A few conditions of the head and neck Describe each 1. Acromegaly 2. Hydrocephalic 3. Puffy moon face

1. Excessive growth hormone causing thick skin and facial bones 2. Excessive CSF causing cranium enlargement 3. Cushing syndrome

Ch 12: Head And Neck With Vision And Hearing Basics Flashcards by Alyssa Quintela

How many bones is the facial skeleton composed of

and what a soft organs does it contain and support EEN(M)T

Fish skeleton is composed of 22 bones

Contains and supports

eyes
eyes
nose
mouth
throat

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What do the suture lines in the facial bones join together

Name the 3 sutures and where they are

The suture lines join the facial bones together, there’s 3

coronal
sagittal
lambdioidal

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What do the facial muscles enable (allow basic movements)

Facial muscles allow

chewing
smiling
frowning

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What are the two major neck muscles what do they make up and go to the serve as

What is the major blood vessel found in the anterior posterior triangle

Two major neck muscles are 1.sternocleidomastoid
2. Trapezius

Make up the anterior posterior triangle that is used as a landmark when assessing Neck

Carotid is found in between the anterior posterior triangle

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What blood supply components can you find in the head and neck

Carotid artery
Temporal artery
Enteral and internal jugulars

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What are the cranial nerves that you can test in the head and neck (broad category)

Give name and test

CN v: trigeminal - sense test (dull or sharp)

Cn vii: facial- mimicking facial movements

Cn xi: accessory- neck movement and rom

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What does the CN v trigeminal nerve supply, and where does it apply it to

Trigeminal nerve supplies motor and sensory innervation to forehead and cheeks

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Give a brief breakdown of the process of vision (five total steps)

Light enters cornea
Bent into central fovea (macula)
Object inverted reversed and focused on to retina
4 simulation sent through visual pathway to brain
Image converted to original form

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Give the three portions of the neural pathway to the CNS

Optic nerves
Optic chiasm
Optic trucks

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What is the complex function of hearing

The complex function of hearing is sound

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Give us your body systems that the structures of the head and neck interact with

Integumentary(skin), neurological (CN), respiratory (trachea), vascular (arteries),
GI, lymphatic (lymph nodes), endocrine (thyroid)

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Give the five structures of the head (what its commonly referred to as)

1. Eyes

ears
nose
mouth
- throat
brain

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When assessing the head shape and size what is the specific word you use to describe it

Normocephalic

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A few conditions of the head and neck
Describe each

Acromegaly
Hydrocephalic
Puffy moon face

Excessive growth hormone causing thick skin and facial bones
Excessive CSF causing cranium enlargement
Cushing syndrome

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What do you look at when doing a head assessment from the mouth down

Note nasal labial folds (symmetrical?)
Note skeletal structure
    -muscles
    -blood supply: external/internal               carotid arteries 
Salivary glands (3types) 
   1. parotid:top 1/2 by molars
   2. Submandibular
   3. Sublingual

Note TMJ
- no any resistance, crepitus, pain, tenderness

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When doing a head assessment what are the cranial nerves you test for (2 specific one related to head, not to include eyes)

Give number give name give what they test

CN v: Trigeminal-Sharp or dull 4 QUAD
- test sensory (sharp/dull) and motor (TMJ)

CN vii: facial- mimic faces
-test sensory (peppermint gum on ea side of tongue) and motor (mimic faces)

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When doing a neck assessment what is the cranial nerve you test and how do you test it

CN xi: accessory - shrug shoulder/ ROM

Apply resistance to shoulders have patient shrug
turn head v resistance
Range of motion of neck

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When doing a neck assessment what landmark do you note

What are the components of the landmark

What is palpable within the landmark

Note the anterior posterior triangle composed of the sternocleidomastoid and trapezius muscle

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Where is the trachea in relation to the thyroid and what are you noting about the trachea

The trachea is under the thyroid and you are noting if it is midline also noting the Cricoid Cartilage for any pain or discomfort/ midline

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What is an important aspect of the neck assessment to note (extra structure related to endocrine system) and how do you assess it

The thyroid is vital to the neck assessment you asses by having your fingers over patients throat and have them swallow

Go behind patient have them look forward tilt it down and turn all the way to the right palpate thyroid then turn all the way to the left palpate thyroid

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What shape is a butterfly and we’re in your palpating as patient swallows what are you palpating

