NR 509 Immersion Exam (Answered)
Introduction
___________, my name is ____________, I will be doing your exam today. I'll begin
with inspecting your face. I'll note that I don't see any discolorations or lesions & the
head is midline & symmetrical.
Lymph nodes
Next, I'll palpate the lymph nodes. I'll begin with the preauricular lymph nodes, right in
front of the ear, and postauricular, right behind the ear. Then I will palpate her occipital
lymph nodes in the back of the head. And then I'm gonna move forward and palpate the
tonsillar lymph nodes. Come under the jawline, the submandibular lymph nodes, and
the submental. Now I will go to the anterior cervical lymph nodes, and the posterior
cervical lymph nodes. And I will end with the supraclavicular lymph nodes right about
the clavicles. I do not feel any enlargement, and they are equal bilaterally.
Face
I'm testing trigeminal nerve, which is cranial nerve # 5. Palpating over the masseter
muscle as the pt clenches the jaw. I don't feel any distortions & my pt has great
strength. Now, I'm testing the sensory portion of the trigeminal nerve. I'll ask my pt to
close your eyes & let me know where you feel my touch. (>> Forehead, right cheek, left
cheek, chin, nose)
Next, I'll test the facial nerve, which is cranial nerve # 7. I'm going to ask you to do some
facial expressions. I'm going to have you smile, next, frown for me. Now raise your
eyebrows & puff up your cheeks, pucker your lips. I notice all expressions have bilateral
symmetry.
Ears
Now, I'm going to inspect the ears. I'm looking for nodules or skin lesions. They're both
symmetrical, no nodules or skin lesions are noted. I'm going to look inside the ear canal
with the otoscope. I see that the external auditory canal is clear, there's no swelling,
redness, drainage or cerumen. The tympanic membrane is pearly gray & there is no
effusion in the middle ear. I'll do the other ear. Looking into the external auditory canal. I
see there is no swelling, redness, drainage, or cerumen. Pt's tympanic membrane is
pearly gray & there's no effusion in the middle ear. Next, I'm going to palpate pinna for
any nodules or tenderness. Now the tragus. No nodules or tenderness are noted.
Acustic nerve CN8
I will be testing your acoustic nerve, which is cranial nerve # 8, which is hearing. I'll be
performing a whisper test. I want you to cover one of your ears & I will stand behind
you, cover my mouth & whisper 3 words & I want you to repeat them to me (1, 2, 3) &
let's do the other side (4, 5, 6). Hearing is intact bilaterally.
Eyes
I'm going to assess the pt's eyes. I'm going to look at the conjunctiva. I notice that
they're pink & clear, no drainage or lesions & the sclera is white & clear. I'm going to
test cranial nerve # 2, the optic nerve, covering central vision. Using the Snellen eye
, pocket chart, I'm going to stand 6 ft away & ask the pt to cover 1 eye & read the lowest
line possible (LTFPH). Repeat with the other eye. Now with both eyes. The pt has
normal vision, 20/20 in the L eye, R eye, & both eyes.
Cranial nerve 2
I'll continue with cranial nerve # 2, the optic nerve, this time assessing peripheral vision.
Please stand, so we can be at the same eye level. I'm going to ask the pt to look
straight ahead & not move their head ((hands right above shoulders, move hands in
"come" motion)) Can you see my hands now? >> Let me know when you do>> I'm
going to cover above, ((w/hands on either side of face, move hands)) Do you see them
now? >> Let me know when you do>> Now from below ((hands on pt sides, bring hands
upward)) Do you see them now? >> Let me know when you do. The pt's peripheral
vision is normal. Again, I'm checking cranial nerve # 2, the optic nerve for pupil
response to light. I'm using the ophthalmoscope head & turning on my light. Please look
at my nose. I notice that the pupil constricts. I will check the other eye. The pupils are
about 2-3 mm's & both respond to light equally.
