Professional Documents
Culture Documents
A. Appearance
• Dress Is appropriate for setting, season, age, gender and social group.
B. Behavior
• Level of Consciousness The person is awake, alert, and aware of stimuli from
• Mood and Affect Mood and affect are consistent to place and condition.
C. Cognitive Function
direction.
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D. Thought and Perception
1. The client is asked to close his eyes and occlude one nares.
*** Each side is tested separately, ideally with two different substances.
1. Test the functioning of Cranial Nerve that innervates the facial structures.
Normal Finding:
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B. Cranial Nerve II (Optic Nerve)
Testing for visual acuity and peripheral vision assesses the optic nerve.
Visual Acuity is tested using a Snellen chart for those who are illiterate and
unfamiliar with the western alphabet, the E chart, in which the letter E faces in
different directions maybe used. The chart has a standardized number at the end
of each line of letter; this number indicates the degree of visual acuity when
The numerator 20 is the distance in feet between the chart and the client or
The denominator 20 is the distance from which the client eye can read the
lettering, which correspond to the number at the end of each letter line;
optic pathway; while measurement of less than 20/20 vision is an indication of either
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In testing visual acuity you may refer to the following:
2. A person who wears corrective lenses should be tested with and without them to
3. Only one eye should be tested at a time; the other eye should be covered by an
4. Make the client read the chart by pointing at a letter randomly at each line;
5. A person who can read the largest letter on the chart (20/20) should be checked if
they can perceive hand movement about 12 inches from their eyes, or if they can
macular area, the area of central vision. However it does not test the sensitivity of
the other areas of the retina, which perceive the more peripheral stimuli. The
vision.
The performance of this test assumes that the examiner has normal visual fields,
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The following steps in conducting the test:
1. The examiner and the client sit or stand opposite each other, with the eyes at the
2. The client covers the eye with opaque card, and the examiner covers the eye that
3. Instruct the client to stare directly at the examiner’s eye, while the examiner
stares at the client’s open eye. Neither looks out at the object approaching from
the periphery.
4. The examiner hold an object such as pencil or penlight, in his hand and gradually
moves if in from the periphery of both direction horizontally and from above and
below.
5. Normally the clients should see the object at the same time the examiner sees it.
All the 3 Cranial nerve are tested at the same time by assessing the Extra Ocular
1. Stand directly in front of the clients and hold a finger or a penlight about 1ft
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2. Instruct the client to follow the direction of the object held by the examiner
4. Instruct the client to fix his gaze momentarily on the extreme position in each
5. The examiner should watch for jerky movement of the eye (nystagmus).
6. Normally the clients can hold position and there should be no nystagmus.
Sensory Function;
• Run cotton wisp over the fore head, cheek and jaw on both side of the face.
• Ask the client if he/she feel it, and where she feels it.
Motor Function
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E. Cranial Nerve VII (Facial)
Sensory Function
• Place sweet, sour, salty or bitter substances near the tip of the tongue.
Motor Function
• Ask the client to smile, frown, raise eye brow, close lids, whistle, or puff the
cheeks.
Normal Finding:
• Face is symmetrical
Examination of the cranial nerve VIII involves testing for hearing acuity and balance.
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Hearing Acuity
A. Voice test
2. Instruct the client to occlude the ear canal of the other ear.
3. The examiner then covers the mouth and using a soft-spoken voice whisper non-
4. Normally the client will be able to hear and repeat the number.
B. Watch Test
4. If the client says yes, the examiner should validate by asking at “What are you
6. Normally the client can identify the sound and on which side was heard.
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This test is useful in determining whether the client has a conductive hearing loss
vibrating tuning fork is placed on the middle of the forehead or top of the skull.
Conduction loss: a sound lateralizes to defective ear (Heard louder on defective ear)
as few extraneous sounds are carried through the external and middle ear.
c. Position the tuning fork in front of the client’s ear canal when he no
Normal: sounds should be heard when tuning fork is placed in front of the ear anal as
Conduction loss: sound is heard longer by one bone conduction than by air
conduction.
Sensorineural loss: Sound is heard longer by air conduction than by bone conduction.
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G. Cranial Nerve IX and X (Glossopharryngeal and Vagus Nerve)
1. Sensory Function:
2. Motor function:
• The uvula and the soft palate should rise in the midline and the
• Touch the posterior pharyngeal wall with a tongue blade and note
• Note the voice of the client ( should be smooth and not strained)
• Examine the stetamoid and the trapezius muscle for equal size. Check
equal strength by asking the person to rotate the head forcibly against
• Note the forward thrust in the midlines as the client protrudes the
tongue.
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• Ask the person to say “light, tight, dynamite”, the sounds lingual speech
(letters l, t, d) is clear.
Balance test:
A. Tandem walking
Tandem walking decreases the base of support and accentuates problem with
coordination. Normally, the person can walk straight and stay balanced. Inability
to tandem walk may indicate upper motor neuron lesion such as multiple sclerosis.
B. Romberg test
• Ask the person to stand up with feet together and arms at all side.
• Ask the client to close the eyes and to hold the position for about 20
seconds.
• Normally, a person can maintain posture and balance even with the
Positive Romberg sign (loss of balance that occurs when closing the eyes)
function.
Coordination tests:
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A. Rapid alternating movements (RAM)
• Ask the person to pat the knees with both hands, patting alternately
• Ask the person to touch the thumb to each finger on the same hand,
• With person’s eyes open, ask the client to touch your finger then touch
his own nose repeatedly. After several times, move your finger to a different
spot.
C. Finger-to-Nose test
• Ask the client to touch the tip of his nose with his index finger,
• Ask the clients to close his eyes and identify an object that is placed in
his hand.
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• Test a different object in each hand.
* Normally, a person will explore the object with the fingers and correctly name
it. Testing the left hand assesses right parietal lobe functioning. Astereognosis
• With the client’s eyes closed, use a blunt instruction to trace a number or a letter
on the palm.
• Ask the person to tell you what the number or letter is.
2+ Average normal
0 No response
Technique:
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• Place thumb on the biceps tendon and strike a blow on the thumb.
Normal Response:
Technique:
• Tell the person to relax the arm as the examiner suspends it by holding the upper
arm.
Normal Response:
Technique:
• Strike the forearm directly 2-3cm above the radial styloid process.
Normal Response:
Technique:
• Let the lower leg dangle freely to flex the knee and stretch the tendons.
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• Strike the tendon directly just below the patella.
Normal Response:
Technique:
Normal Response:
Technique:
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• Have the person assumes a supine position, with the knee slightly bent.
• Use the handle end of the reflex hammer to stroke the skin.
• Stroke from the side of the abdomen towards the midline at both the upper and
Normal Response:
Technique:
• With the reflex hammer, draw a light stroke up the lateral side of the sole of the
foot and inward across the ball of the foot (“Inverted J”).
Normal Response:
• Plantar flexion of all the toes and inversion and flexion of the forefoot.
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