields.

What is hemianopsia?

Loss of half of the visual field.

What does the corneal light reflex test?

Eye alignment.
Normal = light reflection is in the same position in both pupils.

How are extraocular movements tested?

Cardinal fields of gaze — patient follows finger/pen without moving head.

Normal extraocular movement?

Smooth, parallel, coordinated.

What is nystagmus?

Involuntary rhythmic eye movement → abnormal.

Normal aging changes of the eyes?

↓ pupil size
↓ lens elasticity → presbyopia
Lens thickens/yellows → cataracts may develop
↓ night vision

What cranial nerve controls hearing?

CN VIII = vestibulocochlear/acoustic nerve. Nurs2144 Week 6 Lecture - EENT

Important ear symptoms?

Hearing loss
Earache
Discharge
Tinnitus = ringing
Vertigo = spinning sensation

What should you inspect on the ear?

Pinna/auricle, canal, redness, swelling, lesions, discharge, cerumen.

What can pain when moving the pinna/tragus indicate?

Otitis externa.

How is the whisper test performed?

Test one ear at a time → occlude other ear → whisper 3 letters/numbers → patient repeats them.

Conductive hearing loss?

Problem in outer/middle ear preventing sound transmission.

Sensorineural hearing loss?

Problem in inner ear or CN VIII, often causing difficulty understanding speech.

What does the Weber test assess?

Lateralization of sound.
Normal = sound heard equally in both ears.
Sensorineural loss = sound heard better in the good ear.

What does the Rinne test compare?

Air conduction (AC) vs. bone conduction (BC).

Normal Rinne result?

AC > BC

Rinne with conductive hearing loss?

BC ≥ AC

Rinne with sensorineural hearing loss?

AC > BC, but hearing is decreased.

What is bone conduction?

Sound vibrations travel through bone directly to the inner ear, bypassing the outer/middle ear.

What cranial nerve controls smell?

CN I = olfactory.

Important nasal terms?

Rhinorrhea = nasal discharge
Epistaxis = nosebleed

Normal nasal mucosa?

Pink and moist, without ulcers or polyps.

How do you test nasal patency?

Close one nostril at a time and have patient inhale.
Both nares should be patent (open).

How are the sinuses assessed?

Palpate frontal and maxillary sinuses.
Pain/tenderness may indicate sinusitis.

Important cranial nerves for mouth/throat?

CN IX = glossopharyngeal
CN X = vagus
CN XII = hypoglossal

What does saying "ah" assess?

Soft palate and uvula movement.
Normal = symmetrical rise; associated with CN X.

Normal oral mucosa?

Pink and moist.

What abnormal mouth/throat findings should be noted?

Exudate, swelling, ulcers, enlarged tonsils, abnormal color, dry mucosa.

Tonsil grading?

+1 = visible
+2 = between pillars and uvula
+3 = touching uvula
+4 = tonsils touching each other

What does the gag reflex test?

CN IX + CN X.

How do you test CN XII?

Ask patient to stick out tongue.
Normal = tongue protrudes midline.

What might dry oral mucosa indicate?

Dehydration.