CLASS 2 - HEENT Flashcards
HEENT
- Head
- Ears
- Eyes
- Nose
- Throat
HEENT ASSESSMENT FACTORS
- Skull
- Face
- Neck
- Thyroid
- Regional lymphatics
- Blood supply
- Eyes and ears
SUBJECTIVE DATA ASSESSMENT
- Past medical history
- Family history
- Health maintenance
- Personal and social
COMMON/CONCERNING HEAD ASSESSMENT SYMPTOMS
- Headache
- History of head injury
COMMON/CONCERNING EYE ASSESSMENT SYMPTOMS
- Injury
- Visual disturbances
- Spots (scotomas)
- Flashing lights
- Use of corrective lenses
- Pain
- Redness
- Excessive tearing
- Double vision
COMMON/CONCERNING EAR ASSESSMENT SYMPTOMS
- Ringing (tinnitus)
- Hearing loss
- Pain
- Discharge
COMMON/CONCERNING NOSE ASSESSMENT SYMPTOMS
- Drainage (rhinorrhea)
- Congestion
- Sneezing
- Nose bleeds (epistaxis)
COMMON/CONCERNING OROPHARYNX ASSESSMENT SYMPTOMS
- Soreness
- Gum bleeding
- Hoarseness
COMMON/CONCERNING NECK/THYROID ASSESSMENT SYMPTOMS
- Lumps
- Pain
- Stiffness
- Temperature intolerance
- Excessive sweating
HEAD INJURY PREVENTION
- Decrease head injuries (concussion identification, use of seat belts/helmets)
- Reduce fall injures (playground safety, home safety)
ORAL HEALTH PREVENTION
- Decrease dental caries and periodontal disease)
- Increase detection of oral pharyngeal cancers
- Decrease use of tobacco products that increase risk for oral cancer
- Increase number of people receiving dental and oral care
HEAD INSPECTION ASSESSMENT
- Symmetry
- Hair distribution, quantity
- Scalp: scaling, nevi (separate hair)
- Skull: size and contour
- Face: expression, contours
- Skin: color, pigmentation, hair distribution, lesions
HEAD PALPATION ASSESSMENT
- Hair texture
- Skull: lumps, tenderness
- Face: sinuses
- Skin: texture, temperature
- TMJ
- Temporal arteries
NOSE/SINUSES INSPECTION ASSESSMENT
- Anterior and interior surface: asymmetry or deformity
- Inside of nose using otoscope: mucosa color, swelling bleeding, exudate, polyps
- Inside of nose using otoscope: septum deviation, inflammation, perforation
NOSE/SINUSES PALPATION ASSESSMENT
- Palpate frontal and maxillary sinus with circular motions for tenderness, inflammation, or pain
MOUTH/PARYNX INSPECTION ASSESSMENT FACTORS
- Lips
- Oral mucosa
- Gums and teeth
- Roof of mouth
- Tongue and floor of mouth
- Pharynx: soft palate, anterior and posterior pillars, uvula, tonsils, pharynx
LIP INSPECTION ASSESSMENT
- Color
- Moisture
- Lumps
- Ulcers
- Cracking
ORAL MUCOSA INSPECTION ASSESSMENT
- Color
- Ulcers
- Nodules
GUMS AND TEETH INSPECTION ASSESSMENT
- Color
- Presence/position of teeth
- Color of gums
- Bleeding gums
ROOF OF MOUTH INSPECTION ASSESSMENT
- Color
TONGUE AND FLOOR OF MOUTH INSPECTION ASSESSMENT
- Color
- Texture
- Ulcers
- Nodules
PHARYNX INSPECTION ASSESSMENT
- Color
- Symmetry
- Presence of exudate
- Swelling
- Ulceration
- Tonsillar enlargement
TONSIL GRADING SCALE
- +1: Tonsils are visible
- +2: Tonsils are between the pillars and the uvula
- +3: Tonsils are touching uvula
- +4: One or both tonsils extend to the midline of the oropharynx
NECK INSPECTION ASSESSMENT FACTORS
- Symmetry
- Masses
- Scars
- Enlarged lymph nodes
- Position and alignment of trachea
- Symmetry of thyroid gland
NECK PALPATION ASSESSMENT FACTORS
- Lymph nodes: pre auricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, supraclavicular
- Thyroid gland
LYMPH NODE PALPATION ASSESSMENT
- Gentle, circular motion using finger pads
- Size
- Shape
- Delimitation
- Mobility
