Head and Neck, Regional Lymphatic System Flashcards
Head structure
cranial bones
sutures
facial bones
facial muscles
salivary glands
Neck structure
neck muscles
anterior and posterior triangles
thyroid gland
Lymphatics
preauricular
posterior auricular-mastoid
occipital
submental
submandibular
tonsillar
superficial cervical
deep cervical
posterior cervical
supraclavicular
Developmental considerations for infants
fontanelles, head growth and lympthatic system
Pregnant women
slight enlargement of thyroid
older adults
sagging facial skin
Developmental considerations infants
skull-head circumference, caput succedaneum, cephalhematoma
Face-symmetry, appearance, presence of swelling
Neck-muscle development and head control
special considerations
Developmental considerations in older adults
presence of senile tremors, concave cervical curve, and dizziness on range of motion
Subjective data-health history
headache
head injury-loss of consciousness
dizziness-spinning, lightheadedness
neck pain or limitation of motion
lumps or swelling
history of head or neck surgery
thyroid problems
additional health questions-infants
prenatal drug exposure, type of delivery, growth pattern
additional health history questions-older adults
dizziness and neck pain
Objective data-physical exam
head-insepct and palpate skull
size and shape (normocephalic)
Temporal area-artery and mandibular joint
Head-insepct the face
Facial structures
sinuses
Inspect
symmetry and ROM
Palpate
Lymph nodes-location, size, shape, mobility, consistency and tenderness
Trachea and thryoid gland (posterior and anterior) also auscultate for bruit
Promoting health
Helmet use is legislated provincially
helmets reduce the risk of head or brain injury by 85-88%
ensure sport specific helmets are worn
Pediatric facial diferences
Fetal alcohol syndrome
Down’s Syndrome
Allergic saulte and crease
Atopic (allergic) facies
External anatomy of the eye
eyelids, palpebral fissure, limbus, canthus, caruncle
What are the visual pathways and visual fields
Refraction of light rays
Crossing of fibres at optic nerve
What are the visual reflexeses
Pupillary light reflexes
fixation
accomodation
Developmental considerations for older adults with eyes
presbyopia
macular degenration
cataracts
glaucoma
diabetic retinopathy
decreased tear production
decreased adaptation to darkness
cultural-african descents 3-6 x more rate of glaucoma
Developmental considerations for the eyes in children
They have limited eye function at birth
By age 7-8 they are far-sighted
Subjective data-health History in eyes
vision difficulty-decreased acuity, blurring, blind spots
Pain
strabismus and diplopia
redness and swelling
watering and discharge
history of ocular problems
glaucoma
glasses or contacts
self care behavioiurs-eye protection and last exam
any medications
vision loss
Additional health history questions for infants in eyes
other’s vaginal infection during delivery
developmental milestones
routine vision testing
safety measures
additional health questions for older adults with eyes
movement and visual difficulty
glaucoma testing
catarcts
dryness of eyes
decreased activities
Objective Data-physical exam
prep-position
equipment-snellen eye chart, handheld visual screener, opaque card or occuluder
penlight
applicator stick
opthalmoscope
Central vision acuity-snelen eye chart and ner vision
Visual fields-confrontation test
External inspection of the eyes
general-inspection is preorbital edema
eyebrows, eyelids and lashes (ptosus and xanthelasma)
Eues (exophthalmos)
Inspect what on the eyes
cornea and lens (shine light from side)
conjunctiva and sclera (patient looks up, and pull lids down gently)
Extraocular Muscle Function
Inspect-diagnostic positions test
patient follows movement of object 12 inches away
Normal-track with both eyes
nystagmus only normal at extreme lateral gaze
Accomodation
Have patient focus on examiners finger and move it towards their nose
observe for convergence and pupillary constriction
Pupillary light reflex
part of neuro exam
dark room , shin light from side and measure pupils before and after light
pupil should be resting 3-5mm
brisk or sluggish response?
consensual response-opposite pupil also constricts
PERRLA
pupils, equal, round, reaction to light and accomodation
Access visual acuity
Snellen eye chart
20 feet away
20/20 vision is normal
top # is distance from chart and bottom is # someone with normal vision could read the line
20/30 is nearsight
higher the bottom number the worst the nearsighted is
Development of the eyes for kids
children 2 and a half to 3 test by showing familiar objects
children 3-8 get tumbling e effect
Use of ophthalmoscope
functions as appendage of examiners eye
shine light into eye. find red reflex, then follow in to view ocular fundus
Locate the optic disk?