Cranial nerves 3,4,&6
Next, I'm going to be checking cranial nerves # 3, the ocular motor, cranial nerve # 4,
the trochlear, & cranial nerve # 6, the abducens. I will choose an H pattern to assess the
extraocular muscles of the eye. If you'll follow my finger, with your eyes only. All EOMs
are intact equally.
Nose
I'm going to inspect the nose. I see that it's midline, there's no obstruction, fracture or
swelling. I'll begin by inserting the speculum of the otoscope inside the nose. I see pink
& moist turbinates & the septum is midline, straight & there's no deviation. On the other
side, I see a straight septum, the turbinates are pink & moist. There's no swelling or
bogginess.
Next, I'll palpate the pt's sinuses beginning with the frontal sinuses. Let me know if you
feel any tenderness. The maxillary sinuses, tenderness? No tenderness noted.
Mouth
Now, I'm going to inspect the throat & mouth. The lips, I see they are pink & moist. Can
you open your mouth? I don't see any signs of decay or cracks in the teeth. The gums
look pink & there is no redness or swelling. The buccal mucosa on both sides is moist &
pink. Upper hard & soft palates are intact, pink & moist. The tongue is smooth, pink &
moist. If you'll lift your tongue up, please. I don't see any nodules or drainage & it's pink
& moist on the floor of the mouth. Now I'll look at the posterior pharynx & it's pink &
there is no post nasal drainage. ((Grade tonsils if present, +1 normal or +2 mid-line,
bilateral))
Cranial nerve 9, 10 & 12
Cranial nerve # 9 the glossopharyngeal, which is the gag reflex & I won't not be testing
for that. I'll check cranial nerve # 10, which is the vagus nerve. I'll have the pt go ahead
& open your mouth again ((w/my light shining in pt mouth)) & say "ahhh" The uvula rises
symmetrically with phonation. Then we have cranial nerve #12, the hypoglossal. I'll have
you stick your tongue out & move it side to side.
Next, I'm palpating the TMJ. I'm palpating both sides. Please open your mouth & close.
Do you have any tenderness? I don't feel any subluxation, crepitus, clicking, or
tenderness.
Introduction
___________, my name is ____________, I will be doing your exam today. I'll begin
with inspecting your face. I'll note that I don't see any discolorations or lesions & the
head is midline & symmetrical.
Lymph nodes
Next, I'll palpate the lymph nodes. I'll begin with the preauricular lymph nodes, right in
front of the ear, and postauricular, right behind the ear. Then I will palpate her occipital
lymph nodes in the back of the head. And then I'm gonna move forward and palpate the
tonsillar lymph nodes. Come under the jawline, the submandibular lymph nodes, and
the submental. Now I will go to the anterior cervical lymph nodes, and the posterior
cervical lymph nodes. And I will end with the supraclavicular lymph nodes right about
the clavicles. I do not feel any enlargement, and they are equal bilaterally.
Face
I'm testing trigeminal nerve, which is cranial nerve # 5. Palpating over the masseter
muscle as the pt clenches the jaw. I don't feel any distortions & my pt has great
strength. Now, I'm testing the sensory portion of the trigeminal nerve. I'll ask my pt to
close your eyes & let me know where you feel my touch. (>> Forehead, right cheek, left
cheek, chin, nose)
Next, I'll test the facial nerve, which is cranial nerve # 7. I'm going to ask you to do some
facial expressions. I'm going to have you smile, next, frown for me. Now raise your
eyebrows & puff up your cheeks, pucker your lips. I notice all expressions have bilateral
symmetry.
Ears
Now, I'm going to inspect the ears. I'm looking for nodules or skin lesions. They're both
symmetrical, no nodules or skin lesions are noted. I'm going to look inside the ear canal
with the otoscope. I see that the external auditory canal is clear, there's no swelling,
redness, drainage or cerumen. The tympanic membrane is pearly gray & there is no
effusion in the middle ear. I'll do the other ear. Looking into the external auditory canal. I
see there is no swelling, redness, drainage, or cerumen. Pt's tympanic membrane is
pearly gray & there's no effusion in the middle ear. Next, I'm going to palpate pinna for
any nodules or tenderness. Now the tragus. No nodules or tenderness are noted.
