Assessment of Head and Its Structures Flashcards
part of a human body which
includes the ears, brain, forehead, cheeks,
chin, eyes, nose, and mouth, each of which
aid in various sensory functions such as
sight, hearing, smell, and taste,
THE HEAD
Parts of the Head
- ## Ears
MAJOR SENSORY ORGANS IN THE HEAD:
The outer, middle, and inner ear are
responsible for collecting auditory
information. Responsible for hearing and balance
Ears
MAJOR SENSORY ORGANS IN THE HEAD:
- valuable sense organ that gives us the ability to see.
- It allows for light perception and vision, including the ability to differentiate between colors and depth.
Eyes
MAJOR SENSORY ORGANS IN THE HEAD:
- contains the teeth, tonsils, and tongue.
- 2 main functions: Eating and speaking
- Three nerves (facial, glossopharyngeal, and vagus) sends taste information to the brain and interpreted.
- The tongue enables speaking; its movement inside the mouth helps form sounds that become words.
Mouth
MAJOR SENSORY ORGANS IN THE HEAD:
- Responsible for smelling
- Olfactory nerves in your upper nasal cavity send messages to your brain to help you distinguish an infinite number of smells.
- Gateway to Respiratory System, the body’s
system for breathing
Nose
NORMAL SKULL AND FACE CHARACTERISTIC: Size, shape and
symmetry
- fiounded (normocephalic)
- Symmetrical
- Smooth skull contour
DEVIATION FROM NORMAL SKULL AND FACE CHARACTERISTIC: Size, shape and
symmetry
- Lack of symmetry (asymmetry)
- Increased skull size
NORMAL SKULL AND FACE CHARACTERISTIC: Nodules, masses
and depressions
- Smooth, uniform in consistency
- Absence of nodules or masses
DEVIATION FROM NORMAL SKULL AND FACE CHARACTERISTIC: Nodules, masses
and depressions
- Sebaceous cysts
- Local deformities from trauma
- Masses and nodules
NORMAL SKULL AND FACE CHARACTERISTIC: Facial features
- Symmetrical
- Palpebral fissures equal in size
- Symmetrical nasolabial folds
DEVIATION FROM NORMAL SKULL AND FACE CHARACTERISTIC: Facial features
- Asymmetrical
- Exophthalmos
- Myxedema facies
- Moon face
NORMAL SKULL AND FACE CHARACTERISTIC: Eyes
No edema
DEVIATION FROM NORMAL SKULL AND FACE CHARACTERISTIC: Eyes
- Periorbital edema
- Sunken eyes
NORMAL SKULL AND FACE CHARACTERISTIC: Symmetry of facial movements
Symmetric facial movements
DEVIATION FROM NORMAL SKULL AND FACE CHARACTERISTIC: Symmetry of facial movements
- Asymmetric facial movements
- Drooping of lower eyelid and mouth
- Involuntary facial movements
THE EXTERNAL EYE Structures
- eyelids
- conjunctiva,
- lacrimal apparatus,
- cornea,
- anterior chamber
Parts of the Eyes External
- Eyelid
- Pupil
- Sclera
- Iris
Parts of the Eyes Internal
- Cillary Body
- Cornea
- Iris
- Lens
- Sclera
- Retina
- Choroid
- Optic Nerve
ASSESSMENT OF THE EYE Includes
▪External eye structure
▪Visual fields
▪Extra ocular muscle test
▪Visual acuity
ASSESSMENT OF THE EYE EQUIPMENT
▪ Cotton tip applicator
▪Gauze pad
▪Clean gloves
▪Millimeter ruler
▪Penlight
▪Snellen’s or Echart
▪Opaque card
ASSESSMENT OF THE EYE: Eyebrows
▪ Hair distribution and alignment
▪Symmetry
▪Skin quality
▪movement
ASSESSMENT OF THE EYE: Eye lashes
▪ Evenness of distribution
▪Direction of curl
ASSESSMENT OF THE EYE: Eye lids
▪ Surface characteristics
▪Position in relation to cornea
▪Ability to blink and frequency of
blinking
▪Lesions/ edema / stye /
signs of infection
ASSESSMENT OF THE EYE: Bulbar and palpebral conjunctiva
▪ Color
▪Texture
▪Presence of lesions
ASSESSMENT OF THE EYE: Lacrimal gland, lacrimal sac and nasolacrimal duct
▪ Edema
▪ Tenderness
▪ Evidence of tearing
ASSESSMENT OF THE EYE: Cornea
▪ Clarity and texture
▪ Perform corneal
sensitivity test
ASSESSMENT OF THE EYE: Pupils
▪ Color
▪ Shape
▪ Symmetry of size
▪ PERLA (pupils are round and react to light and accommodation)
ASSESSMENT OF THE EYE: VISUAL FIELDS Normal
When looking straight ahead, client can see objects in the periphery
ASSESSMENT OF THE EYE: VISUAL FIELDS DEVIATION FROM NORMAL
- Visual fields smaller than the normal
- One half vision in on or both eyes