Thyroid is butterfly shaped with two lobes

As the patient swallows when you’re palpating with two fingers you are palpating the isthmus

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What are the thyroid hormones and what do they control

Thyroid hormones are T3 and T4 that control the metabolic rate

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What is a normal finding when palpating the thyroid gland (say it as if you were doing assessment)

If I were gland normally should be non-palpable but symmetric with no masses

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What do tender warm And palpable lymph nodes mean

If tender and warm there is an infection of a lymph node

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What are characteristics of a cancer is lymph node that need immediate investigation (include numberical size)

If a lymph node is + 1CM, fixed (doesn’t move) hard non-tender and or rubbery There needs to be immediate evaluation for cancer

When you were searching for tracheal deviation and you note tracheal deviation what else do you see and what does it indicate When is the diagnosis especially notable

If noted tracheal deviation you will also see cyanosis and shortness of breath because a patient is experiencing an emergency tension pneumothorax Especially if patient involved in MVC

How many pairs of parathyroid glands do we have what do they produce what do they secrete and what are normal findings

We have two pairs of parathyroid glands embedded in thyroid gland lobes they produce PTH Secrete calcium and calcitonin Normal findings are nonpalpable

How do you know to suspect a meningitis alert

If the patient comes in complaining of a headache, has a fever, and nuchal rigidity there is a meningitis alert

How many lymph nodes do we have in the head and neck and what bigger system are they part of other than lymphatic

80 lymph nodes total that are part of the immune system

What is the purpose of lymph notes and where do they drain too

They filter potential pathogens and drain fluid that moves out of the circulation into the: - right subclavian - thoracic duct

How do you know if a node is going upstream Instead of down like it’s supposed to

The note will be enlarged( inflamed)

What are normal age related findings to find in older adults (4things ) Facial structure Mouth Eyes normal finding Ears

- more prominent bony structures (face) - tooth loss - Glare intolerance - thickened eardrums

What is a Abnormal finding in older adults in relation to Parkinson’s

Abnormal: a mask like facial appearance where : 1. muscles are rigid 2. decreased reflexes 3. a shuffling gate

Why are skin lesions more likely in older adults

Because of thinning skin making tears highly likely

In what area of skin do you carefully want to search for skin cancer in your older population

In areas that are commonly exposed to sun

What to disease processes are more common as you get older and only increase with age

Hypo and hyper thyroidism

Give all related information for hypo thyroidism When it’s an emergency what the patient’s labs will look like and what findings will you see

Myexedema is an emergency ⬆️TSH (+5) ⬇️T3 (under 80)/T4 (under 5) Findings: ⬆️CO2⬇️O2

Give all related information for hyperthyroidism Including when it’s an emergency , labs you’ll see in the patient, findings you’ll see in the patient, and what it poses an increased risk for

Thyroid storm (graves dis) = emergency Labs ⬇️TSH (below 0.3)⬆️T3 (+200) /T4(+12) Findings * tachycardia * diarrhea - anxiety - fever - weakness Hyper thyroidism poses an increased risk for thyroid tumors

What are normal TSH lab findings

0.3-5

What are normal T3 findings

80-200

What are normal T4 findings

5.0-12

give four instances you would perform in Urgent Assessment In relation to head and brain injury

1. Trauma 2. Epidural hematoma 3. Subarachnoid bleed 4. Traumatic brain injury

How does an epidural hematoma present and how do you fix it

Epidural hematomas present with bleeding around protective layer around brain skull Fixed with burr hole craniotomy

What does a subarachnoid bleed present with Describe no injury (cause) Describe when injury (how it develops)

Subarachnoid bleed present with severe sudden onset headache No injury : caused by aneurysm Injury: after a fall patient won’t remember but headache gets so bad that they come to the ER

If a patient has a acute head or neck injury what do you do and what are you wait for to ensure no damage

With a cute head or neck injuries you immobilize (aka stabilize) the C-spine Until cross lateral x-ray ensures there is no damage

If there is an acute head injury What status change are you noting what is the acronym used to assess alertness and what does it stand for

With a cute hand injuries you’re noteing a mental status change Acronym is AVPU Stands for alert to verbal, pain, or unconscious

How do you know to be alert for meningitis when a patient comes to the ER

If patient has a headache, fever, and nuchal rigidity be alert for meningitis

How do you know to differentiate a possible cardiac situation From meningitis What do cardiac situations present with

