Cranial Nerves
Life is like a box of chocolates
Diseases
MY EYES
Life is like a box of chocolates
100
You would use the Snellen Test to assess and *PERRLA
Which cranial nerve am I?
Cranial Nerve 2
Optic Nerve
100
What are some cardinal signs and symptoms of Parkinson’s Disease?
TRAP!
They can’t stop themselves from going forward and back
Nonmotor- difficulty sleeping, depression, nightmares, and emotionally liable due to lack of sleep
100
Think FAST, What are the S/Ss using FAST?
F-
A-
S-
T-
F- Facial Dropping
A- Arm Weakness
S- Speech
T- Time
100
Name this show GRACE WHERE YOU AT
SpongeBob Square Pants 
100
What are you looking for when assessing a Neuro assessment?
Assess for L vs. R side symmetry
200
As Kurt stated (hey bestie where you at)
You would assess by holding one nostril and using coffee beans
Which cranial Nerve am I?
Cranial Nerve One
Olfactory
200
True or False: You can send your pt to get a MRI or CT Scan to see if they have Parkinson’s Disease?
No, you would need to see to identify [resence of TRAP and response to drugs of LEVADOPA AND CARBADOPA
200
Patients have a *gradual* level of the muscles tiring throughout the day
S/S: Fluctuating weakness, multiple systems affected, and at risk for aspiration
Which disease am I?
Myasthenia Gravis
*ADLS would be stronger to assess in the morning
200
What is Myopia?
Near-Sightedness
You can see Far
200
True or False: You can perform your assessment when the client is performing ADL (such as brushing teeth)?
True!
*That is the best TIME to assess
300
Smile as I take your picture!
Ask pt to raise eyebrows
Which nerve am I assessing for?
Cranial Nerve 7
The Facial Nerve
300
In preference, which drug is best to give to a Parkinson’s pt? Why do we prefer this drug?
Sinemet: The Combo of Levodopa/Carbodopa
WHY: The Carbodopa helps with the higher uptake of dopamine
300
This is an autoimmune disorder where the following occurs
* Myelin Sheath goes through demyleinazation with inflammation and it can regenerate
* Gliosis (scar tissue)
*Risk for Pneumonia and UTI
NO CURE, and you must teach sterility to pt and caregiver
MS- Multiple Sclerosis
Hint: MS (Myelin Sheath) or MS (Multiple Systems)
300
What is Hyperopia?
Far-Sightedness
You can see near you
300
What are some Stroke Risk Factors?
HTN, Smoking, Drinking, drugs, Prior Stroke, Obesity, Increase in fats and sodium, and Diabetes
400
Open your mouth and say AHHHH
*You would use a tongue blade and check for *gag reflex and assess for swallowing
Which cranial Nerve am I?
Cranial Nerve 9
Glossopharyngeal Nerve
400
What is something we ask pts with Parkinson’s to avoid?
Protein
400
It’s a TRAP! What is Trap to look for Parkinson’s?
T- R- A- P-
T-Tremors
R- Rigidy
A- Akinesia
P- Postural Instability
**Other signs include difficulty, sleep, and shuffle gait and teach to avoid Protein in diet
400
What is Presbyopia?
The loss of accommodation associated with age. Lens become larger, firmer, and less elastic. Inability to focus on near objects.
400
You’re performing a test on your pt, you tell them to stand with their feet together, eyes closed, no shoes on. They have a bed behind them for support. As you reach out your hands by their sides and you are in front of them. You are looking if the pt is swaying.
Which test is this? What indicates a positive and what indicates a negative result?
Roomberg Test
Positive- Swaying
Negative- NO Swaying
500
You would assess facial sensation, such as grabbing a cotton ball to the person’s face and ask
" how does it feel"
you can also assess for chewing
Trigeminal Nerve
Cranial Nerve 5
500
It is near the end of the day, you are checking on a pt with MG. What is something you would expect to be decreased by the end of the day? What are they at risk for?
ADLs, Speaking, Swallowing, Breathing, weakness in lungs
*At risk for Pneumonia*
Focus in on respiratory with these pts
500
S/S: Progressive motor disorder, muscle contraction, total paralysis, no cure, risk for infection, depression, and muscle atrophy
ALS
500
What is Astigmatism?
The uneven or irregular curvature of the cornea. Light rays look scattered as they do not enter at one single point. Can occur with any other refractive error.
500
People with this disease feel a *morning stiffness, what do they have?
Parkinsons Disease
*They have issues with the time it’s takes them in the morning so know this for planning*
600
You would use a tuning fork to assess
Which cranial nerve am I?
Cranial Nerve 8
Vestibulocochlear Near
600
What is ALS and what are some things to look for?
