head, eyes, ears, nose and throat Flashcards
what body parts are included in an examination of head and neck
includes the skull, face, hair, neck shoulders, lymph nodes, thyroid gland, trachea position, carotid arteries, and jugular veins
what techniques should be used for assessment
inspection, palpation, and ausculation to examine the head and neck and the use of a stethoscope
head and neck contain multiple structures
-skill encloses the brain
- facial structures include eyes, ears, nose, and mouth
- neck structures include:
the upper portion of the spine
esophagus
trachea
thyroid gland
arteries
veins
lymph nodes
expected findings of skull after inspection, palaption, and ausculation
size (normocephalic)
no depressions, deformities, masses, tenderness
overall contour and symmetry
expected findings for face
symmetry of facial features symmetry of expressions no involuntary movements able to clench teeth client close their eyes feel touch when touches fasical movements and symmetry
expected findings of neck
muscles of the neck symmetric
shoulders equal in hight and with average muscle mass
range of motion (ROM) of neck
moving the head smoothly and without distress in the following directions:
- chin to chest (flexion)
- ear to shoulder bilaterally (lateral flexion)
- chin up (hyperextension)
place your hands not he client shoulders and ask them to shrug their shoulders against resistance
turn the head against resistance of your hand
lympth nodes
chains of lympth nodes extend from the lower half of the head down into the neck
- palpate each node for enlargement, in the following sequence:
- supraclavicular nodes: above the clavicles
- lympth nods are usually difficult to palpate and not tender or visible
- evaluate any enlarged nodes for location, tenderness, size, shape, consistency, mobliltiy, and warmth
assessing trachea
inspect and palpate for any devisation from midline above the suprasternal notch
- masses in neck or mediastinum and pulmonary abnormalities cause lateral displacement
what are parts of the eyes are included when examining eyes
external and internal anatomy of the eye, visual pathways , fields, visual acuity, extraocular movements, and reflexes
what is the primary technique for examination of the eyes
inspection, with a limited amount of palpation that require gloves
unexpected findings of the eyes
loss of visual fields, asymmetric corneal light refelx, periorbital edema, conjunctivtis, and corneal abrasion
equtment for inspecting the eye
snellen and rosenbaum charts
eye cover
ishihara test: for color blindness
extraocular movements (EOMS) - penlight opthalmoscope eye cover gloves
what chart do you use if client can read
snellen chart, rosenbaum chart, or newspapers to measure visual acuity
inspecting eyes for seeing charts
make sure glasses and contacts are on for test
ensure reading material is in clients language
have client read smallest line of print visible
note smallest line read
what do you inspect to determine coordination of the eye muscle
assess external ocular movements
what to test for eye
assess for parallel eye movemnts, postion of the upper eyelid , and the presence of abnormal eye movement when client looks in each direction
test the corneal light reflex by directing a light onto the eyesand look to see if the reflection is symmetric on the corneas
screen for strabismus- abnormal eyes shaking
- cover one eye, ask client to look in one direction, remove cover and expect both eyes to be gazing in same direction
expected findings of outside of eyes
eyes parallel to eachother without bulging
eyebrows symmetric from inner to outer canthus: can raise and lower symmetrically
eyelds close completely and open
eyeslahses curving outward with no inflammation
no edema or redness in the area of the lacrimal gland s
expected findings of conjunctiva
palperbal pink
bulbar transparent
scelerae will be white in those who have fair skin, light yellow with brown macules in clients who have dark complexion
expected findings for corneas, lenses, irises
corneas clear, shinny, and smooth
lenses clear, cloudy, with cataracts
irises round and illuminating fully when u she a light across from side to side
partially illuminated iris indicated glacoma. note colors of irises
how to examine eye
eyes should be examined in a dark room
with opthalmoscope-use the lens selctor disc to find large white disc
use your right eye to examine clients right eye
instrct client to state at a point somewhere behind u
expected findings of eyes of internal eyes
optic, retina, inside the pupil
optic disc is light pink or more yellow than the surrounding retina
