Head and Neck

Question 1

Framework of the head is the skull; divided into 2 subsections:

Answer 1

the cranium and the face.

Question 2

Facial bones give shape to the face: consists of __ bones

Answer 2

14

➢Maxilla (2)
➢Zygomative (cheek) (2)
➢Inferior conchae (2)
➢Nasal (2)
➢Palatine
➢Vomer (1)
➢Mandible (jaw) (1)

Question 3

Structure located in the facial region:

Answer 3

➢Parotid gland
➢Mandibular salivary gland

Question 4

Composed of muscles, ligament and the cervical vertebrae

Answer 4

The Neck

Question 5

______________________ and
_________ muscles allow movement and provide
support to the head and neck.

Answer 5

STERNOMASTOID and Trapezius

Question 6

muscles rotates and flexes the
head,

Answer 6

Sternocleidomastoid

Question 7

muscle extends the
head and moves the shoulders.

Answer 7

Trapezius

Question 8

The eleventh cranial nerve is responsible for muscle
movement that permits shrugging of the shoulders
by the

Answer 8

tapezius muscles

Question 9

turning the head
against resistance by the

Answer 9

stemomastoid muscles.

Question 10

located under the mandible, anterior to
the stenomastoid muscle.

Answer 10

Anterior triangle

Question 11

locate between trapezius and
sternomastoid muscles.

Answer 11

Posterior triangle

Question 12

located in the
posterior neck and support the cranium.

Answer 12

Cervical Vertebrae

Question 13

Internal jugular veins and carotid arteries – located bilaterally, parallel
and anterior to the sternomastoid muscles.
➢It is important to avoid bilaterally compressing the carotid arteries when
assessing the neck, as bilateral compression can reduce the blood supply to
the brain.

Answer 13

BLOOD VESSELS

Question 14

argest endocrine gland
produces thyroid hormones that increase metabolic rate

Answer 14

THYROID GLAND

Question 15

through which air enters the lungs is composed of: C
shaped hyaline cartilage rings

Answer 15

TRACHEA

Question 16

first upper tracheal ring, has small notch in it.

Answer 16

Cricoid cartilage

Question 17

larger and located just above the
cricoid cartilage

Answer 17

Thyroid cartilage (“Adam’s apple”)

Question 18

is attached to the tongue, lies above the thyroid
cartilage and under the mandible.

Answer 18

➢ Hyoid bone

Question 19

filter lymph, a clear substance composed mostly of
excess fluids, filtering removes bacteria and tumor cells from lymph.
➢Produce lymphocytes and antibodies as a defense against invasion by
foreign substances.
➢Not palpable or they may feel like very small beads.
➢If the nodes become overwhelmed by microorganisms, as happens with
an infection they swell and become painful
➢If cancer metastasizes to the lymph nodes, they may enlarge but not
painful.

Answer 19

• Lymph nodes

Question 20

Post auricular
Tonsillar
Occipital
Submandibular

Answer 20

Pre-auricular

Question 21

Superficial cervical
Posterior cervical
Deep cervical
Supraclavicular

Answer 21

Submental

Question 22

Describe how it feels

Answer 22

Character:

Question 23

Did it begin after some sternous activity, exercise,

accident or a direct injury?

Answer 23

Onset:

Question 24

Does it radiate to the back, arms or shoulders?

Answer 24

Location:

Question 25

How long does it last? Does it come and go?

Answer 25

Duration:

Question 26

Are you able to continue your daily schedule and sleep at night?

Answer 26

Severity:

Question 27

Does it tend to occur more with exercise or stress? Are there any activities that relieve it or make it worse?

Answer 27

Pattern:

Question 28

Do you have any limitation of movement of your head or neck or arms with this pain? Do you have any numbness or tingling with it? Do you experience headaches?

