this is Sarah with register nurse rn.com and in this video I'm going to be going over a nursing assessment of the cranial nerves cranial nerves 1 through 12 and if you would like to watch a complete head-to-toe nursing assessment you can access this card up here in the corner or in the YouTube description below to watch that video so the first thing what you want to do is you want to provide privacy to the patient perform hand hygiene and explain what you will be doing so let's get started we're going to test the olive Factory cranium nerve one the sense of smell so Ben what I'm going to have you do is I'm going to have you close your eyes and I'm going to put something in front of your nose and have you breathe in and smell and you tell me what you smell and whenever you do this use something that's Pleasant smelling not something that's really stinky because it could elicit like a gag reflex or something like that if the person has a sensitive nose Okay vanilla okay and this was vanilla extract and that is correct so that cranial nerve is is intact to test cranial nerve 2 you're going to be doing two tests number one you're going to look at the confrontation visual field and you're going to be looking at their peripheral vision next you'll be looking at visual Acuity and using a smelling chart to assess that first we're going to test the peripheral vision by doing the confrontation visual fill test and to do that you're going to have the patient stand in front of you about arms length away okay Ben what I'm going to have you do is I'm going to have you cover up your right eye and I'm also going to cover up my left eye so on the same side and B I want you to look at this eye and don't look at my fingers okay and I just want you to tell me how many fingers you see and you're going to do this in the upper and lower visual fields in about the middle of the visual field so here we go two correct three very good okay let's do it on the opposite again stare at this eye okay and don't look at my fingers three one very good now we're going to test visual Acy using a Snelling chart and what you're going to do is you're going to have your patient stand about 20 feet from the chart so Ben if you'll stand about right there for me and ask your patient do you wear glasses no okay and if your patient does wear glasses you'll want them to wear those for this test okay so what we're going to do look at that chart over there and try to read the lowest line for me that you can read okay okay and first we're going to cover your right eye then your left eye and then we'll do both eyes Okay so cover your right eye okay and what line can you read eight okay read it for me d e f p o t e c okay very good okay now we're going to cover up your left eye and do the same thing and again whatever line you can read let me know eight eight again okay d e f p o t e c okay and now read with both eyes and what line a okay d e f p o t e c okay and he read from line eight so that means that he has 2020 vision and this means that he can see the same line of letters at 20 feet that a person with normal vision can see at 20 feet however let's say that in his left eye he could only read like line six which is 2030 that would mean that his left eye sees at 20 ft that a person with normal vision would see at 30 next what we're going to do is we're going to assess cranial nerve three which is ocular motor four tular and then six which is abducent and we're going to do several tests to check their function the first one what we're going to do is we're going to be looking for any involuntary shaking of the eye called nagas and how we're going to do that is we're going to take our pin light we're going to hold it about 12 to 14 inches away from the patient's nose and Ben what I want you to do is keep your head still don't move your head and just use your eyes to watch where I move the pin light and as you're doing this you're going to do you're going to perform it in the six cardinal fields of gaze and and you're just going to move it and you're looking for any involuntary shaking of the eyes so here we go next we're going to see how reactive the pupils are to lie and to do that we're going to dim the lights a little bit and we're going to have the patient stare off at a distant object that helps dilate those pupils and then we're going to shine using our pin light in at the side and we're going to see how that pupil responds it should constrict and then on the other side it should constrict as well so say their Baseline pupil size was like 3 millim it should go down to 1 ml and it should happen on both sides okay so B stare off at that object right on the wall over there for me okay and that dilates the peoples and we're just going to shine light in at the side okay okay constrict constrict okay let dilate again then go to the other side do the same again and they both constricted in equal size next what we're going to do is we're going to check for accommodation and how we do that is we turn the lights back on we just previously had them dim but we now make it light again we're going to have him stare off at a distant object that helps dilate the pupils and we're going to take a pin light you can use a pin light finger and you're just going to slowly move it inward to the nose and what you're looking for is that those pupil's constrict they accommodate and the eyes cross while looking at the pin light so here we go stare off in the distance please and I don't want you to move your head or anything just keep it real still and just follow this pin light okay ready okay so now we can document cuz we just checked all of the things with the eyes we can document that the pupils are equal round reactive to lie and accomodate so that's where that acronym p e r r l a comes into play we're going to go ahead and test cranial nerve five which is the trigeminal nerve and this nerve is responsible for many things like mastication so what I'm going to have you do B is I'm going to have you clinch your teeth like bite down for me and I'm going to feel the Meer muscle which is right there and it should be a nice firm ball and then feel the temporal muscle now what I'm going to do to also test that nerve is have him try to open his mouth against resistance so try to do that for me okay and he can do that and while we're here we're going to go ahead and look at the facial expressions and test cranial nerve 7even which is the facial nerve so can you close your eyes tightly for me and open them up okay now smile for me friend and puff out your cheeks okay and he did that with e so that cranial nerve is intact next we're going to test cranial nerve eight which is the vestibulo cular nerve and what I'm going to do is I'm going to include one of his ears and then whisper two words on the other side he needs to tell me what I said so you ready mm okay I'm going to include this one apple banana apple banana okay very good cat dog cat dog okay and that nerve is intact next what we're going to do is we're going to assess cranial nerve nine the glosso faren gel so what I'm going to do is I'm going to have you say ah and what you want is that uela to move up ah okay and then we're just going to test the gag reflex I'm sort of just going to poke a little bit back there and elicit a gag CL okay there you go gags really good and um cranial nerve 10 the Vegas is intact because he's able to talk with talk to me without heness and he's able to swallow then what we're going to do is we're going to test cranial nerve 11 which is the accessory nerve so being what I'm going to have you do is move your head side to side up and down okay and then shrug try to shrug against my resistance and he does that with ease so that nerve is intact next what we're going to do is we're going to a cranial nerve 12 which is the hypo glossal nerve and what I'm going to have you do Ben is I'm going to have you stick out your tongue and move it side to side okay and he does that with ease okay so that wraps up how to perform a nursing assessment of the cranial nerves and don't forget to check out that head to toe nursing assessment video thank you so much for watching and don't forget to subscribe to our channel for more videos