Head and Neck Flashcards
1
Q
inspect and palpate the skull
A
- do at the same time
- Size and shape
- Symmetry
- Smoothness
- Temporal Area
- Temporal artery
- TM joint
2
Q
inspect the face
A
- Facial expression –> miserable, short of breath, etc
- Symmetry
- Note any involuntary movement –> a tick
- Note any abnormal structures
3
Q
inspect and palpate the neck
A
- Symmetry
- Head is midline
- Accessory muscles are midline
- Range of Motion (chin to chest, ear to shoulder)
- Note limitation of movement
- Test muscle strength by ROM against resistance (CN
V (5) motor)
- Sensation (neurological)
- Touch face with wisp of cotton and ask where they
felt it (CN V sensory)
- Touch face with wisp of cotton and ask where they
- Test CN VII (7) (motor)
- Check movement and symmetry by having patient
smile, frown, puff cheeks, show, teeth
- Check movement and symmetry by having patient
4
Q
lymph nodes
A
- Have patient sit comfortably/bend the head slightly toward the side being palpated to relax muscles in the area.
- Face patient and conduct the assessment of both sides simultaneously.
- Palpate the nodes using a circular motion
- Palpate the 9 groups (see page 145)
- Note the following
- size & shape
- tenderness & location
- delimitation—lymph node position
- mobility
- consistency
- presence of surrounding inflammation
5
Q
what does buildup of pressure do to the trachea?
A
shifts it
6
Q
trachea
A
- Midline
- Palpate for deviation or
shift
7
Q
thyroid gland - posterior approach
A
- Bend head slightly forward and to the right
- Thyroid moves when swallowing
- Palpate for lobe enlargement
8
Q
thyroid gland - anterior approach
A
- Alternate method of palpating
- Awkward to perform
- Tilt head forward and to the right
- Displace trachea to the person’s right
- Palpate for lobe enlargement
9
Q
auscultation of the thyroid
A
- If the thyroid is enlarged, auscultate it for a bruit
- If present, heard best with the bell
10
Q
head, face, and neck subjective data
A
- headache, head injury, dizziness, neck pain or limitation of motion, lumps or swelling
11
Q
preparation for examination
A
- Client
- greet the patient
- upright position
- visualize underlying structures
- always compare right and left sides
- use same systematic approach each time
- Environment
- ensure warm area
- quiet room
- light in room to ensure adequate observation
12
Q
equipment and supplies for head and neck assessment
A
- gloves – when touching scalp
- small cup of water (for swallowing)
13
Q
subjective data for eyes
A
- vision difficulty (decreased, acuity, blurring, blind spots)
- pain (always bad)
- strabismus, diplopia
- redness, swelling
- watering, discharge
- history of ocular problems
- glaucoma
- use of glasses or contacts
- patient-centered care
- cataracts – fogginess over lens
14
Q
preparation for eye exam
A
*Position the person standing for vision screening then sitting up with the head at your eye level
15
Q
equipment and supplies for eyes
A
- Snellen (More letters) or E-chart (just Es. concerned w/ direction of legs of E)
- Hand-held near vision screener
- Penlight
- Eye cover—opaque cards (also use hands)
- Ophthalmoscope
- Gloves (in case something is draining)
16
Q
test central visual acuity
A
- Controlled by cranial nerve II (optic)
- Snellen Chart (stand 20 ft from wall chart)
- Leave glasses on
- Shield one eye at a time
- Ask person to read the smallest line of letters possible
- The top number indicates the distance from the chart (20) and the bottom number gives the distance at which a normal eye could read that particular line
17
Q
near vision screening
A
- Test for those over 40
- Use a hand help vision screener with various sizes of print
18
Q
test visual fields
A
- Screens for a loss in peripheral vision
- Eye Cover test
- Client covers one eye. Examiner covers eye directly
opposite - Position yourself directly in front of client 2 feet away.
- Eyes should be level.
- Have client look directly into your eye.
- The patient covers one eye with an opaque card as you
cover the opposite eye (you are testing the uncovered eye) - Slowly bring your wiggling finger in from the periphery in several directions
- Ask the client to tell you when finger can be seen
- You and the client should see your fingers at the same
time. - Repeat on opposite side.