Answer 28

Associated factors:

Question 29

Describe any previous head or neck problems (trauma, injury, falls) you have had * How were they treated (surgery, medication, physical therapy) * What were the results? * Have you ever undergone radiation therapy for a problem in your neck region?

Answer 29

Past Health History

Question 30

Do you find that you have headaches when you take any of the following medications? * Is there a history of head or neck cancer in your family? * Is there a history of migraine headaches in your family?

Answer 30

Family History

Question 31

* Do you smoke or chew tobacco? If yes, how much? * Do you use alcohol or recreational drugs? Describe the type used and how much?

Answer 31

Lifestyle and Health Practices

Question 32

Examining the head allows the nurse to evaluate the overlying protective structures (cranium and facial bones) * This examination can detect head and facial shape abnormalities, asymmetry, structural changes or tenderness. * Assists the nurse to detect enlarged or tender lymph nodes * Thyroid enlargement, nodules masses or tenderness may be detected by palpating the thyroid gland.

Answer 32

Physical Examination

Question 33

Instruct the client to remove any wig, hat, hair ornaments, pins, rubber bands, jewelry, and head or neck scarves.

Answer 33

Preparing the client

Question 34

➢Take care to consider cultural norms for touch assessing the head. Some cultures, prohibit touching the head or touching the feet before touching the head.

Answer 34

Cultural Considerations

Question 35

Ask the client to sit in an upright position with the back and shoulders held back and straight * Explain the importance of remaining still during most of the inspection and palpation of the head and neck. * Explain the need for the client to move and bend the neck for examination of muscles and for palpation of the thyroid gland.

Answer 35

Preparing the Client

Question 36

Inspect the neck. Observe the client’s slightly extended neck for position, symmetry and lumps or masses. Shine a light from the side of the neck across to highlight any swelling. * Neck is symmetric, with head centered and without bulging masses. * Swelling, enlarged masses – or nodules – may indicate an enlarged thyroid gland, inflammation of lymph nodes, or a tumor.

Answer 36

The Neck

Question 37

The thyroid cartilage and cricoid cartilage move upward symmetrically as the client swallows.

Answer 37

Normal Findings THE NECK

Question 38

Asymmetric movement generalized enlargement of the thyroid gland is considered abnormal. -

Answer 38

Abnormal Findings - THE NECK

Question 39

C7 (vertebrae prominens) usually visible and palpable. OLDER ADULT CONSIDERATIONS In older clients, cervical curvature may increase because of kyphosis of the spine. Moreover, fat may accumulate around the cervical vertebrae (especially in women). This is sometimes called a “dowager’s hump.”

Answer 39

Normal Findings The Neck

Question 40

Prominence or swelling other vertebrae may be abnormal.

Answer 40

Abnormal Findings the neck

Question 41

Palpate the trachea. Place you finger in the sternal notch. Feel each side of the notch and palpate the tracheal rings. The first upper ring above the smooth tracheal rings is the cricoid cartilage.

Answer 41

PALPATION

Question 42

Trachea is midline Landmark are positioned midline. Unless the client is extremely thin with a long neck, the thyroid gland is usually not palpable. However, the isthmus may be palpated in midline, if the thyroid can be palpated, the lobes are smooth, firm, and nontender. The right lobe is often 25% larger than the left lobe. OLDER ADULT CONSIDERATIONS If palpable, the older client’s thyroid may feel more nodular or irregular because of fibrotic changes that occur with aging; the thyroid may also be felt lower in the neck because of age-related structural changes.

Answer 42

Normal Findings Palpation

Question 43

The trachea may be pulled to the affected side in cases of large atelectasis, fibrosis or pleural adhesions, the trachea is pushed to the unaffected side in cases of a tumor, enlarged thyroid lobe, pneumothorax, or with an aortic aneurysm. Landmark are positioned midline. In cases of diffuse enlargement, such a hyperthyroidism, graves’ disease, or an endemic goiter, the thyroid gland may be palpated. An enlarged, ender gland may result from thyroiditis. Multiple nodules of the thyroid may be seen in metabolic processes. However, rapid enlargement of a single nodule suggests a malignancy and must be evaluated further.

