Cranial Nerves and Cardiovascular Location

Cranial Nerves

• Cranial nerves I-XII each have specific functions
• Olfactory (I): smell (sensory)
• Optic (II): vision (sensory)
• Oculomotor (III): eyeball and eyelid movement, pupil constriction (motor)
• Trochlear (IV): eye movement (downward and lateral) (motor)
• Trigeminal (V): facial sensation, chewing (both sensory and motor)
• Abducens (VI): lateral eye movement (motor)
• Facial (VII): facial expressions, taste (anterior 2/3), salivary and lacrimal glands (both)
• Vestibulocochlear/auditory (VIII): hearing and balance (sensory)
• Glossopharyngeal (IX): taste (posterior 1/3), swallowing/gag reflex, salivary gland (both)
• Vagus (X): autonomic functions of heart, lungs, and digestive tract, swallowing (both)
• Accessory (XI): shoulder and neck movement (motor)
• Hypoglossal (XII): tongue movement (motor)

Cardiovascular and Pulmonary Topics

Location of Heart and Great Vessels

• The heart and great vessels are centrally located in the thoracic mediastinum, left of center, between the lungs, and above the diaphragm within the pericardium
• Great vessels include the jugular veins, superior and inferior vena cava, and pulmonary arteries

Neck Veins and Dehydration

• Patients with dehydration or volume depletion often have barely visible neck veins (flat neck veins) when lying down

Sounds During Auscultation

• Bruits: swooshing sounds similar to blood pressure sounds, audible when an artery is partially blocked
• Murmurs: blowing/swooshing sounds caused by turbulent blood flow through the heart or great vessels
• Gallop sounds: additional heart sounds (S3 or S4) indicative of heart failure or volume overload. Summation gallop refers to presence of both S3 and S4.

Steps Prior to Lung Auscultation

• Ensure a quiet environment
• Listen from the top of the lungs, alternating between left and right sides

Vascular and Systemic Topics

Causes of Arteriosclerosis

• Aging
• Hypertension
• High cholesterol
• Smoking
• Diabetes
• Risk factors for Peripheral Vascular Disease (PVD) include family history, diabetes, hypertension, hyperlipidemia, smoking, lack of exercise, and use of oral contraceptives or estrogen replacement therapy

Complications of Hypertension

• Stroke
• Myocardial infarction
• Heart failure
• Chronic kidney disease
• Retinopathy

Breast Lump Documentation

• Location (clock position and distance from nipple)
• Size (cm)
• Shape (round, irregular)
• Consistency (firm, soft)
• Mobility (fixed or movable)
• Tenderness
• Skin changes (dimpling, redness)

Spleen, Gallbladder, Liver, Pancreas Function

• Spleen: red blood cell graveyard, filters blood
• Gallbladder: stores and concentrates bile for fat emulsification
• Liver: produces and secretes bile, metabolic functions, converts glucose to glycogen, produces clotting factors, and detoxifies drugs/alcohol
• Pancreas: secretes digestive enzymes, insulin, and glucagon

Assessment of Pain

• Assess tender areas last
• PQRST (Provocation, Quality, Radiation, Severity, Timing) to evaluate pain lasting more than 6 hours or waking patients up
• Palpate (touch) for tenderness or masses

Osteoporosis Risk Factors

• More common in women with smaller bone frames (white individuals)
• Smoking
• Calcium deficiency
• High salt intake
• Alcohol use
• Physical inactivity

Abduction vs Adduction

• Abduction: movement away from the body's center
• Adduction: movement toward the body's center

Mental Status Deterioration Symptoms

• Headache
• Weakness
• Blurred vision
• Impaired motor function
• Impaired speech
• Decreased level of consciousness (LOC)

Prostatic Hyperplasia (BPH)

• Enlargement of the prostate gland due to hormonal changes.
• Leads to urinary obstruction

Contraindications for Hormonal Contraceptives

• Nicotine intake should be avoided for patients over 35 using estrogen/progesterone
• Hormonal contraceptives may increase the risk of stroke or transient ischemic attack (TIA).

Ectopic Pregnancy

• Fertilization of an ovum outside the uterine endometrium
• Initial symptom mimicking early pregnancy

Newborn Reflexes

• Moro (startle reflex): response to sudden noise or feeling of falling
• Rooting reflex: turning the head toward stimulation of the cheek
• Stepping reflex: flexion and extension of legs in an apparent walking pattern
• Babinski reflex: hyperextension of toes when stroking the foot's sole

Respiratory Distress in Infants

• Grunting
• Nasal flaring
• Intercostal/subcostal retractions
• Increased work of breathing

Adolescent Sexual Activity Assessment

• Assessment of risk factors for sexually transmitted infections (STIs)

Normal Skin Assessment

• Skin warm, dry, intact, consistent with patient's ethnicity, no lesions noted

Tracheal Deviation Causes

• Pneumothorax
• Mass
• Atelectasis
• Pleural effusion
• Tension pneumothorax (requires immediate needle decompression)

Lung Consolidation (Pneumonia)

• Dull percussion over affected lung area
• Presence of wheezes, crackles, gurgles, and purulent sputum

Older Adult Medication Dosing Considerations

• Decreased renal/hepatic function affects medication metabolism/excretion
• Increased sensitivity to medications due to body composition changes

General Survey of Health Assessment

• Physical appearance (age, sex, LOC, skin color, facial features, body structure, symmetry, weight, stature)
• Mobility (gait, range of motion, assistive devices)
• Behavior (mood, affect, speech, dress, hygiene)

Assessing the Airway, Breathing, and Circulation (ABCs) in Emergencies

• Airway concerns (obstruction, stridor)
• Breathing assessment (effectiveness)
• Circulation assessment (hypotension, dysrhythmias, decreased cardiac output)

Performing a PERRLA Exam

• Inspect external eye structures (no ptosis, clear sclerae)
• Inspect pupil size (equal, round) reactivity to light and accommodation (PERRLA)
• Check for impaired vision
• Palpate external eye structures (no swelling or redness)

Assessing Cortical Sensory Function

• Stereognosis: identify objects in the palm with eyes closed
• Graphesthesia: identify numbers traced on the hand

Rapid Hand Movements

• Test cerebellar function (upper and lower extremities)

COPD Risk Factors

• Tobacco smoking