27. CARNIAL NERVES On Old Olympus Towering Tops A Finn And German Viewed Some Hops Olfactory (I) Optic (II) Occulamotor (III) Trochlear (IV) Trigemenal (V) Abducens (VI) Facial (VII) Acoustic (VIII) Glossopharyngeal (IX) Vagus (X) Spinal Accessory (XI) Hypoglossal (XII) M S M M M/S M M/S S M/S M/S M M
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32. Normal: ■ Able to read without difficulty ■ Visual acuity intact 20/20, both eyes Hippus phenomenon: Brisk constriction of pupils in reaction to light, followed by dilation and constriction - may be normal or sign of early CN III compression. Abnormal: ■ CN II deficits - can occur with stroke or brain tumor. ■ Changes in pupillary reactions - can signal CN III deficits. ■ Increased ICP causes changes in pupillary reaction As pressure increases, response becomes more sluggish until pupils finally become fixed and dilated.
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58. Hopping in place, alternating knee bends ( some individuals cannot hop owing to aging or obesity)
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68. F. Superficial Reflexes Abdominal Reflex ■ Stroke patient’s abdomen diagonally from upper and lower quadrants toward umbilicus. ■ Contraction of rectus abdominis. Umbilicus moves toward stimulus.
69. Perianal Reflex ■ Gently stroke skin around anus with gloved finger. Normal: ■ Anus puckers. Cremasteric Reflex ■ Gently stroke inner aspect of a male’s thigh. Normal: ■ Testes rise. Bulbocavernosus Reflex ■ Gently apply pressure over bulbocavernous muscle on dorsal side of penis. Normal: ■ Bulbocavernosus muscle contracts.
81. Fully alert- 15, a score of 7 or less reflects coma. (Kozier p. 703-704)
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90. Neurologic Exam: Meningeal signs Brudzinski’s sign - neck stiffness - involuntary flexion of hips and knees when flexing neck is positive sign for meningeal irritation
91. Neurologic Exam: Meningeal signs Positive Kernig’s sign -excessive pain in the lower back when examiner attempts to straighten knees with client supine and knees and hips flexed