Progressive neuromuscular disorder with loss of motor neurons
Muscle contractions, total paralysis, they are AOx4, *depression, GI slowed down- constipation, difficulty with fine motor skills
600
S/S: Urge to move legs, feels like bugs are crawling on them, pain at night, daytime fatigue, can have delirium for not being able to sleep for days on end. Pt can be agitated due to lack of sleep
Teach: Promote sleep, give opioids or benzos: to help sleep and relieve pain at night, dopamine agonists such as pramipexole- do not use homemade supplements at home
RLS (Restless Leg Syndrome)
*We are looking for diagnostic testing, you cannot test to see if they have RLS using tests such as CT Scan
600
If you have astigmatism, and you are driving a night, what shape do the lights look like?
Stars
600
What is the allocated drinking for patients with stroke?
2 for men
1 for women
700
“Can you shrug your shoulders for me”?
Which cranial nerve am I?
Cranial Nerve 11
Accessory Nerve
700
True or False : A pt with ALS is Psychologically impaired
FALSE
700
The healthcare provider is assessing a patient with a diagnosis of Parkinson disease (PD). Which of the following assessments will the healthcare provider anticipate?
A) Pill- Rolling Tremor when the hand is at rest
B) An absence of stereognosis
C) Twisting and protruding movements of the tongue
A) Pill Rolling Tremor when the hand is at rest
700
How would we correct and interventions we would take for Myopia or Hyperopia?
If you were to give a word how would you help them?
Glasses, Lasix, or Contacts
We can also orient the pt, clockface for the direction of food, and can we fold money a certain way that way they know which amount they are giving700
True or False: Your patient has an occasional drink, they are at risk for a stroke
False
800
Sensory, motor, & autonomic function of viscera
Same Assessment as Nine
Cranial Nerve 10
Vagus Nerve
800
What are some interventions we can do as nurses for someone who has muscle contractures?
Passive ROM, rolling up a cloth or towel and place in their hands to prevent them from atrophying
You may notice is a contracture occurs, pts will develop a smell due to the bacteria, and it can lead to infections with their nails not being clipped and creating cuts, and there is no cure
800
S/S: *Severe Headache, Dysarthria (impaired muscular control of speech (pronunciation, articulation, phonation), Difficulty Swallowing, Expressive Aphasia, Receptive Aphasia, or Global (both expressive and receptive)
Diagnostic: CT Scan, MRI Scan, CTA and MRA, and US Doppler of Carotids
Chronic Stroke
CT Scan, MRI Scan (shows size, location, and type), CTA and MRA (show size, location, type, and extent of occlusion), and US Doppler of Carotids (search for Bruits)
What do we teach? Prevention: Smoking Cessation, exercise decrease fats and carbs and increase in vegs and fruits, exercise 40 mins a day, etc * Promote Lifestyle Changes*
800
What are some signs and symptoms of a retinal detatchment
Flashes of light, Cobweb over visual field, like a curtain closing, once fully detached- creates *painless* loss of peripheral visions
800
What are some things we can teach for our stroke pts?
Exercise: 30 mins a day/ 5 days a week
BP Control: if you are over 65, systolic- 150
Under 65- systolic- 140
After care: pt’s psychological status and lifestyle changes
900
These three cranial nerves assess cardinal signs
Which ones are they?
Cranial Nerve 3, 4, and 6
900
What is something to look for with a pt with ALS, specifically respiratory?
Aspiration Pneumonia
900
S/S: Genetic Disease- 50/50 Chance to contract it, Suicidal ideations, depression
Treat: Provide supportive care, Increase caloric diet (4,000-5,000 calories) ROM, and provide comfort
Huntington’s Disease
900
What is macular degeneration
1) Painless and slow
2) Sereve and quick
3) Most common- dry and nonexudated
Their visual field becomes blotchy- correct with reader
Wet/exudated macular degeneration- medical intervertion
900
With MS, Do they ever return back to baseline?
Remember with MS, you can have multiple episodes because you can go into an exacerbation and come back out. The point at which you don’t come back out is when the myelin sheath gets destroyed and it creates glyosis (scare tissue)
1000
You would assess for tongue movement
“Stick your tongue out” or move side to side
Hypoglossal Nerve
Cranial Nerve 12
Hint: Lip Gloss
1000
If a patient has hearing impairment, what are some interventions?
Tell me about Otic DropsDO NOT OVERENUNICATE
Do you yell?
Brock: No that’s ruuude
Talk slowly, and simple sentences, etc
Otic Drops: Store at room temperature. Why? If you pout something cold it can cause vertigo and remember to pull the pinna for both adults (up) and children (down)
1000
If your pt has a sudden painful onset of hearing loss, does that indicate an emergency?
When is hearing loss NOT an emergency?
1) YES
(Too much ear wax)
1000
What are some reasons for hearing loss
Tati where you at?
Age, medications (Furosemide), Loop Direuretics, aminglycidies, antibiotics, NSAIDs, * Butetanide, Bumex
1000
What is something extremely particular we are looking for in our MS Patients?
What do we need to teach them and their caregivers?
*UTIs and Pneumonia*
As well as: *extremity weakness, coordination and balance problems, speech impairment, ataxiaTeach: Sterility- since they may self cath