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- Olfactory- sense of smell
- First assess patency by occluding a nostril at a time. Then with eyes closed, occlude one nostril and present an aromatic substance.
- Optic- central and peripheral vision
- Test visual acuity by confrontation.
- Occulomotor- Pupilary constriction
- Dim lights, use penlight from side, and slowly bring to center, note response.
- Trochlear- Move eyes down toward tip of nose.
- Instruct patient to follow your finger while you move it down toward his nose
- Trigeminal- Face (forehead, cheek, jaw)
- Check sensation in all three areas with cotton wisp. Use wisp to check corneal reflex-blink bilaterally
- Palpate the temporal and masseter muscles as the person clenches teeth. Try to separate the jaws by pushing down on the chin.
- Abducens- Eye movement to the sides
- Ak patient to look toward each ear. Follow fingers through six cardinal fields of gaze. Observe for nystagmus or twitching.
- Facial- facial movements and expression
- Assess for facial symmetry. Blink, wrinkle forehead, close eyes, smile, puff cheeks, show teeth.
- Whispered voice test, Weber, and Rinne tuning fork tests.
- Glossopharyngeal- phonation and swallowing
- Observe the patient's ability to swallow by noting how he handles secretions.
- Vagus- talking and swallowing
- Ask patient to say Ahhhh. Uvula should be midline and palate should rise.
- Spinal- neck and shoulder movement
- Ask patient to raise shoulders against your hands. Turn head against your hand.
- Hypoglossal- tongue
- Stick out tounge, should be midline. Ask to say "light tight dynamite" and note lingual speech, letters l,t,d,n should be clear and distinct.
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