Immersion Exam NR 509

Immersion Exam NR 509 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.