Ch 12: Head And Neck With Vision And Hearing Basics Flashcards
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
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
What do the facial muscles enable (allow basic movements)
Facial muscles allow
- chewing
- smiling
- frowning
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
What blood supply components can you find in the head and neck
Carotid artery
Temporal artery
Enteral and internal jugulars
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
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
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
Give the three portions of the neural pathway to the CNS
- Optic nerves
- Optic chiasm
- Optic trucks
What is the complex function of hearing
The complex function of hearing is sound
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)
Give the five structures of the head (what its commonly referred to as)
1. Eyes
- ears
- nose
- mouth
- throat - brain
When assessing the head shape and size what is the specific word you use to describe it
Normocephalic
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
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
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)
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
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
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
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
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
What are the thyroid hormones and what do they control
Thyroid hormones are T3 and T4 that control the metabolic rate
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
What do tender warm And palpable lymph nodes mean
If tender and warm there is an infection of a lymph node
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 :
- muscles are rigid
- decreased reflexes
- 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
- Epidural hematoma
- Subarachnoid bleed
- 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
- the R. Subclavian
2. Thoracic duct
When collecting subjective data what are assessment risk factors
(3 broad)
- personal history
- Medication
- 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
- Activity intolerance
- Fatigue
- Chronic pain
- 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
- Allow rest period before activity
2. Small short term activity goals