- Consistency
- Tenderness
PREAURICULAR LYMPH NODE ANATOMY
- Front of the ear
POSTERIOR AURICULAR LYMPH NODE ANATOMY
- Superficial to the mastoid process
OCCIPITAL LYMPH NODE ANATOMY
- At the base of the skull
TONSILLAR LYMPH NODE ANATOMY
- Under the angle of the mandible
SUBMANDIBULAR LYMPH NODE ANATOMY
- Halfway between the angle and the tip of the mandible
SUBMENTAL LYMPH NODE ANATOMY
- Midline, behind the tip of the mandible
SUPERFICIAL CERVICAL LYMPH NODE ANATOMY
- Overlying the sternomastoid muscle
POSTERIOR CERVICAL LYMPH NODE ANATOMY
- In the posterior triangle along the edge of the trapezius muscle
DEEP CERVICAL CHAIN LYMPH NODE ANATOMY
- Deep under the sternomastoid muscle
SUPRACLAVICULAR LYMPH NODE ANATOMY
- Just above and behind the clavicle
THYROID GLAND PALPATION ASSESSMENT
- Posterior approach: stand behind patient and have them swallow
- THYROID SHOULD NOT BE PALPABLE
- Consistency
- Masses
- Tenderness
EAR INSPECTION ASSESSMENT
- Auricle & ear canal for lesions
- Signs of infection
- Tympanic membrane for landmarks, fluid
EAR PALPATION ASSESSMENT
- Auricle for tenderness with movement
- Mastoid bone behind ear
EAR WHISPER ASSESSMENT
- Palpate and move tragus slightly
- Two syllabus word whispered in other ear
EAR AIR AND BONE CONDUCTION ASSESSMENT
- Weber: strike sound, hold on head between ears (lateralization of sound? - conduction loss)
- Rinee: comparing time of air vs. bone conduction
T/F: Air conduction > bone conduction
- True
OTITIS MEDIA
- Fluid or infection in the middle of the ear
OTITIS EXTERNA
- Fluid or infection on the outside of the ear
STRABISMUS
- One eye goes the opposite way (lazy eye)
PTOSIS
- Drooping eyelid that covers more than 50% of the eye
SNELLEN EYE CHART ASSESSMENT
- Person 20 feet from the chart (or 6 feet from card)
- Cover one eye and read smallest line of letters possible
- Example: 20/30 -1 with glasses
- Person missed one letter (can only have 2 misses on a line)
- Can read at 20 feet what normal eye can see from 30 feet away
VISUAL FIELDS (CONFRONTATION) EYE ASSESSMENT
- Tests patient’s peripheral vision
- Stand in front of patient and look directly into provider eyes
- Wiggle fingers in bowl-like pattern that covers all fields
EXTRAOCULAR MOVEMENTS (EOM’S) EYE ASSESSMENT
- Eyes coordinated by 6 muscles and 3 cranial nerves (III, IV, VI)
- Patient look forward only moving eyes
- “H” pattern
- Look for eyes moving in parallel fashion and nystagmus (beats of the eye)
CORNEAL LIGHT REFLEX EYE ASSESSMENT
- Tests for alignment of eyes
- Patient look forward and shine light 12” away
- Reflection of light on corneas should be the same spot in each eye
COVER/UNCOVER EYE ASSESSMENT
- Assesses for weak muscles in eye
- Straight ahead as one eye is covered
- Uncovering the eye it should still be parallel to the other eye
DIRECT AND CONSENSUAL EYE ASSESSMENT
- Tests sensory paths controlled by cranial nerve III
- Bright light to see pupil constriction (direct)
- Shine light again on same eye and watch other eye (consensual)
ACCOMMODATION EYE ASSESSMENT
- Assessing muscles of the lens
- Look at distant object (pupils dilate)
- Shift gaze to your finger held 3 inches from their eyes (pupils constrict)
PERRLA
- Pupils Equal and Round, Reactive to Light and Accommodation
RED REFLEX EYE ASSESSMENT
- Test for reflection of light off the inner retina
- Shine opthalamascope in eye and see red
- If no red is seen, could mean retinal detachment