Acustic nerve CN8
I will be testing your acoustic nerve, which is cranial nerve # 8, which is hearing. I'll be
performing a whisper test. I want you to cover one of your ears & I will stand behind
you, cover my mouth & whisper 3 words & I want you to repeat them to me (1, 2, 3) &
let's do the other side (4, 5, 6). Hearing is intact bilaterally.
Eyes
I'm going to assess the pt's eyes. I'm going to look at the conjunctiva. I notice that
they're pink & clear, no drainage or lesions & the sclera is white & clear. I'm going to
test cranial nerve # 2, the optic nerve, covering central vision. Using the Snellen eye
, pocket chart, I'm going to stand 6 ft away & ask the pt to cover 1 eye & read the lowest
line possible (LTFPH). Repeat with the other eye. Now with both eyes. The pt has
normal vision, 20/20 in the L eye, R eye, & both eyes.
Cranial nerve 2
I'll continue with cranial nerve # 2, the optic nerve, this time assessing peripheral vision.
Please stand, so we can be at the same eye level. I'm going to ask the pt to look
straight ahead & not move their head ((hands right above shoulders, move hands in
"come" motion)) Can you see my hands now? >> Let me know when you do>> I'm
going to cover above, ((w/hands on either side of face, move hands)) Do you see them
now? >> Let me know when you do>> Now from below ((hands on pt sides, bring hands
upward)) Do you see them now? >> Let me know when you do. The pt's peripheral
vision is normal. Again, I'm checking cranial nerve # 2, the optic nerve for pupil
response to light. I'm using the ophthalmoscope head & turning on my light. Please look
at my nose. I notice that the pupil constricts. I will check the other eye. The pupils are
about 2-3 mm's & both respond to light equally.
Cranial nerves 3,4,&6
Next, I'm going to be checking cranial nerves # 3, the ocular motor, cranial nerve # 4,
the trochlear, & cranial nerve # 6, the abducens. I will choose an H pattern to assess the
extraocular muscles of the eye. If you'll follow my finger, with your eyes only. All EOMs
are intact equally.
Nose
I'm going to inspect the nose. I see that it's midline, there's no obstruction, fracture or
swelling. I'll begin by inserting the speculum of the otoscope inside the nose. I see pink
& moist turbinates & the septum is midline, straight & there's no deviation. On the other
side, I see a straight septum, the turbinates are pink & moist. There's no swelling or
bogginess.
Next, I'll palpate the pt's sinuses beginning with the frontal sinuses. Let me know if you
feel any tenderness. The maxillary sinuses, tenderness? No tenderness noted.
Mouth
Now, I'm going to inspect the throat & mouth. The lips, I see they are pink & moist. Can
you open your mouth? I don't see any signs of decay or cracks in the teeth. The gums
look pink & there is no redness or swelling. The buccal mucosa on both sides is moist &
pink. Upper hard & soft palates are intact, pink & moist. The tongue is smooth, pink &
moist. If you'll lift your tongue up, please. I don't see any nodules or drainage & it's pink
& moist on the floor of the mouth. Now I'll look at the posterior pharynx & it's pink &
there is no post nasal drainage. ((Grade tonsils if present, +1 normal or +2 mid-line,
bilateral))
Cranial nerve 9, 10 & 12
Cranial nerve # 9 the glossopharyngeal, which is the gag reflex & I won't not be testing
for that. I'll check cranial nerve # 10, which is the vagus nerve. I'll have the pt go ahead
& open your mouth again ((w/my light shining in pt mouth)) & say "ahhh" The uvula rises
symmetrically with phonation. Then we have cranial nerve #12, the hypoglossal. I'll have
you stick your tongue out & move it side to side.
Next, I'm palpating the TMJ. I'm palpating both sides. Please open your mouth & close.
Do you have any tenderness? I don't feel any subluxation, crepitus, clicking, or
tenderness.
