exam 2 Flashcards
Understand the names, functions and assessments of the following cranial nerves: CN III
CN III - oculomotor nerve - controls most eye movement. Motor function to elevate the eye, depress the eye, adduct the eye, elevate and abduct the eye, helps to constrict the pupils, and helps with eye accommodation. Also serves parasympathetic functions like pupil constriction and lens accommodation. You can assess it by testing for pupillary response (direct light reflex and accommodation reflex), asking the client to follow your eye movement, looking for drooping of the eyes.
Understand the names, functions and assessments of the following cranial nerves: CN IV
CN IV - trochlear nerve -> the smallest nerve and has primarily motor function. Downward and lateral movement of the eye, depression of the eye. Can assess it by checking for double vision, check eye movement by asking them to follow your fingers (look for abduction and adduction), look for a presence of a head tilt, look for presence of a vertical deviation (misalignment of the eyes)
Understand the names, functions and assessments of the following cranial nerves: CN V
CN V - trigeminal nerve -> the largest cranial nerve and has sensory and motor functions. Sensory - the ophthalmic branch (forehead, scalp, upper eyelid, and cornea), the maxillary branch (cheeks, upper lip, nasal cavity, upper teeth), mandibular branch (sensation from the lower lip, chin, jaw, and lower teeth). Motor function -> controls chewing; masseter, temporalis, medial pterygoid, lateral pterygoid. Can assess by light touches testing for sensation, a gentle pinprick checking for sensation, checking temperature sensation, checking the corneal reflexes. For testing motor reflexes test jaw movement, jaw opening, and jaw reflexes.
Understand the names, functions and assessments of the following cranial nerves: CN VI
CN VI - abducens nerve -> primarily a motor function nerve. Controls the lateral rectus muscle of the eye, and is responsible for abduction. Can be tested by testing lateral eye movement, if the eye turns inward, if the person experiences double vision.
Understand the names, functions and assessments of the following cranial nerves: CN XI
CN XI - accessory nerve -> controls specific muscles involved in head and shoulder movement. Contributes to motor innervation of the larynx, pharynx, and soft palate with help from the vagus nerve. Helps with motor innervation of the sternocleidomastoid and the trapezius
What hormones are secreted by the thyroid gland?
T4 -> thyroxine which is the main hormone secreted by the thyroid gland, crucial in regulating metabolism, growth, and development.
T3 -> triiodothyronine which helps regulate metabolism, increases the rate of cellular processes, and affects the cardiovascular and nervous system.
What is the difference in assessment findings between the different types of headaches?
o Cluster
occurring in cyclical “clusters” with periods of remission in between
- typically characterized by an extremely severe, stabbing pain usually around one eye and is typically the most intense type of headache. Cluster headaches may include watery eyes, nasal congestion, and restlessness. They tend to to occur in short but intense bursts of time lasting for a few hours
What is the difference in assessment findings between the different types of headaches?
o Migraine
o Migraine - unilateral, pulsating pain on one side of the head, moderate to severe intensity, aggravated by physical activity, accompanied by nausea, vomiting, sensitivity to light (photophobia), and sound (phonophobia), and may also present with prodromal symptoms like mood changes, fatigue, or food cravings before the headache onset;
- tend to last several hours to several days
What is the difference in assessment findings between the different types of headaches?
o Tension
o Tension - bilateral, pressing or tightening pain around the head, often described as a band-like sensation, mild to moderate intensity, tenderness in the scalp and neck muscles upon palpation, the pain may be located in the forehead, temples, or back of the head, and is usually not worsened by physical activity
- tend to last for a long period of time but are not typically very severe
What is meningitis? What are the characteristic findings of meningitis?
Meningitis is an inflammation of the membranes that surround the brain and the spinal cord.
Some symptoms include fever, chills, vomiting, headache and sensitivity to light, stiff neck, confusion and altered mental status, rash, limb pain, pale skin, cold hands and feet. Some causes can be fungal infections, viral infections, bacterial infections, parasites, injuries, cancers, certain drugs
What is the temporomandibular joint? How would you assess it on a patient?
This is the point that connects the lower jaw to the temporal bone of the skull, which is located in front of the ear. To assess it you would palpate the joint area while having the patient perform jaw movements and listening for clicking or popping sounds. You should also be checking for tenderness or pain, along with assessing range of motion.
- is inferior to the temporal artery and next to the ear
What is a bruit? In what two areas/circumstances (that we have discussed in class) might you auscultate for one? (think neck/vascular assessment) How do you auscultate for one in each of these areas?
