cranial nerves

General Survey

Inspect overall appearance, hygiene, posture, gross deformities, and general well-being.

Orientation Assessment (AAOx3/4)

Ask patient name, location, date/year, and situation to assess level of consciousness and cognition.

Vital Signs Assessment

Measure temperature, blood pressure, heart rate, respiratory rate, oxygen saturation, and pain rating.

CN I - Olfactory Test

Ask patient to close eyes, occlude one nostril at a time, and identify familiar scents (e.g., coffee, alcohol).

Olfactory(sensory)

test for smell; Question the patient concerning any difficulties with smelling.

Eyes closed, occlude one nostril, identify familiar scent. cn 1-grossly intact

CN II - Optic Test

Assess visual acuity (finger count), visual fields by confrontation, color identification, and focus on near/far objects.

CN III - Oculomotor Test

Inspect pupils using penlight for size (3-7 mm), equality, and reaction to light and accommodation (PERRLA).

CN IV - Trochlear Test

Ask patient to follow penlight downward and inward.

CN VI - Abducens Test

Ask patient to move eyes laterally (side to side).

CN V - Trigeminal Test

Test facial sensation using sharp/dull; palpate TMJ while patient opens/closes mouth and moves jaw side-to-side.

CN VII - Facial Test

Ask patient to smile, frown, raise eyebrows, puff cheeks, and identify anterior taste (sweet/salty).

CN VIII - Vestibulocochlear Test

Perform whisper test to assess hearing.

CN IX - Glossopharyngeal Test

Observe throat and swallowing; assess posterior taste (bitter).

CN X - Vagus Test

Ask patient to say 'ahh,' observe uvula rise, assess speech and cough.

CN XI - Spinal Accessory Test

Ask patient to shrug shoulders and turn head against resistance.

CN XII - Hypoglossal Test

Ask patient to protrude tongue, move it side-to-side/up/down, press tongue against cheek, and say 'D-L-N-I.'

Head & Scalp Assessment

Inspect and palpate head for size, shape, lesions, tenderness, masses, lice, and dandruff.

Facial Inspection

Inspect facial symmetry, movement, rashes, inflammation, or lesions.

Eye Inspection

Inspect eyelids, eyebrows, conjunctiva, sclera, pupil size, and alignment.

PERRLA Assessment

Use penlight to assess pupil equality, roundness, and reaction to light and accommodation.

Ear Inspection

Inspect ear alignment, symmetry, and angle; palpate for tenderness or masses.

Internal Ear Inspection

Inspect ear canal with penlight for cerumen, cilia, redness, swelling, or discharge.

Nose Inspection

Inspect each nostril with penlight for patency, drainage, masses, and septal deviation.

Sinus Palpation

Palpate frontal and maxillary sinuses for tenderness or swelling.

Mouth & Throat Inspection

Inspect lips, mucosa, gums, tongue, teeth, tonsils, and moisture using penlight and tongue blade.

Lymph Node Assessment

Palpate cervical lymph nodes for size, tenderness, mobility, and swelling.

Tracheal Position Check

Palpate trachea to ensure it is midline.

Thyroid Palpation

Palpate thyroid while patient swallows to assess for enlargement or nodules.

Carotid Pulse Assessment

Palpate carotid pulses one side at a time and assess strength (0-4+).

Carotid Auscultation

Auscultate carotid arteries with bell while patient holds breath to assess for bruits.

Jugular Venous Distention (JVD)

Position patient supine at 30-45°, inspect neck veins using penlight.

Chest Inspection

Inspect chest for symmetry, lesions, scars, masses, and shape.

Chest Palpation

Palpate chest using dorsum of hand for temperature and tenderness; assess turgor.

Chest Excursion

Place hands on posterior chest and assess symmetrical expansion during deep inhalation.

Lung Auscultation

Auscultate anterior, lateral, and posterior lung fields using diaphragm in a stepladder pattern.

Adventitious Sound Assessment

Identify abnormal lung sounds such as crackles, wheezes, or rhonchi.

Heart Auscultation

Auscultate five cardiac valve areas using diaphragm and bell.

Apical Pulse Assessment

Auscultate apical pulse at 5th intercostal space, midclavicular line, for one full minute.

Capillary Refill Test

Press nail beds and observe refill time (normal ≤ 2-3 seconds).

Peripheral Pulse Assessment

Palpate and/or auscultate aortic, renal, iliac, and femoral pulses bilaterally.

Abdominal Inspection

Inspect abdomen for symmetry, scars, lesions, distention, and shape.

Abdominal Auscultation

Auscultate bowel sounds in all four quadrants using diaphragm before palpation.

Vascular Abdominal Auscultation

Auscultate abdominal aorta and renal/iliac arteries using bell.

Abdominal Palpation

Palpate lightly for tenderness, masses, and distention.

Upper Extremity Inspection

Inspect arms, hands, and nails for symmetry, lesions, edema, deformities, and nail abnormalities.

Upper Extremity Palpation

Palpate skin temperature, pulses (radial, ulnar, brachial), and assess capillary refill.

Upper Extremity Strength Test

Test hand grips and arm resistance against push/pull movements.

Lower Extremity Inspection

Inspect legs and feet for symmetry, lesions, edema, varicose veins, and nail condition.

Lower Extremity Palpation

Palpate skin temperature, pulses (femoral, popliteal, posterior tibial, dorsalis pedis), and assess edema.

Lower Extremity Strength Test

Test leg strength by resistance, dorsiflexion, plantarflexion, and side-to-side movement.

Back Inspection

Inspect back for scars, lesions, masses, and spinal alignment.

Spinal Palpation

Palpate spinal processes for tenderness or deformities.

Gait Assessment

Observe patient walking for balance, posture, and coordination.

Safety Check Before Exit

Lower bed, raise side rails, lock brakes, ensure call light and belongings are within reach.