Pupils should be round and bilaterally equal in size.Dim the lights of the room before performing this test. Test bilateral pupils to ensure they are equally round and reactive to light and accommodation. An unexpected finding is involuntary eye movement which may cause the eye to move rapidly from side to side, up and down, or in a circle, and may slightly blur vision referred to as nystagmus. Watch for smooth movement of the eyes in all fields. At eye level, move the penlight left to right, right to left, up and down, upper right to lower left, and upper left to lower right. Stand 1 foot in front of the patient and ask them to follow the direction of the penlight with only their eyes. Test eye movement by using a penlight.See Figure 6.13 for a card used to assess near vision.įigure 6.13 Assessing Near Vision Cranial Nerve III, IV, and VI – Oculomotor, Trochlear, AbducensĬranial nerve III, IV, and VI (oculomotor, trochlear, abducens nerves) are tested together. Near vision is assessed by having a patient read from a prepared card from 14 inches away. Alternative charts are available for children or adults who can’t read letters in English. If the patient is wearing glasses or contact lens during this assessment, document the results as “corrected vision.” Repeat with each eye, having the patient cover the opposite eye. Record the corresponding result in the furthermost right-hand column, such as 20/30. Ask the patient to cover one eye and read the letters from the lowest line they can see. Test far vision by asking the patient to stand 20 feet away from a Snellen chart. For example, a result of 20/40 indicates this individual can see this line at 20 feet but someone with normal vision could see this line at 40 feet. The numerator of the fractions on the chart indicates what the individual can see at 20 feet, and the denominator indicates the distance at which someone with normal vision could see this line. See Figure 6.12 for an image of a Snellen chart. See Figure 6.11 for an image of a nurse performing an olfactory assessment.įigure 6.11 Assessing Cranial Nerve I (Olfactory) Cranial Nerve II – Opticīe sure to provide adequate lighting when performing a vision assessment.įar vision is tested using the Snellen chart. Cranial Nerve I – OlfactoryĪsk the patient to identify a common odor, such as coffee or peppermint, with their eyes closed. Instructions for assessing each cranial nerve are provided below. When performing these tests, examiners compare responses of opposite sides of the face and neck. When performing a comprehensive neurological exam, examiners may assess the functioning of the cranial nerves.
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