Cardiac situations have no fever or headache Present with referred pain to left arm jaw or neck

How do you know to suspect if a lymph node is cancers

Upon inspection if lymph node is palpable, + 1CM, fixed (does not move) hard, rubbery

How do you know to suspect for infection in lymph nodes

If lymph node is palpable, TENDER, warm

What are you check for if a patient comes in complaining of otitis media (middle ear infection) or pharyngitis

Check the post and preauricular nodes to see if warm, tender, palpable

If excess fluid moves out of the circulation where does the lymphatic system drain it back into

1. the R. Subclavian | 2. Thoracic duct

When collecting subjective data what are assessment risk factors (3 broad)

1. personal history 2. Medication 3. Family history

When collecting subjective data what personal history is relevant to risk factors for the head and neck

Any head injuries (falls) or spontaneous injuries like a subarachnoid bleed

When collecting subjective data What medications are relevant to the assessment of risk factors

Synthroid and anything containing iodide

When collecting subjective data what is Relevant family history information in relation to the assessment of risk factors 1 relates to throid

Any history of cancer, hypo/hyper thyroidism

For the head and neck how do you reduce injury risk Primary

PRIMARY PREVENTION Use a helmet, seatbelt, car seats

For the head and neck how do you prevent thyroid disorder complications Tertiary

TERTIARY PREVENTION Receive treatment

For the head and neck how do you Facilitate early detection of masses or malignant nodes

SECONDARY PREVENTION Follow up with annual screenings

What is an important fact in relation to pregnant women for migraines

Pregnant women suffer more migraines because of hormonal changes

What is the percentage of women who suffer from an enlarged thyroid postpartum

5 to 10% of women suffer in a large thyroid postpartum

What is a common assessment finding in children ages 1 to 5 among there lymph nodes that is not a cause for concern

In children 1 to 5 It is common to find a palpable node that is nontender and freely movable

Give a few common head and neck symptoms And quick facts about them

Headache, neck pain -Head injury, CVA, meningitis, MI, migraines Limited neck movement -range of motion no extremity numbness or sensory loss Hypo/hyper thyroidism Sleepiness

If a patient has facial drooping and has undergone a mental status change what are you assessing for and what is the acronym you use to assess

With facial DROOPING and a mental status change assess for CVA Use FAST F facial symmetry A alert and oriented S slurred speech T time of onset (only have 3 hrs for thrombolytic)

Give the major lymph nodes in the head or neck | Two have other names and 2 of them added

*Preauricular *Postauricular *submandibular *Submental *Tonsillar (AKA Retropharyngeal) *Anterior cervical (AKA sub maxillary) *Posterior cervical deep *Occipital *Supraclavicular infra clavicular

What does it mean if your submandibular lymph nodes are enlarged

Means in mouth/throat inflammation

What is the exact position of your posterior cervical lymph node

Behind sternocleidomastoid

If you palpate a LEFT supraclavicular note what is it associated with and what is the other name

Palpating a LEFT supraclavicular note is associated with gastric and lung cancer Other name : verclause note

Starting head assessment what are you expecting

``` Inspect head symmetry -no noted the deformities, symmetrically bilateral Assess hair and scalp -no noted lesions or masses -scalp intact -no noted pedicosis -no noted areas of alopecia -no breakage at ends -no noted hair loss facial symmetry --eyebrows, eyelashes, Eyes, ears, nose, nasal labial folds, mouth ``` Trachea -mIDLINE Thyroid -no Goiter present

When do you auscultate a thyroid and for what

Only if patient has a goiter | For a bruit with the bell

What are you always wanna wear when inspecting the scalp

Gloves because of pediculosis, nits

What areas of the body should you use cultural considerations when examining that are based on genetics

- skin color - Eye shape - nose - lips

Who is TSH secreted by

The anterior pituitary gland

If there is a neck injury or head trauma what are a few diagnostic test s you would run

City, MRI, lumbar puncture (meningitis), 3 thyroid labs

What are nursing diagnosis related to head and neck

1. Activity intolerance 2. Fatigue 3. Chronic pain 4. Knowledge deficit related to new diagnosis

What are outcomes related to the head and neck

Patient verbalizes increased energy | Pain goals are met

What are nursing interventions we can do for head and neck

1. Allow rest period before activity | 2. Small short term activity goals