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Nursing Fundamentals/Assessment > Head and Neck > Flashcards

Head and Neck Flashcards

1
Q

Inspect head and scalp for

A

tilt, tremor

size, shape (molding), symmetry, lesions, trauma

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2
Q

Inspect facial features for

A 
symmetry
shape 
unusual features 
tics
characteristic faceis
pallor/pigmentation
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3
Q

Palpate head and scalp for

A

symmetry, tenderness (sinuses)
scalp movement
sutures, fontanels
hair texture, color distribution

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4
Q

Auscultate the temporal arteries for

A

thickening, hardness and tenderness

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5
Q

Inspect and palpate the…

A

salivary glands

and check for infant head cricumference

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6
Q

Inspect neck for the following

A

tracheal position
tracheal tug
movement of hyoid bone and cartilage
lymph nodes

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7
Q

Palpate thyroid gland for

A 
consistency 
size 
shape 
configuration 
tenderness 
nodules 
auscultate for bruits if gland is enlarged 
ROM of neck
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8
Q

Skulls is composed of seven fused bones

A

Frontal: 2 bones
Parietal: 2 bones
Temporal: 2 bones
Occipital: 1 bone

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9
Q

What are the three facial cavities

A

eyes, nose and mouth

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10
Q

Face bones

A 
frontal 
nasal 
zygomatic 
ethmoid
lacrimal 
sphenoid 
maxillary 
madible (movable)
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11
Q

What cranial nerves innervate the muscles of the fave

A

CN V and VII

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12
Q

Salivary Glands

A

Produce saliva - moisten, prevent caries and intiate digestion of carbs

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13
Q

Three paired glands

A

Parotid
Submandibular
Sublingual

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14
Q

Structure of the neck formed by

A

cervical vertebrae
ligaments
SCM muscles
trapezium muscle

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15
Q

Posterior triangle consists of

A

trapezius
SCM
clavice

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16
Q

Anterior triangle consists of

A

medial border of SCM

madible

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17
Q

Neck contains

A 
trachea 
esophagus 
internal and external jugular veins 
common carotid 
internal and external carotid arteries 
thyroid
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18
Q

Thyroid

A

largest endocrine gland
T3 - thyroxine
T4 - triiodothyronine

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19
Q

Infants

A

Bones are soft and separated by sutures
sutures ossify (6-18 years)
Fontanels close (2 months - 2 years)
Skull is molded when infant is exiting the birth canal
resumes normal shape and size within first few days
Ossification of sutures begins after brain growth at about 6y/o

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20
Q

Male Adolescent Changes during Childhood

A

Nose and thyroid cartilage enlarge

Facial hair appears on upper lip

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21
Q

Pregnant women

A

Euthyroid state
Increase in renal clearance of iodine
thyroid enlarges to produce sufficient hormones
Adequate iodine intake (200mcg/day) will not cause thyroid to change in size

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22
Q

Older Adults

A

T4 production and degradation decreases

Thyroid gland becomes fibrotic

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23
Q

HPI: Head injury

A

independent observer description
state of conciousness after injury - immediately, 5 minutes after, combative, alert or dazed
predisposing factors-epilepsy, hypoglycemia, syncope
associated symptoms - head or neck pain, laceration, local tenderness, change in breathing pattern, diplopia, discharge, n/v, incontinence, ability to move extremeties
medications

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24
Q

HPI: Headache

A

onset - time of day?
duration - relieved by medication or sleep, clusters
location - entire head, neck, sinus, behind eyes,
character
severity
visual prodone - scotoma, hemianopia, decreased vision or blindess
pattern - awakens patient, worse in evenings?
change in LOC
associated symptoms
precipitating factors - alcohol, fever, fatigue, food, stress, allergies, menstrual cycle, sexual, oral contraceptives, caffeine
treatment efforts medications

