Nervous System (NS)

Sensory Nerves (SN) 31

Pairs
Cervical Thoracic Lumbar Sacral Coccygeal
Central Nervous System (CNS) Peripheral (8 pairs) (12 pairs) (5 pairs) (5 pairs) (1 pair)
* Controls, Integrates & regulates Nervous System
every part of the body (PNS) I Olfactory (S) - Smell Cotton ball
* transmits/
Cranial Nerves (CN) II Optical (S) - Sight Snellen’s Chart
distributes
electrical 12 Pairs
Brai Spinal III Occulomotor (M) – upward OTA test
impulses movement of eyes/eyelids, pupil
n Cord (SC)
Sensory Motor constriction , light accommodation
(Afferent) (Efferent)
Upward Downward IV Troclear (M) – downward OTA test
movement of eyes/eyelids
movement movement
V Trigeminal (S) – Facial Facial – Pin prick
Sensation; & corneal reflex (M) – Corneal – cotton
mastication wisp
Motor – Ice Drop
Somatic Autonomic VI Abducens (M) – lateral Stick
(Voluntary) (Involuntary) movement of eyes/eyelids
OTA test
Soma = muscles, Visceral organs
skeletons, tendons, VII Facial (S) – Taste, anterior
tongue sweet/salty (M) – facial Hearing acuity –
ligaments ) whisper, watch
expression
(Afferent) tic, audiometry;
Sympathetic Parasympathetic
VIII Acoustic (S) – hearing / Conductive/Sensor
 activated  Activated balance y Neural –
during stress; during rest IX Glassopharyngeal (S) – Taste, Weber’s Test &
 Fight or Flight and posterior tongue, bitter/sour (M) Rinne’s Test
response relaxation; move- ment pharynx, swallowing, gag V. Integrity –
reflex Caloric
Balance –
X Vagus (S) – sensation of pharynx,
Romberg’s
larynx and soft palate (M) motor area
of parasympathetic nervous system

XI Spinal Accessory (M) – neck & Shrugging

shoulder movement Shoulder and
neck resistance
XII Hypoglossal (M) - Tongue Test
 CRANIAL NERVES

CN CODE CODE Cranial Nerve Code Sensory, Motor or Both HOW TO TEST
NO.
Ask your patient to close eyes, get a cotton ball, dab with scents
1 Oh O OLFACTORY Some Sensory - Smell (alcohol, vinegar, etc.) and let him smell it.
L
O Snellen’s Chart
2 Oh p OPTICAL Say Sensory - Sight (N= 20/20; legally blind = 20/200)
Where: a) For Normal 20/20, 20 = the number on the chart while
the denominator 20 = ft. in distance; b) For 20/200, 200 = ft.
distance a N person can see in 200 ft.
O Motor - Sight – upward movement OTA test – a test pertaining to eye movement. About 2 feet away
3 Oh C OCULOMOTOR Marry of eyes/eyelids, pupil constriction from your patient put your finger on top of the his/her nose and let
and light accommodation him/her follow it as you move it to different directions forming a
letter H
T Motor - Sight – downward/inward
4 To R TROCHLEAR Money movement of eyes/eyelids (a.k.a. OTA TEST (“muta test)
O palibat-libat)
T Testing For Sensory Integrity:
5 Touch R TRIGEMINAL But Sensory – Facial sensation and For Facial Integrity – Pin prick test; using a sterile pin light
I Corneal Reflex touch with patient’s forehead.
For Corneal Reflex – Cotton Wisp Test; using cotton, lightly
touch the bottom of eyelids with it, the patient should blink.

Testing For Motor Integrity: Using an ice drop stick. Let the
Motor - Mastication patient bite it from the side, then try to pull it out; there must be
some resistance…do it on the other side as well.

6 And A ABDUCENS My Motor - Sight – Lateral (side-to- OTA TEST (“muta test)
side) movement of eyes/eyelids
CN CODE CODE Cranial Nerve Code Sensory, Motor or Both HOW TO TEST
NO.
Sensory – Taste, anterior
7 Feel F FACIAL Brother tongue (sweet and salty) Sensory Testing – let the patient taste different kinds of food even
those that are not sweet and salty.
X Motor Testing – let the patient do several facial expressions e.g.
smile, frown, etc.
Motor – facial expression
I.) Hearing Acuity
8 A A ACOUSTIC Says Sense of hearing and balance 1.) whisper test
2.) watch tic test
3.) audiometry (most accurate test)

II.) Conductive or Sensory Neural Hearing Loss (what kind?)

