Chapter 13: Head, Face, And Neck Flashcards
Questions to ask about headaches
Ask pts if they have any unusually frequent or unusually severe headaches?
RED FLAG: a severe headache in an adult or child who has never had it before
When is it NORMAL for the thyroid gland to enlarge?
During the third trimester during pregnancy
Aging adults
facial bones? skin? teeth?
- Facial bones and orbits are more prominent
- Facial skin sags due to decreased elasticity, decreased sub Q fat, and decreased moisture in the skin
- teeth may be missing, too
Tension headaches
- Common; regular
- Tend to be occipital, frontal, or with band like tightness
- Viselike
- Associated with anxiety or stress
Migraine headaches
- Tend to be supra orbital, retro-orbital, or frontotemporal
- Throbbing
- Pain is often severe
- Migraines often occur about twice a month, lasting 1 to 3 days
- Aggravating factors: alcohol, letdown after stress,menstruation, eating chocolate, eating cheese
- Usually had nausea, vomiting, visual disturbances
- sometimes associated with family history
- people tend to lie down to ease the pain
Symptoms of meningitis and encephalitis.
Nuchal rigidity and fever
Cluster headaches
- sudden; more often in males; go to the ER
- (Vascular)
- Produce pain around the eye, temple, forehead, and cheek
- Pain is always unilateral and always on the same side of the head
- Excruciating
- occur once or twice per day, each lasting 1/2 to 2 hours for 1 to 2 months..remission may last months or yrs.
- Associated with daytime naping and alcohol ingestion
- Eye reddening, eye drooping, rhino rhea, and nasal congestion
People with cluster headaches feel the need to move around and not lie down.
The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry. This finding would be related to which factor?
A. An increased loss of elastin and a decrease in subcutaneous fat in the elderly
B. An increase in elastin and a decrease in subcutaneous fat in the elderly
C. Increased numbers of sweat and sebaceous glands in the elderly
D. Increased vascularity of the skin in the elderly
A
A 70-year-old woman tells the nurse that every time she gets up in the morning or after she’s been sitting she gets “really dizzy” and feels like she is going to fall over. The nurse’s best response would be:
A. “I’ll refer you for a complete neurologic examination.”
B. “Have you been extremely tired lately?”
C. “You need to get up slowly when you’ve been lying or sitting.”
D. “You probably just need to drink more liquids.”
C. You need to get up slowly when you’ve been sitting or lying down
The nurse has just completed a lymph node assessment on a 60-year-old healthy female patient. The nurse knows that most lymph nodes in healthy adults are normally:
A. shotty.
B. not palpable.
C. large, firm, and fixed to the tissue.
D. rubbery, discrete, and mobile.
B. Not palpable
The nurse is examining a patient who tells the nurse, “I sure sweat a lot, especially on my face and feet but it doesn’t have an odor.” The nurse knows that this could be related to:
A. the apocrine glands.
B. a disorder of the stratum germinativum.
C. a disorder of the stratum corneum.
D. the eccrine glands.
D. The eccrine glands
Inspecting the face
Note the symmetry of eyebrows, palpable fissures, nasolabial folds, and sides of the mouth
Note any abnormal facial features
A patient comes to the clinic complaining of neck and shoulder pain and is unable to turn her head. The nurse suspects damage to cranial nerve (CN) _____ and proceeds with the examination by _____.
A. XII; assessing for a positive Romberg sign
B. XI; palpating the anterior and posterior triangles
C. XII; percussing the sternomastoid and submandibular neck muscles
D. XI; asking the patient to shrug her shoulders against resistance
D. XI; asking the patient to shrug her shoulders against resistance
When examining the eye, the nurse notices that the patient’s eyelid margins approximate completely. The nurse recognizes that this assessment finding:
A. may result in problems with tearing.
B. is expected.
C. may indicate a problem with extraocular muscles.
D. indicates increased intraocular pressure.
B. Is expected
Range of motion in the neck ( testing ROM)
Note any limited range of motion
Ask the person to touch chin to chest, touch each ear to shoulder without elevating shoulder, extend head back.
The neck should be supple, with smooth motion, and controlled
- if abnormal, may be arthritis
Range of motion in the neck ( testing muscle strenght)
Test the muscle strength of cranial nerve XI by having the patient shrug their shoulder while the examiner tries to resist
-as person moves the head, notice any enlargements of the salivary gland and lymph gland. should be no enlargements noticed.
Pulsations in the neck
Check for any Pulsations in the carotid artery, normally their are none while in a sitting position.
Abnormal findings of lymph nodes
Parotid is swollen with mumps
Parotid enlargement has been found with aids
Lymph nodes in the neck
Check the lymph nodes in the neck
Normally they are not palpable. and not tender
What is lymphadenopathy?
Enlargement of the lymph nodes (>1 cm) from infection, allergy, or neoplasm.
Cervical nodes
Cervical nodes are often palpable in a healthy person but lymph nodes are not supposed to be palpable
Normal nodes feel moveable, discrete, soft, and nontender
If nodes are palpable:note..
Note their location, size, shape, delimitation, mobility, consistency, and tenderness
Acute infection for nodes
Acute onset; < 14 days duration, nodes are bilateral,enlarged, warm, tender, and firm but freely moveable
Cancerous nodes
Are hard, >3 cm,unilateral, nontender, matted and fixed
Chronic inflammation for nodes
In tuberculosis,the nodes are clumped
Nodes with HIV infection
Enlarged, firm, nontender, and mobile. Occipital node enlargement is common
Other node enlargement
A single, enlarged, nontender, hard, left supraclavicular node (virchow’s node) may indicate neoplasm in thorax or abdomen.
