NR509 Advanced Physical Assessment Immersion Notes: Summary & Clinical Guide

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Summary Immersion Notes - NR509 / NR 509 (Latest

2025) : Advanced Physical Assessment - Chamberlain

1 inspection of face/head .....ANSWER.....note the face is

symmetrical without discoloration or lesions. next I inspect the

head noting it is midline and symmetrical.

2 palpating lymph nodes for tenderness and enlargement.

.....ANSWER.....begin with pre articular, in front of the ears, move

to postauricular, behind the ears. Then occipital, at the base of

the posterior scalp, the tonsils lymph nodes, near the angle of the

jaw. Then the submandibular and submental nodes. Next palpate

the anterior cervical and posterior lymph nodes. And lastly the

supraclavicular lymph nodes. Note that there is no swelling and

they are equal bilat.

3 Test cranial nerve #5 the trigeminal nerve.

.....ANSWER.....Motor component. I will palpate over the massiter

muscle while she clenches her jaw. Note distortions and strength.

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Sensory- I will have her close her eyes and tell me where I am

touching. (touch areas of face)

4 Test CN #7 facial nerve .....ANSWER.....I will have her do some

facial expressions. raise eyebrows, smile, frown, puff out cheeks,

pucker lips. Note symmetry and strength of these.

5 Inspect EARS .....ANSWER.....Look for swelling, redness, nodules,

symmetry. inspect the auditory canal for redness, clear, no

swelling, no drainage, no cerumen, Tympanic membrane pearly

gray, no effusion.

6 Palpate Ears .....ANSWER.....palp pinnas for nodules or

tenderness. palp tragus

7 Test CN #8 vestibulocochlear nerve .....ANSWER.....Perform

whisper test. cover one ear then the other. provider covers mouth.

8 Inspect EYES .....ANSWER.....Look at lids, conjunctiva- pink,

clear, no lesions, no drainag; sclera- white

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9 Test CN #2 Optic Nerve which controls central, peripheral

vision and pupil response .....ANSWER.....Snellen eye chart- have

pt cover one eye, read the lowest line, cover the other eye and

read lowest line, read lowest line with both eyes "20/20 in right,

left and both eyes." Test peripheral vision with hands at side of

head. "peripheral vision is intact". Check pupillary response to

light. "pupils are 2-3mm are reactive and appropriate response

to light"

10 Test CN #3 occulomotor, CN #4 Trochlear and CN #6

Abducens which control extraocular movement

.....ANSWER....."Follow my finger with just eyes# and move in "H"

pattern. "All EOMs intact"

11 Nose exam inspect .....ANSWER.....symmetrical and no

deformities. Use otoscope push nose to side and up. "Turbinates

mucous membranes are pink and moist. No bogginess no

drainage. not obstructed septum is straight"