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25
HPI: Stiff neck
neck injury or stain, head injury, swelling fever, bacterial or viral character - limited ROM, pain with movement, pain relieved by movement, radiating predisposing factors - unilateral vision, hearing loss, work position efforts to treat - heat or PT
26
HPI: thyroid problems
Change in temperature preference swelling of neck - dysphagia, redness, pain with touch, change in texture of hair, skin and nails change in emotional stability - mood or energy increased prominence of eyes (exopthalmus) tachycardia, palpitations change in menstrual flow change in bowel habits medications: thyroid preparations
27
PMHx
head trauma, subdural hematoma, recent lumbar puncture radiation treatment around head and neck Headaches: migraines, vascular surgery for tumor, goiter seizure disorder thyroid dysfunction
28
FH
headaches: type, character | thyroid dysfunction
29
Personal and Social
Employment risks stress injury risks nutrition - intolerances, skipping meakls use of alcohol, street, recreational drugs sports played, weight training, new activities, use of productive padding and helmet if necessary
30
Hx for infants
prenatal hx - maternal use of drugs, uterine abnormalities, treatment of hyperthyroidism birth hx - firstborn usually torticollis, c-section, difficult delivery, unsual head shape - bulging or flattening head control acute illness - diarrhea, vom, fever, limited head movement, irritability (meningitis) congenital abnormalities - craniofacial, microcephaly neonatal screening for hypothyroidism -
31
Hx for pregnant women
Gestation or postpartum duration presence of preexisting conditions hx of pregnancy -induced HTN use of alcohol or recreational drugs
32
Hx for older adults
Dizziness with head or neck movement | weakness or impaired balance
33
Inspection of head and face
``` facial features facial asymmetry tics spasms, tremor? - horizontal jerking or bobbing head position and shape - upright and still skull size and shape scalp hair pattern ```
34
Palpation of head and face
``` skull symmetric and smooth scalp movement hair texture temporal arteries temporomandibular (TMJ) joint salivary glands ```
35
Percussion and Auscultation
Percussion is not routinely performed | Auscultation is only used for bruits in cerebral aneurysm or temporal arteritis
36
Neck
``` muscle symmetry alignment of trachea landmarks of triangles fullness at base of neck masses webbing unusual shortness asymmetry carotid artery prominence JVD ROM ```
37
Palpation of Neck
tracheal alignment smoothness and tenderness of hyoid bone, thyroid cartilage, cricoid cartilage tracheal tugging (possible aortic aneurysm) Cardarelli sign Lymph nodes
38
Inspection of thyroid gland
symmetry and swallowing symmetry
39
palpation of thyroid gland
size and shape configuration and consistency tenderness nodules
40
Auscultation of thyroid gland
If enlarged, auscultate for vascular sounds | A hypermetabolic state increases blood supply and soft rushing sound (vascular bruit) may be heard
41
Examination in infants
``` head circumference head symmetry and shape fontanels scalp scaling or crusting, dilated scalp veins hair and hairline cephalhematoma head control, position and movement ```
42
Inspection of infants
facial features, symmetry | neck symmetry, size and shape
43
Palpation of infants
suture lines and fontanels - sites of fusion should not be palpable after 6 months, sagittal suture may be felt craniotabes: softening of the outer table of the skull neck muscle tone and masses trachea thyroid goiter Scalp should move freely over skull c no tender, swelling or depression
44
Transillumination
Inspect skull of infants for possible lesions or rapidly increasing head circumference A ring of 2cm or less (or 1cm at occiput) Any larger will indicate excess fluid or decreased brain tissue in the skull
45
Palpation in children
Can be performed with one finger Bruits common up to age 5 Thyroid may or may not be palpable
46
Examination of pregnant women
inspect for chloasma - dark brown "confetti" blotches on face Palpate for hypertrophy of thyroid Auscultate for thyroid bruit
47