ASSESSMENT OF THE EYE: EXTRA OCULAR MUSCLE TEST NORMAL
Both eyes coordinated, move in unison, with parallel alignment
ASSESSMENT OF THE EYE: EXTRA OCULAR MUSCLE TEST DEVIATION FROM NORMAL
- eye movements not coordinated or parallel
- Strabismus (cross eye)
- Nystagmus
ASSESSMENT OF THE EYE: VISUAL ACUITY Normal
- Near Vision: Able to read newsprint/ magazine
- Distant Vision: (Snellen’s Chart) 20/20 vision on Snellen’s type chart
ASSESSMENT OF THE EYE: VISUAL ACUITY DEVIATION FROM NORMAL
- Difficulty reading newsprint
- Denominator of 40 or more on Snellen-type chart with corrective lenses
REFRACTIVE ERRORS
▪Myopia
▪Hyperopia
▪Presbyopia
▪Astigmatism
IDENTIFY THE REFRACTIVE ERRORS
- Nearsightedness
Myopia
IDENTIFY THE REFRACTIVE ERRORS
- Farsightedness
Hyperopia
IDENTIFY THE REFRACTIVE ERRORS
- Loss of elasticity of the lens and thus
loss of ability to see close objects
Presbyopia
IDENTIFY THE REFRACTIVE ERRORS
- An uneven curvature of the cornea
that prevents horizontal and vertical rays from focusing on the retina
Astigmatism
Inflammation of the bulbar and palpebral conjunctiva
CONJUNCTIVITIS
Inflammation of the lacrimal sac
DACRYOCYSTITIS
fiedness, swelling and
tenderness of the hair follicle
HORDEOLUM (STY)
Inflammation of the iris
IRITIS
“Black eye” resulting from
injury
CONTUSION or HEMATOMA
Opacity of lens and its
capsule
CATARACTS
A disturbance in the
circulation of aqueous fluid
which causes an increase in
intra ocular pressure
GLAUCOMA
FUNCTIONS OF THE EAR
Hearing and Balance
FUNCTIONS OF THE EAR: Hearing
The eardrum vibrates when sound
waves enter the ear canal and pass vibrations to the oval window, which is a membrane at the entrance to the inner ear.
FUNCTIONS OF THE EAR: Balance
Balance is achieved through a
combination of the sensory organ in the inner ear, visual input, and information received from receptors in the body, especially around joints.
ASSESSMENT OF THE EAR Includes
▪Auricle
▪external ear canal
▪Tympanic membrane
▪Hearing acuity
ASSESSMENT OF THE EAR Techniques used
Inspection and Palpation
ASSESSMENT OF THE EAR EQUIPMENT
- Otoscope
- Ear specula
- Clean gloves
AURICLE(INSPECTION): Color Normal
- Same as facial skin
AURICLE(INSPECTION): DEVIATION FROM
NORMAL Color
- Cyanosis
- Pallor
- excessive redness
AURICLE(INSPECTION): NORMAL Symmetry of size
Symmetrical
AURICLE(INSPECTION): Symmetry of size DEVIATION FROM NORMAL
Asymmetrical
AURICLE(INSPECTION): Position NORMAL
Auricle aligned with outer cantus of eye
about 10 degree from vertical
AURICLE(INSPECTION): Position DEVIATION FROM NORMAL
Low set ears
AURICLE(PALPATION): Texture elasticity
and areas of tenderness NORMAL
- Mobile, firm and non tender
- Pinna recoils after it is folded
AURICLE(PALPATION): Texture elasticity
and areas of tenderness DEVIATION FROM
NORMAL
- Lesions
- Flaky, scaly skin
- Tenderness
EXTERNALEAR AND TYMPANICMEMBRANE CHARACTERISTIC: Normal External
ear canal
- Distal third contains hair follicles and
glands
EXTERNALEAR AND TYMPANIC MEMBRANE CHARACTERISTIC: DEVIATION FROM NORMAL External ear canal
- redness and discharge
- Scaling
EXTERNALEAR AND TYMPANIC MEMBRANE CHARACTERISTIC: NORMAL Cerumen
- Dry cerumen
- Grayish tan color
- Sticky wet cerumen in various shades of brown
EXTERNALEAR AND TYMPANIC MEMBRANE CHARACTERISTIC: DEVIATION FROM
NORMAL Cerumen
- Excessive cerumen
- Obstructing canal
EXTERNALEAR AND TYMPANIC MEMBRANE CHARACTERISTIC: NORMAL Tympanic
membrane (color and gloss)
- Pearly gray color
- semitransparent
EXTERNALEAR AND TYMPANIC MEMBRANE CHARACTERISTIC: DEVIATION FROM
NORMAL Tympanic membrane (color and gloss)
- Pink to red
- Some opacity
- Yellow amber or deep red dull surface
GROSS HEARING ACUITY TESTS
- Watch tick test
- Whisper test
- Tuning fork tests
Tuning fork tests
- Weber’s test
- Rinne test
WATCH TICK TEST
*With eyes closed, the patient should be instructed to acknowledge hearing the gentle rubbing of the examiner’s fingers approximately 3-4 inches away from his right and left ear.