- Client covers one eye. Examiner covers eye directly
19
Q
inspect extraocular muscle fxn – corneal light reflex
A
- Assesses the parallel alignment of the eye axes
- Shine a light at the bridge
of the nose from 12 in away - Note where the reflection of light falls on the corneas
- It should be in the exact spot on each eye
- muscular fxn problem if light doesn’t shine in the same spot in both eyes
20
Q
diagnostic positions test
A
- Have the person hold their
head steady and follow the
movement of your finger - From 12 inches away, move
it to each of the six positions - Progress clockwise
21
Q
inspect external ocular structures
A
- General
- Ability to move around the room
- Facial expression
- Eyebrows
- Symmetry
- Scaling or lesions
- Eyelids & lashes
- Skin intact
- Redness, swelling, discharge, or lesions
22
Q
inspect external ocular structures cont
A
- Eyeballs
- Aligned normally in their sockets
- Note protrusions or sunken appearance
- Conjunctiva & Sclera
- Moist & glossy
- Clear
- White
- Note color change, swelling, or lesions
- Lacrimal Apparatus
- Note redness or swelling
23
Q
inspect anterior eyeball structures
A
- Cornea and lens
- Shine a light to check for smoothness & clarity
- Iris & pupil
- Pupillary light reflex
- Direct: shining the light in directly in one eye
- Consensual: what the other eye does
- Pupillary light reflex
- Accommodation: have item –> start out come in and see if they converge
- PEERLA
- Pupils equal, Round, React to Light and Accommodation
24
Q
opthalmascopic exam
A
- Ocular Fundus
- Optic disc
- Retinal vessels
- Background of the fundus
- Macula
25
cone of light in ears
- 5 o clock (right)
- 7 o clock (left)
26
conductive hearing
- transmission of sound thru external and middle ear
- BC>AC
27
perceptive/sensorineural hearing
- transmission of sound waves in inner ear
28
subjective data for ear
* Earache: otitis or otitis media
* Infections
* Discharge: amt, odor, color, consistency
* Hearing loss: how did it happen? when? why?
* Environmental noise
* Tinnitus: ringing in ears. did it come out of nowhere and did it last a long time
* Vertigo: equilibrium dizziness. could be neurological or ear problem
* Patient-centered care
29
preparation for examination (ear)
- Sitting up straight with head at the examiner’s eye level
- May to clean out the ear canal if there is a large amount of cerumen (ear wax)
30
equipment used for ears
- tuning fork
- otoscope
31
inspect and palpate external ear
- Size, shape, & alignment
- Skin condition
- Tenderness
- external auditory meatus
* Note swelling, redness, drainage, discharge
- inspect with otoscope
- up and back for adults and down and back for children
- external canal
- note swelling, redness, drainage, discharge
- tympanic membrane
- color: pearly gray
- cone of light
32
use of otoscope
* use largest speculum that can be inserted without causing pain
* tip client’s head away from you
* adults---auricle upward and backward
* children---auricle downward
* insert speculum gently
* vary angle at which you insert speculum
33
hearing tests
* Hearing Acuity
* Pure tone audiometer
* Assesses the ability to hear sounds of varying frequency
* Whispered voice test
* 1-2 feet behind
* Whisper 3 random numbers and letters
* Tuning fork tests
* Weber
* Rinne
34
weber tuning fork
- should hear/feel it equally
- bad ears = sound will go to bad ear
35
rinne tests
- put on mastoid behind ear and then when they stop hearing move it to in front of ear – normal is AC > BC
36
subjective data for nose
* Discharge
* Frequent colds
* Sinus pain
* Trauma
* Epistaxis --> bloody nose
* Allergies
* Altered smell --> could be indicative of illness
37
subjective data for mouth and throat
* Sores or lesions (fever blisters, cold sores, etc)
* Sore throat
* Bleeding gums (indicative of illness, blood disorders, brushing teeth)
* Toothache (when? what happened before that)
* Hoarseness
* Dysphagia
* Altered taste
* Smoking (diff sense of taste)
* Alcohol consumption (affect how things look inside and taste)
* Patient-centered care
38
equipment of mouth nose and throat
- Gloves
- 4 x 4-inch gauze pad
- Penlight
- Otoscope with short, wide-tipped speculum
- Nasal speculum
- Two tongue blades
39
inspect and palpate the external nose
* Note deformity, asymmetry,
inflammation or skin lesions
* Test nostril patency
40
inspect and palpate nasal cavity
* Inspect using a wide-tipped
speculum
* Note swelling, discharge,
bleeding, or foreign body
* Observe for septum deviation (shouldn't have a hole)
* Inspect condition of turbinates
* Note presence of polyps
* Assess smell (CN I) by having the patient close their eyes and identify a familiar smell
41
palpate sinus areas
- press the frontal and maxillary sinuses
- note reports of pain and discomfort
- no sound just presence of pain or not
- transillumination
- no current evidence to support this technique
- healthy sinuses do not illuminate
- take flashlight, shine in mouth, and look @ sinuses
- if you have problems, they will illuminate
42
inspect the mouth
- Lips: Note color, moisture, cracking, lesions
- Teeth & gums: Note any that are missing, diseased, or loose
- Tongue: Observe surface for color, surface characteristics, & moisture (move the tongue)
- Buccal mucosa: Observe for color, nodules or lesions
- Palate (hard & soft): Note color, smoothness, and mobility
- Observe the uvula
- Observe for gag reflex
- Note speech
43
inspect the throat (pharynx)
- Tonsils: Note surface characteristics, color, indentations
- Grade
- 1+ Visible
- 2+ Halfway between
tonsillar pillars & uvula (sore throat. have trouble swallowing)
- 3+ Touching the uvula
- 4+ Touching one another