Examination in older adults
facies - facial distortions sunken eyelids, loose and wrinkled evaluate ROM for pain or crepitus or jerkiness Palpate thyroid for nodules or abnormalities Thyroid will be more fibrotic Feels nodular an irreguar
48
Abnormalities of the head
``` Classic migraine Common migraine cluster hypertensive muscular tension temporal arteritis ```
49
Abnormalities of thyroid
Hypo-, hyperthyroidism | Myxedema - skin disorder
50
Graves disease
Autoimmune, antibodies go to TSH, leading to overactive thyroid
51
Hashimoto disease
Autoimmune antibodies AGAINST thyroid causing hypothyroidism
52
Thyroid isthmus
lies across the trachea below the cricoid cartilage A pyramidal lobe extends upward from isthmus and slightly to the left of midline present in about 1/3 of population
53
Head bobbing may indicate?
aortic insufficiency if nodding is synchronized c a pulse
54
Unilateral hearing loss indicator
``` holding the head tilted to one side to favor good eye or ear or torticollis (excessive contraction of SCM) ```
55
Facies
edema, bruising, coarsened features, exophthalmos (eye-bulging), hirsutism, lack of expression, excessive perspiration, pallor or pigmentation
56
When facial asymmetry is present....
Note whether features on one side of the face are affected or one portion such as forehead, lower face or mouth. Facial nerve paralysis when entire side of the face is affected and suspect facial nerve weakness when lower face is affected Mouth problem? peripheral trigeminal nerve
57
Tics
spasmodic muscular contractions of the face, head or neck | Possibly psychogenic or Tourette's
58
Alopecia
hair loss Bitemporal recession of hair or balding at the crown is common in men Hair loss in younger girls may be d/t tight braiding Fungal infection of scalp may be tinea capitis
59
Palpation of salivary glands
check for asymmetry or enlargement fixed, movable, soft, hard, tender or nontender Have pt open mouth to express material through ducts
60
Stenson duct
is the parotid duct that opens into the mouth next to the maxillary second molar tooth
61
Submandibular duct (Wharton duct)
opens in a small papilla at the sides of the frenulum Enlarged, tender gland may indicate either viral or bacterial infection, or a ductal stone preventing saliva from exiting gland. Discrete nodule may be cyst or tumor (benign or malignant)
62
Chvostek sign
Percussion of masseter muscle may produce a hyperactive masseteric reflex in those c hypocalcemia
63
Webbing, excessive cervical skin or an unusually short neck may be...
Chromosomal abnormality | Turner syndrome
64
Cervical lymphadenitis
Edema of the neck may be a local infection Mass filling the base of the neck or visible thyroid tissue that glides upward when the patient swallows may be enlarged thyroid
65
ROM of neck
flex, extend, rotate, and laterally turn head and neck Movement should be smooth and painless and not cause dizziness Nuchal ridgidity, resistance to flexion, may be meningeal irritation (CN XI)
66
Compare space between the trachea and SCM on each side
Unequal space may indicate displacement of the trachea from midline and may be associated with a mass or pathologic condition in chest
67
Thyroid cartilage
Hyoid, thyroid and cricoid should be smooth and nontender and should move under finger when patient swallows
68
Thyroid Gland - Swallowing
Inspect for size, symmetry and contour | Inspect lateral side for enlargement
69
Inspection for goiter
no visible thyroid on lateral inspection
70
Cardarelli sign
pressing and displacing thyroid to pt's left increase contact between left bronchus and aorta Systolic pulsations form aorta can be felt at the surface is aneurysm is present
71
Oliver sign
grasp cricoid cartilage and applying upward pressure whle the patient stands with his or her chin extended up Downward tug may be felt if aneurysm is present
72
Abnormalities in thyroid during swallow eval
Right lobe 25% larger then left consistency should be firm yet pliable coarse tissue or gritty sensation may be inflammation enlarged, tender thyroid is thyroidits

Nursing Fundamentals/Assessment (24 decks)

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