*A watch, which the examiner can hear at a specific distance from his ear, is placed next to the patient’s ear. Ask him to note when the watch sound disappears. Note that the examiner has to have normal hearing to do this exam (in at least one ear).
WATCH TIC TESTS Normal Findings
*In a quiet room, the patient should be able to hear the physician’s fingers rubbed lightly together 3-4 inches from his ear.
WATCH TIC TESTS With aging
- Progressive bilateral presbycusis (old hearing): Sensory neural loss
- Difficulty appreciating consonants
Whisper Voice Test
- stand an arm’s length away
(approximately 2 ft.) behind the patient. - cover ear of patient that is not being tested by putting their finger over the tragus.”
- take a deep breath and exhale fully
before whispering the number-letter
combination. - Have the patient repeat what they hear.
- If the patient successfully repeats,
move on to testing the other ear. - If the patient is unsuccessful, reattempt
testing with a different number-letter-
number combination. If a patient gets 3
total letters and/or numbers correct
after a second attempt, it is considered
a pass. - Remember to document the results.
Whisper Voice Test Normal Findings
Patient repeats sequence correctly
Whisper Voice Test Abnormal Findings
4 of the 6 possible numbers and letters are incorrect.
AUDITORY ACUITY TEST Identification
- test for lateralization.
- uses tuning fork
Weber test
WEBER’S TEST NORMAL
Sound is heard in both ears or is localized at the center of the head (Weber negative)
WEBER’S TEST ABNORMAL
- Bone conductive hearing loss
- Sensory neural disturbances
(Weber positive)
AUDITORY ACUITY TEST Identify
- evaluates hearing loss by comparing air conduction to bone conduction.
Notes: Air conduction hearing
occurs through air near the ear.
Rinne Test
RINNE TEST Normal
- AC > BC
- Positive fiinne
RINNE TEST abnormal
- BC > AC
- BC = AC
- Negative fiinne
ASSESSMENT of NOSE AND SINUSES Techniques
Inspection and Palpation
ASSESSMENT of NOSE AND SINUSES EQUIPMENT
❑Nasal speculum
❑Penlight
❑Clean gloves
❑Gauze pads
ASSESSMENT OF THE NOSE
▪ Inspect nose for any deviations in: shape, size, color, flaring or discharges from nares
▪Lightly palpate the external nose for: tenderness, masses, and displacement of bone and cartilage
▪Determine patency of both nasal cavities
▪ Inspect the nasal cavities using nasal speculum. Observe mucosa for redness, swelling, growths and discharges
▪Inspect the nasal septum between the nasal chambers
▪Palpate the maxillary and frontal sinuses for tenderness
ASSESSMENT of MOUTH AND OROPHARYNX Techniques
▪ Inspection
▪ Palpation
ASSESSMENT of MOUTH AND OROPHARYNX Techniques EQUIPMENT
▪ Clean gloves
▪ Tongue depressor
▪ Gauze pads
▪ Penlight
LIPS AND BUCALMUCOSA
(INSPECTION): NORMAL Outer Lips
Symmetry, contour, color, texture and
ability to purse lips
- Uniform pink color, soft, moist and smooth
- Symmetrical
- Able to purse lips
LIPS AND BUCALMUCOSA
(INSPECTION): DEVIATION FROM
NORMAL Outer Lips Symmetry,contour, color, texture and ability to purse lips
- Pallor, cyanosis
- Blisters, swelling, scaling
- Inability to purse lips
LIPS AND BUCALMUCOSA
(INSPECTION): NORMAL Inner Lips and
Buccal Mucosa
- Color, moisture, texture and
presence of lesions
- Uniform pink color, soft, moist
and smooth - Glistening and elastic texture