1) Conductive – the damage is in the external/middle ear;
there is a problem of air conduction (air/ sounds waves
cannot come in);

2) Sensory Neural – refers to the perception of sound the

brain will interpret what sound it is; the damage is in
the inner ear (trochlear part)
CN Sensory,
NO CODE CODE Cranial Nerve Code Motor or HOW TO TEST
. Both
(contd. HOW TO TEST?
8 .) A ACOUSTIC Says Sense of 1.) WEBER’S TEST http://www.webster.edu/~davittdc/ear/weber/weber.htm
A (VESTIBULOCOCH hearing and
LEAR) balance

Strike the tuning fork and place on the middle of the skull. If the patient hears it at the same intensity in both
ears then this is normal. If the patient hears the sound in the bad ear then the hearing loss is conductive
hearing loss. However, if the patient hears the sound in the good ear the hearing loss is sensory neural.

2.) RINNE’S TEST

Strike the tuning fork and place it on at the back of the ear specifically on the mastoid process (bony part at the
back of the ear). Time it for 1 minute (or any baseline data), ask the patient to tell you when the sound
disappears, if the patient says the sound disappears in 1 minutes (for example) this is called bone
conduction. Strike the fork again and put it in front of the ear. Time it. The normal hearing would have an
air conduction twice longer (2x) than bone conduction (2 minutes in this example). Thus, if air conduction
is just the same or less than bone conduction, then the patient has a conductive hearing loss.
The Rinne test is useful for distinguishing
between conductive and sensorineural hearing losses. With a conductive
hearing loss, bone-conducted sound is heard as long as or
longer than air-conducted sound, whereas with a sensorineural
hearing loss, air-conducted sound is audible longer than bone-conducted
sound. In a normal hearing ear, air-conducted sound
is louder than bone-conducted sound.
CN CODE COD Cranial Nerve Code Sensory, Motor HOW TO TEST
NO E or Both
.
(contd..)
8 A A ACOUSTIC Says Sense of hearing and Test for vestibular integrity is CALORIC test: “COWS” (cold-opposite,warm-same)
(VESTIBULOCOCHLE balance
AR)  This involves the oscillation of eyeball or nystagmus
 Instill water to the ear, then observe the direction of nystagmus:
 If cold water --- the normal direction of nystagmus is on the opposite direction
(e.g. water instilled on right ear, nystagmus is towards the left)
 If warm water --- the normal direction of nystagmus is on the same side as where
the water is instilled.

Test for sense of Balance is ROMBERG’S test:

 Let the patient stand feet together and eyes closed for about a minute. He should be
able to stand steady and not fall down. The nurse should position at the side of the
patient and facing the patient to be ready if in case the patient will fall out of balance.

9 Girl’s G GLOSSO-PHARYNGEAL Bad Sensory – Taste – at the

posterior tongue (likod)
(bitter and sour)
X

Motor – movement of Let patient swallow, watch for movement of the throat area
pharynx, swallowing
and gag reflex
CN CODE C Cranial Nerve Code Sensory, Motor HOW TO TEST
NO. O or Both
D
E
Sensory – Sensation – in your Stimulate pharynx with tongue depressor to elicit gag reflex
10 Vagina V VAGUS Business pharynx, larynx and soft palate Let patient say “ah” & watch out for symmetric rise of uvula & soft palate

Motor – movement of larynx

and the motor area of the main
nerve for the enervation of the
parasympathetic Nervous
System.

11 So S SPINAL Marry Motor – Neck and shoulder
ACCESSORY movement (take note that
when we refer to spinal nerves
it is neck down (kuryente sa
baba), while cranial nerves
are those above the neck
(kuryente sa taas)
Test For Spinal Nerve Accessory:
1) Shrugging shoulder test
 Let the patient sit down.
 Position yourself at the back of the patient
 Hold down both of his shoulders and let him shrug.
 Normally, there must be some degree of resistance
2) Neck resistance test
 Let the patient turn his head facing the side.
 Put your hand on his cheek
 Instruct the patient to turn his head towards the opposite direction
 Do the same on the opposite side
 Normally, there should be some degree of resistance

What muscle is used on the neck?
sternocleidomastoid (SCM) and trapezius

 just let the patient stick out his tongue towards the right and towards the left
12 Heavenly H HYPOGLOSSAL Money Motor – movement of tongue