Hodgkin’s lymphoma
Painless, rubbery, discrete nodes that gradually appear
Trachea abnormalities
Trachea is PUSHED to the unaffected side: with an aortic aneurysm, tumor, unilateral thyroid lobe enlargement, and pneumothorax
Trachea is PULLED toward the affected side: large atelectasis, pleural adhesions, or fibrosis
Trachea:
Trachea is midline: palpate for any tracheal shift
Displace the trachea in the sternal notch and note any deviations. Trachea should be symmetric, firm, mobile
Tracheal tug
Rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysm
Thyroid gland
Normally the thyroid is not palpable in an adult. If the person has a long, thin neck sometimes you’ll feel the isthmus over the tracheal rings. The lateral lobes usually are not palpable; check them for enlargement, consistency, symmetry, and the presence of nodules.
Auscultating the thyroid
If the thyroid is enlarged, auscultate it for the presence of a bruit. This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope. Bruits are ABNORMAL
The aging adult
arteries?
The temporal arteries may look twisted and prominent
Senile tremors: a mild rhythmic tremor of the head is normal, including head nodding and tongue protrusion.
Parkinson’s disease
A deficiency of the neurotransmitter dopamine and degeneration of the basal ganglia in the brain. The immobility of features produces a face that is flat and expressionless, with elevated eyebrows, staring gaze, oily skin, and drooling
-does not affect brain activity.
Aging adults
glands?
Dizziness is common, slow range of motion, prolapse of submandibular glands
Allergic salute and crease
The transverse line on the nose is a feature of chronic allergies. It occurs when the child chronically uses their hand to push the nose up and back to relieve itching and to free swollen turbinates, which allows air passage
Cushing syndrome
Excessive secretion of ACTH and chronic steroid use, the person develops a moonlike face, prominent jowls, red cheeks, hirsutism on the upper lip, lower cheeks, and chin; acne rash on the chest
Hyperthyroidism
Goiter is an increase in the size of the thyroid gland and it occurs with hyperthyroidism, Hashimoto’s thyroiditis,and hypothyroidism. Graves’ disease is the most common cause of goiters. Graves’ disease consists of bulging eyeballs (exophthalmos ). Symptoms include nervousness, fatigue, weightloss, muscle cramps, and heat intolerance.
Signs include: tachycardia, shortness of breath, excessive sweatiness, fine muscle tremor, thin silky hair and skin, infrequent blinking, and a staring appearance
A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse should suspect:
A. hypertension
B. cluster headaches
C. tension headaches
D. migraine
B. Cluster headaches
A patient has come in for an examination and states, “I have this spot in front of my ear lobe here on my cheek that seems to be getting bigger and is tender. What do you think it is?” The nurse notes swelling below the angle of the jaw and suspects that it could be an inflammation of his:
A. parotid gland
B. submental lymph node
C. occipital lymph node
D. thyroid gland
A. Parotid gland
The nurse has just completed a lymph node assessment on a 60-year-old healthy female patient. The nurse knows that most lymph nodes in healthy adults are normally:
A. rubbery, discrete, and mobile.
B. not palpable
C. large, firm, and fixed to the tissue.
D. shotty.
B. Not palpable
The physician reports that a patient with a neck tumor has a tracheal shift. The nurse is aware that this means the patient's trachea is: A. Pulled to the affected side B. Pushed to the unaffected side C. Pulled downward D. Pulled downward in a rhythmic pattern
B. Pushed to the unaffected side
After teaching a patient about management of migraine headaches, the nurse determines that the teaching has been effective when the pt says?
I will try to lie down someplace dark and quiet when the headaches begin.
When a pt is experiencing a cluster headache, the nurse will assess for
Unilateral eyelid swelling
expressions are formed by the facial muscles which are mediated by ____.
cranial nerve VII, the facial nerve
facial sensations of pain or touch are mediated by the three sensory branches of cranial nerve___.
V, the trigeminal nerve.
Is the thyroid gland palpable?
NO
The highest is the ___ bone, palpated high in the neck at the level of the floor of the mouth.
hyoid
The ____ are a major part of the immune system, whose job is to detect and eliminate foreign substances from the body.
lymphatics
Nodes are located throughout the body but are accessible to exam only in four area: ____. The greatest supply is in the ___.
head, neck , axillae and inguinal region.
head and neck
Subjective data includes?
Headache Head Injury Dizziness Neck pain, limitation of motion Lumps of swelliing History of head or neck surgery
loss of consciousness ____ a fall may have a cardiac cause (heart block)
before
light-headed, swimming sensation, feeling of falling
dizziness
true rotational spinning from neurologic diease
vertigo
vertigo is ____, the person feels like the room is spins
objective
vertigo is ____, the perception is that the person spins
subjective
acute onset of neck stiffness with headache and fever occurs with ____.
meningeal inflammation
difficulty swallowing
dysphaGia
A patient presents with excruciating headache pain on one side of his head, especially around his eye, forehead, and cheek that lasts about 1/2 to 2 hours, occurring once or twice each day. The nurse should suspect:
A. hypertension
B. cluster headaches
C. tension headaches
D. migraine
B
a mild rhythmic tremor of the head is normal, including head nodding and tongue protrusion.
senile tremors