Bruit is a whooshing sound that is heard with a stethoscope, it indicates that there is turbulent blood flow within an artery, and most likely a partial obstruction or narrowing of a vessel.
In a clinical setting you would typically assess these in the neck on the carotid arteries and in the abdomen over the aorta, these are looking for potential carotid issues, and a possible aneurysm respectively.
For the carotid, have the person turn their head away from you and place the bell side of the stethoscope over the carotid listening while they hold their breath. For aorta, have them lay in a supine position and place the bell of the stethoscope moving from the epigastric to the umbilic region.
What’re the differences between Bell’s Palsy and a Cerebrovascular Accident (CVA/Stroke)?
Bell’s Palsy is usually weakness or paralysis of one side of the face and is typically caused by inflammation of the facial nerve. Can cause drooping, weakness, or paralysis of one side of the face.
A stroke is typically caused by disruption of blood flow to the brain, often due to a blood clot or bleeding. Can affect one of both sides of the face, can cause weakness, numbness, or paralysis in the face, arm or leg. Stroke is an emergency
What is the correct technique to assess lymph nodes in the head/neck? What’re normal vs abnormal findings with lymph nodes?
To assess lymph nodes in the head and neck, use gentle, circular motions with your fingertips to palpate along the predictable drainage pathways, comparing both sides simultaneously, noting size, consistency, mobility, and tenderness; normal lymph nodes are small, moveable, and not palpable, while abnormal findings include enlarged, firm, fixed nodes, or noticeable asymmetry between sides
what does PERRLA stand for
PERRLA -> pupils equal, round, reacting to light, and accommodating
the types of light reflex tests
Direct light reflex - darken the room and ask them to gaze into the distance to let the pupils dilate, advance a light in from the side and note the response. Normally there will be a constriction of the same-sided pupil, and simultaneous constriction of the other pupil.
Consensual light reflex -> The consensual light reflex is the automatic constriction of the pupil in the eye opposite the one that’s being directly stimulated by light. This reflex helps protect the retina from bright light. Consensual is tested the same way as direct, but is specifically looking at what the other eye will do.
how to interpret a snellen eye chart
A “20/40” result on a Snellen eye chart means that you can see at 20 feet what a person with normal vision can see at 40 feet away; essentially, your vision is slightly less sharp than “normal” vision (20/20), requiring you to be closer to an object to see it clearly compared to someone with typical eyesight.
how to explain the snellen eye chart results to a patient
“Your vision is currently measured as 20/40, which means that you can see at 20 feet what most people can see from 40 feet away.”
“This indicates slightly reduced visual acuity, so you may need corrective lenses to improve your vision.”
“Think of it like this: if you are standing 20 feet away from the eye chart, you can read the same line that someone with normal vision could read if they were standing 40 feet away”
What is another name for ear wax and what purpose does it serve?
Cerumen - Cerumen, also known as earwax, serves the purpose of protecting and lubricating the ear canal by trapping dust, dirt, and bacteria, preventing them from reaching the eardrum, while also acting as a barrier against water and creating an acidic environment that inhibits the growth of harmful microorganisms.
What is the difference between the techniques in assessing an adult’s ear vs a child?
Adults have an S shaped canal so you have to pull the pinna up and back, for infants and children under 3 you must pull the pinna down. Make sure to hold the pinna gently but also firmly and make sure the head is slightly tilted away from you
What are normal assessment findings of the ear when using an otoscope?
The ear canal should be skin-colored but will likely have some hairs and a little cerumen. The eardrum should be a light-gray or pearly-white color and translucent and flat. The eardrum should move in and out. There should be light that reflects off of the eardrum
What might different types of drainage from the ear indicate?
Bright-red blood or watery drainage following a trauma can indicate a fracture to the base of the skull. Redness, edema, purulent, or crusty drainage of the ear canal can indicate an infection. Discharge that is yellow, green, or has dried to a crust can indicate an infection or the presence of a foreign body.
When assessing an older adult, what changes would be expected regarding their ears or nose?
May start to see age related hearing loss which is referred to as presbycusis, may decline in ability to hear high-frequency sounds.
With the nose you may see loss in elasticity, loss of collagen, decrease in bone density, change in appearance of the nose, loss of ability to smell.
Technique for trying to control epistaxis (nosebleed)?
The best way to stop a nosebleed is to sit up, lean forward, and pinch the nose
apply direct pressure by pinching the soft part of your nose between your thumb and index finger while leaning slightly forward, breathing through your mouth, and maintaining pressure for at least 10 minutes