Answer 43

Abnormal Findings Palpation

Question 44

Ask the client to swallow as you palpate the right side of the gland. Reverse the technique to palpate the left lobe f the thyroid.

Answer 44

Neck Assessment Procedure

Question 45

Glandular thyroid may be felt rising underneath your fingers. Lobes should feel smooth, rubbery and free of nodules. - Neck Normal Findings

Answer 45

Coarse tissue or irregular consistency may indicate an inflammatory process. Nodules should be described in terms of location, size and consistency. - Neck Abnormal Findings

Question 46

Auscultate the thyroid only if you find an enlarged thyroid gland during inspection or palpation. Place the bell of the stethoscope over the lateral lobes of the thyroid gland. Ask the client to hold his or her breath (to obscure any tracheal breath sounds while you auscultate).

Answer 46

AUSCULTATION

Question 47

No bruits are auscultated.

Answer 47

Normal Findings - Auscultation

Question 48

A soft, blowing, swishing sound auscultated over the thyroid lobes is often head in hyperthyroidism because of an increase in blood flow through the thyroid arteries.

Answer 48

Abnormal Findings

Question 49

▪ Normally lymph nodes (LN) \, round and smaller than 1 cm are not palpable. ▪ In older clients, the LN become fibrotic fatty and smaller because of loss f lymphoid elements related to aging

Answer 49

Clinical tip * When palpating the LN note the following: ➢Size and shape

Question 50

Lymphadenopathy-lymph node enlargement (exceeds 1 cm), may be cause by infection an autoimmune disorder, or metastatic disease.

Answer 50

Lymphadenopathy

Question 51

normally lymph node delimitation (the LN’s position or boundary) is discrete. ▪ In chronic infection, LN’s become confluent ▪ In acute infection, they remain discrete.

Answer 51

➢Delimitation

Question 52

normal LN is soft, abnormal LN is hard and firm, unilateral node are seen with metastic cancers

Answer 52

➢Consistency

Question 53

not sore or tender

Answer 53

Normal LNs

Question 54

LNs are tender and enlarged

Answer 54

▪ Acute infection

Question 55

After collecting the assessment data, identify abnormal findings and client strengths using diagnostic reasoning.

Answer 55

Analysis of Data

Question 56

Readiness for Enhanced health management: Requests assistance and information on how to quit smoking.

Answer 56

Health promotional diagnosis:

Question 57

risk for Injury to head and neck related to poor posture.

Answer 57

Risk Diagnosis:

Question 58

Ineffective gear during contact sports or slat belt while driving or riding as a passenger.

Answer 58

Actual Diagnosis:

Question 59

TENSION HEADACHE Dull, tight, diffuse MIGRAINE HEADACHE Accompanied by nausea, vomiting and sensitivity, to noise or light.

Answer 59

CHARACTER

Question 60

No problem stage: may occur with stress, anxiety or depression May have prodromal stage (visual, disturbances, vertigo, tinnitus, numbness or tingling of fingers or toes), maybe precipitated by emotional disturbances; anxiety, or ingestion of alcohol, cheese, chocolate, or other foods & substances to which client is sensitive.

Answer 60

ONSET

Question 61

Usually located in frontal, temporal or occipital region Located around eyes, temples, cheeks or forehead; may affect only one side of the face.

Answer 61

LOCATION

Question 62

Lasts days, months or years Lasts up to 3 days

Answer 62

DURATION

Question 63

Aching Throbbing, severe

Answer 63

SEVERITY

Question 64

Symptomatic relief may be obtained by located heat, massage, analgesics, antidepressant and muscle relaxants. REST may bring relief

Answer 64

PATTERN

Question 65

Affect women more often than men Occur more often in women

Answer 65

ASSOCIATED FACTORS