Cranial Nerves
This nerve is responsible for smell reception and interpretation
What is the olfactory nerve, CN I
These sensory functions diminish in older adults.
What is taste, smell and vision?
This is done to assess several sites of the foot in all patients with diabetes and peripheral neuropathy.
What is the monofilament test to assess sensation?
These are risk factors for a stroke.
What are:
Hypertension
• Obesity
• Sedentary lifestyle
• Smoking tobacco products
• Stress
• Increased levels of serum cholesterol, lipoproteins, and triglycerides
• Use of oral contraceptives
• Sickle cell disease
• Family history of diabetes mellitus, cardiovascular disease, hypertension, and increased serum cholesterol levels
• Congenital cerebrovascular anomalies
Fever, a stiff neck, and altered mental status are the classic signs of this diagnosis.
What is acute meningitis?
This nerve is responsible for lateral eye movement.
What is the Abducens CN VI?
These 3 fall screening questions should be asked to assess fall risk.
What is:
- Have you fallen in the past year?
• Do you feel unsteady when standing or walking?
• Do you worry about falling?
Flex the patient’s arm to 45 degrees at the elbow. Palpate the biceps tendon in the antecubital fossa. Place your thumb over the tendon and your fingers under the elbow. Strike your thumb, rather than the tendon directly, with the reflex hammer. Contraction of the biceps muscle causes visible or palpable flexion of the elbow.
What is the proper way to assess biceps reflex?
These are rhythmic oscillatory movements
What are tremors or involuntary movements
Subjective Data
• Drooping eyelids
• Double vision
• Difficulty swallowing or speaking
• Fluctuating fatigue or weakness (worse with exercise, improves with rest)
• Inability to work with arms raised above head
• Difficulty walking
• Symptoms worsen later in the day and improve with rest.
What is myasthenia gravis?
This nerve is responsible for sensory > sensation behind ear and part of external ear canal and parasympathetic > secretion of digestive enzymes; peristalsis; carotid reflex; involuntary action of heart, lungs, and digestive tract
What is the Vagus, CN X nerve?
This test is done to assess older patients balance, strength, and cerebellar function
What is the Timed Up and Go (TUG) test?
Ask the seated patient to pat their knees with both hands, alternately turning up and down the palms of the hands and increasing the speed gradually.
How do you assess Rapid Rhythmic Alternating Movements?
This is the meaning of a 4+ deep tendon reflex score.
Brisk, hyperactive, with intermittent or transient clonus
Rapidly progressive muscle weakness on one side of face (over 2–3 days)
• Feeling of facial numbness
Objective Data
• Facial creases and nasolabial fold disappear on affected side
• Eyelid will not close on affected side and lower lid sags; leads to eye irritation; eye may tear excessively.
• Food and saliva may pool in affected side of mouth.
• Facial sensation is intact.
What is Bells Palsy?
This nerve has motor > movement of facial expression muscles except jaw, close eyelids, labial speech sounds, sensory > taste—anterior two-thirds of tongue, sensation to pharynx and parasympathetic> secretion of saliva and tears
What is the facial, CN VII nerve?
Medications such as benzodiazepines, CNS antidepressants, gabapentinoids, and muscle relaxants have effects that can cause sedation, orthostatic hypotension, and cognitive impairment.
The potential for falls and other injuries can be higher in older adults taking these medications. A formal medication reconciliation by a pharmacist using the American Geriatric Association Beers Criteria may be appropriate.
What is polypharmacy?
Ask the patient (with eyes open and then closed) to stand, feet together and arms at the sides. Stand close, prepared to catch the patient if they start to fall. Slight swaying movement of the body is expected, but not to the extent that falling is a danger.
What is the Romberg test?
This is a perceptual sensation that may signal a seizure.
What is aura?
Tremors
• Muscular rigidity, cogwheel rigidity with jerks
• Stooped posture, balance and postural instability
• Short steps, shuffling, freezing gait, gait may accelerate to maintain upright posture.
• Slow, slurred monotonous speech, voice softening
• Impaired cognition, dementia
What is Parkinson's Disease?
This nerve is responsible for turn head, shrug shoulders, some actions for phonation.
What is the spinal accessory, CN XI nerve?
These reflexes may diminish with aging.
What are deep tendon, superficial, and fine motor abilities?
Direct the patient to touch the toe of one foot with the heel of the other foot. Have the patient walk a straight line, first forward and then backward, with eyes open and arms at the sides.
What is the heel-toe walking or tandem gait assessment?
These are the 4 categories of a neuro assessment.
What is cranial nerves, proprioception and cerebellar function, sensory function, and reflex function.
If this assessment of CN I is abnormal, what would the differential dg list include?
What is inflammation of the mucous membranes, allergic rhinitis, and excessive tobacco smoking; not to miss would include: lesion, trauma or infection.