next to macula
What is a cataract
cloudiness in the lens of the eye
What is a glaucoma test
It determines if the optic nerve is damaged-which may cause a visual problem
What is arcus senilis
lipid ring at corner of retina
indicated carotid artery disease
Structure of the external ear
external ear-external auditory canal and tympanic membrane
Structure of middle ear
Middle ear has malleus, incus and stapes and the eustachian tube
What is the structure of the inner ear
inner ear-vestibule and semicircular canals (bony labryinth)
cochlea
What is the function of the ear
hearing and balance
sound waves travel through external auditory canal to the tympanic membrane (translucent pearly grey that seperates external and middle ear)
Auditory canal is lined with galnds that secrete cerumen
Function of the middle ear
contains malleus, incus and stapes
it conducts sound vibrations
reduces amplitude of loud noises
equalizes air pressure via euschian tube to prevent tympanic membrane rupture
Function of inner ear
vestibule and semicurcular canals (balance) and cochlea (hearing)
info then travels to the brain via cranial nerve VII
Developmental considerations for infants and children with ears
shorter, horizontal eustchian tube -pathogens move from nasopharynx to middle ear
increased incidence of otitis media if bottle fed lying down
Developmental considerations for older adults with ears
cilia course and stiff, impacted cerumen
presbycusis-gradual hearing loss
Cultural and social considerations for the ear
increased incidence of otitis media in aboriginal children, premature infants, infants with down syndrome, infants fed in supine position
Cerumen-genetically determined-dry and wet cerumen
hearing loss is the 3rd most chronic condition in older adults-audism-discrimination based on hearing loss
Promoting health
earbuds placed directly in the ear canal
related to hearing loss
use larger headphones that are noise cancelling
60-60 rule
Subjective data-health history for ears
earaches(otalgia)
infections
discharge (ottorhea)
hearing loss
environmental noise
tinnitis
vertigo
self care-hearing protection and the last hearing test
Infants specifically-ear infections, hearing loss, injury
Objective Data-Physical Exam Ears
prep-poaition and clean the ear
equi[ment-otoscope plus bright light, and pneumatic bulb attachment(kids)
External ear-inspect and palpate size and shape, check skin condition, tenderness, external auditory meatus
Otoscopic exam
Position head and ear, method of holding and inserting otoscope
external canal-colour, swelling, lesions and discharge (colour and odor)
Tympanic membrane
Color and characteristics
positon
integrity of membrane
Tympanic tube insertation
ENT places tube
Testing Hearing
Test hearing acuity-conversational speech, whispered voice test
Tuning forks (Weber) not precise data
Vestibular apparatus (Romberg test)
Development of ears in children
ear position
timing of otoscopic exam
positioning of children
testing hearing acuity and developmental milestones
behavioural manifestations of hearing loss
Development of ears in adults
loss of elasticity of pinna
eardrum gets whiter and more opaque and duller
loss of hearing high tones, and consonants in whispered voice test
isolation in groups
Nose Structure
first segment of respiratory system-warms, moistens and filters air, shaped as a triangle
Mouth structure
first segment of digestive system and an airway for respiratory
bordered by lips, soft and hard palate, cheecks and tongue
contains teeth, gums, tongue and salivary glands
Throat structure
area behind the mouth and nose
seperated from the mouth by tonsils
Structure and Function of nose
external nose
nasal cavity-septum, turbinated and meatus
Paranasal sinuses
frontal, maxillary, ethmoid and sphenoid
Salivary gland examples
parotid
submandibular
sublingual
teeth and gums
Developmental Considerations for infants with the nose, mouth and throat
salivation
deciduous teeth
nose-obligate nose breathers
positioning
tonsils
mouth and throat-sucking tubercle
Pregnant women developmental considerations (nose mouth and throat)
pregnancy related gingivitis
nasal stiffness
epistaxis
hyperemic gums
Developmental considerations for nose mouth and throat for older adults
diminished smell and taste
atrophic tissues
dental changes (malocclusion)
malntrition
purse string appearance of mouth
yellow teeth
Cultural and social considerations for nose, mouth and throat
there is an increased incidencd of dental disease among indigenous people (chnages from traditional diets, lack of access to fluoridated water and dental health services)
correlation between socioeconomic vatriables and dental disease (inadequate dental insurance)
Subjective data for the nose
discharge(rhinorrhea)
frequent colds (upper respiratory)
sinus pain
Trauma
Epistaxis (nosebleeds)
allergies
altered sense of smell
Subjective data-mouth and throat
sores or lesions
sore throat
bleeding gums
toothache
hoarseness/dysphagia/altered taste
smoking/alcohol consumption
self care behaviours-dental care patterns
Additional health history questions for infants and children (mouth and throat)
Mouth disease
throat disease
tooth development
self-care behaviours
Additional health history questions for older adults mouth and throat
mouth dryness xerostomia)
teeth/denturess
mouth care
taste and smell
effect on nutrition
Promoting Health-smokeless tobacco
chewing tobacco and snuff (dry or moist)
this can lead to oral, esophageal or pancreatic cancer
early signs of oral cancer include-ulcers, sores that do not heal
white or red patches
prolonged sore throat or feeling that something is in your throat
numbness or tingling
unexplained bleeding
Physical exam of nose
inspect and plaplate external nose, and nasal cavity
hold the otoscope, nasal septum and turbinates
Havepatient block one nostril and sniff
Physical exam of sinuses
Palpate the sinus area
frontal and maxillary sinuses
Physical exam of the mouth
inspect-lips, teeth and hums, tongue (test cranial nerve)
buccal mucosa
palate and uvula
Physical exam of the throat
tonsils (grading between 1 and 4
1 is visible
2 is halfway between tonsillar pillars and uvula
3 is touching uvula
4 is touching each other
use of tongue blade
posterior pharyngeal wall