LIPS AND BUCALMUCOSA
(INSPECTION): DEVIATION FROM NORMAL Inner Lips and Buccal Mucosa
- Color, moisture, texture and
presence of lesions
- Pallor, leukoplakia (white patches), red, bleeding
- Ixcessive dryness
- Mucosal cysts, irritation from dentures
- Abrasions, ulcerations, nodules
TONGUE/FLOOR OF THE MOUTH
(INSPECTION): NORMAL Position, color,
texture
- Central position
- Pink color
- Smooth, lateral margins
- No lesions
- fiaised papillae (taste buds)
TONGUE/FLOOR OF THE MOUTH
(INSPECTION): DEVIATION FROM NORMAL Position, color, texture
- Deviated from venter
- fied tongue
- Dry, furry tongue (fluid deficit)
- White coating (yeast infection)
- Nodules, ulcerations, ulcerations, tenderness
TEETH AND GUMS (INSPECTION): Normal
- 32 adult teeth
- Smooth, white, shiny tooth enamel
- Pink gums
- Moist, firm texture of gums
- No retraction of gums
TEETH AND GUMS (INSPECTION): DEVIATION FROM NORMAL
- Missing teeth, ill fitting dentures
- Brown/black discoloration of enamel (Dental caries)
- Excessively red gums
- Bleeding
- Swelling
- Tenderness
TONGUE/FLOOR OF THE MOUTH
(INSPECTION/PALPATION)
- Inspect tongue
movement - Inspect base of tongue,
mouth floor & frenulum - Palpate tongue and floor
of mouth
TONGUE/FLOOR OF THE MOUTH
(INSPECTION/PALPATION): Normal Findings
- Moves freely
- No tenderness
- No palpable nodules
TONGUE/FLOOR OF THE MOUTH
(INSPECTION/PALPATION): DEVIATION FROM NORMAL
- Swelling
- Ulcerations
- nodules
SALIVARY GLANDS (INSPECTION): Normal Salivary duct openings
- Same as color of buccal mucosa and
floor of the mouth
SALIVARY GLANDS (INSPECTION): DEVIATION FROM NORMAL Salivary duct openings
- Inflammation (redness and swelling)
Inspect PALATES AND UVULA
▪ Inspect the hard and soft palate: color, shape, texture and presence of bony prominences
▪Inspect the uvula: position and mobility
OROPHARYNX (INSPECTION): Normal Color and texture
Pink, smooth posterior wall
OROPHARYNX (INSPECTION): DEVIATION FROM NORMALColor and texture
- fieddened and edematous
- Presence of lesions
Tonsils (INSPECTION): Normal Color
Discharge Size
- Pink color
- Smooth texture
- No discharge
- Normal size
Tonsils (INSPECTION): DEVIATION FROM
NORMAL Color Discharge Size
- Inflamed
- Presence of discharge
- Swollen
Inspection of Gag Reflex: Normal
it is Present
Inspection of Gag Reflex: Abnormal
Absent of Gag reflex
ASSESSMENT NECK Includes:
▪Neck muscles
▪Lymph nodes
▪Trachea
▪Thyroid gland
▪Carotid arteries and jugular vein
NECK ASSESSMENT TECHNIQUES
❑ Inspection
❑ Palpation
❑ Auscultation
ASSESSMENT of NECK MUSCLES
▪ Inspect the neck muscles
▪ Observe head movements:
▪ Assess the muscle strength
ASSESSMENT of LYMPH NODES
Palpate the entire lymph node for enlargement
- Preauricular
- Parotid
- Posterior Auricular
- Occipital
- Tonsilar
- Submandibular
- Submental
- Superficial Cervical
- Posterior Cervical
- Supraclavicular
TRACHEA(PALPATION): Normal Lateral deviation
Central placement in midline of neck
TRACHEA (PALPATION): DEVIATION FROM
NORMAL Lateral deviation
Deviation on one side (Neck tumor, thyroid or lymph node enlargement)
THYROID GLAND (INSPECTION/PALPATION) Normal
- Not visible on inspection
- Lobes may not be palpated
- Not enlarged
- No nodules/masses
THYROID GLAND (INSPECTION/PALPATION) DEVIATION FROM NORMAL
- Local enlargement
- Inlarged
- Solitary nodules/masses
