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Health Assessment > Head and Neck > Flashcards

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
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2
Q

inspect the face

A
  • Facial expression –> miserable, short of breath, etc
  • Symmetry
  • Note any involuntary movement –> a tick
  • Note any abnormal structures
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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)
  • Test CN VII (7) (motor)
    • Check movement and symmetry by having patient
      smile, frown, puff cheeks, show, teeth
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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
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5
Q

what does buildup of pressure do to the trachea?

A

shifts it

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6
Q

trachea

A
  • Midline
  • Palpate for deviation or
    shift
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7
Q

thyroid gland - posterior approach

A
  • Bend head slightly forward and to the right
  • Thyroid moves when swallowing
  • Palpate for lobe enlargement
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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
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9
Q

auscultation of the thyroid

A
  • If the thyroid is enlarged, auscultate it for a bruit
  • If present, heard best with the bell
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10
Q

head, face, and neck subjective data

A
  • headache, head injury, dizziness, neck pain or limitation of motion, lumps or swelling
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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
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12
Q

equipment and supplies for head and neck assessment

A
  • gloves – when touching scalp
  • small cup of water (for swallowing)
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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
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14
Q

preparation for eye exam

A

*Position the person standing for vision screening then sitting up with the head at your eye level

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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)
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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
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17
Q

near vision screening

A
  • Test for those over 40
  • Use a hand help vision screener with various sizes of print
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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.
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
  • 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
Q

cone of light in ears

A
  • 5 o clock (right)
  • 7 o clock (left)
26
Q

conductive hearing

A
  • transmission of sound thru external and middle ear
  • BC>AC
27
Q

perceptive/sensorineural hearing

A
  • transmission of sound waves in inner ear
28
Q

subjective data for ear

A
  • 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
Q

preparation for examination (ear)

A
  • 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
Q

equipment used for ears

A
  • tuning fork
  • otoscope
31
Q

inspect and palpate external ear

A
  • 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
Q

use of otoscope

A
  • 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
Q

hearing tests

A
  • 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
Q

weber tuning fork

A
  • should hear/feel it equally
  • bad ears = sound will go to bad ear
35
Q

rinne tests

A
  • put on mastoid behind ear and then when they stop hearing move it to in front of ear – normal is AC > BC
36
Q

subjective data for nose

A
  • Discharge
  • Frequent colds
  • Sinus pain
  • Trauma
  • Epistaxis –> bloody nose
  • Allergies
  • Altered smell –> could be indicative of illness
37
Q

subjective data for mouth and throat

A
  • 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
Q

equipment of mouth nose and throat

A
  • Gloves
  • 4 x 4-inch gauze pad
  • Penlight
  • Otoscope with short, wide-tipped speculum
  • Nasal speculum
  • Two tongue blades
39
Q

inspect and palpate the external nose

A
  • Note deformity, asymmetry,
    inflammation or skin lesions
  • Test nostril patency
40
Q

inspect and palpate nasal cavity

A
  • 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
Q

palpate sinus areas

A
  • 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
Q

inspect the mouth

A
  • 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
Q

inspect the throat (pharynx)

A
  • 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

Health Assessment (9 decks)

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