the retina is without lesions. th ecolor will be dark pink in those with dark complexion and light pink in those who have fair skin
without pupil dilation, you might only glimpse the macula when the client looks directly at the light
palpation of eye
palpate the lacrimal apparatus to assess for tenderness and to express any discharge from the lacrimal duct
no tenderness, no discharge, and clear fluid (tears)
PERRLA
P: pupils clear
E: equal and between 3 to 7 mm in diameter
RL: reactive to light both directly and consensually when you direct light into one pupil and then the other
A: accommodation of the pupils when they dilate to look at an object far away and then converge and constrict to focus on a near object
what does the ears, nose, mouth, and throat (ENMT) examination include
external, middle, and internal ear; evaulation of hearing; nose and sinuses; and the mouth and throat
what techniques should be used to assess ENMT
insepction, palpation to examine the ears, nose, sinueses, mouth, and throat
what are you assessing the mouth for
soft palate and the gag refelx
swallowing and speech quality
tongue: movement and strength
equitment for ENMT
otoscope wrist watch tuning fork nansal speculum tongue blade penlight guaze square cotton-tipped applicators
external ears expected findings
the auricles should be of equal size and level with one another
ear color matching face color
no lesions, deformities, or tenderness
no foreign bodies or discharge
pull ear up and back
expected findings for internal ears
typanic membranes are pearly gray and intact, tuat, and free from tears
light reflex is visible and in a well-defined cone shape
external ear canal can vary but is consistent with client’s skin color
cerumen might be present in ear canal
moist cerumen is light brown to gray
whipser test
occlude one ear and test the other to see if client can hear whispered sounds without seeing your mouth move
expected finding: client can hear you whipser softly from 30 to 60 cm (1 to 2ft) away
rinne test
place a vibrating tunning fork firmly against the mastoid bone
have client state when they an no longer hear the sound
note the length of time that the client heard the sound
weber test
place a vibrating tunning fork on top of clients head
ask whether the client can hear the sound best in the right, left or both eqally
expect: client hears sound equally in both ears
expect findings for outer nose
midline, symmetrial, same color
notstril is patent withtout excessive flaring
structure is firm and stable
expected findings of inner nose
septum is midline and intact
mucous membranesa are redder than the oral muscosa and moist with no discharge or lesions
can identify smell
what do you use to examine internal structures of nose
nasal speculum
expectd findings of lips
darker pgimented skin than the face and are moist, symmetric, smooth, with no lesions, and nontender
expectd findings of lip color
range from pink in clients who have pale skin to plum for clients who have dark skin
expectd findings of gums
tight against teeth with no bleedingon gloves from palpation
uniform: in pink color, dark- skinned clients can have bluish/brown patches of pigmintation
expectd findings of mucous membranes
pink and moist with no lesions and some freckled brown pigmentation for dark-skinned clients
hyperpigmentation can occur after age 50 years old
expectd findings of mouth
dorsal surface is pink, presence of papillae and symmetric
underside is smooth
can move tongue up and down side to side
tongue is midline, moist, free of lesions, and moves freely
expectd findings of teeth
shiny, white and smooth
no missing teeth
yellow or darkned teeth are common in older adults
expectd findings of hard palate
whitish, intactm symmetric firm, and concave
expectd findings of soft palate
light pink, intact, smooth, symmestric, and moves with vocalization
uvula
pink, midline, intact, and movs with vocalization
tonsils
same color as surrounding muscosa and vary in size and visibility \+1 barley visible \+2 halfway to the uvula \+3 touching the uvula \+4 touching each other or midline
gag reflex
elicit by using a tongue blade to stimulate the back of the throat
speech
clear and artculate
technique for palpating sinuses
palpat the frontal sinuses by pressing upward with the thumbs from just below the eyebrows on either side of the bridge of the nose
palpate the maxillary sinueses by pressing upward at the skin crevices that run from the sides of the nose to the corner of the mouth
shouldn’t be tender
againg with eyes
decrease visuals, accomondation difficulty distinguishing colors intolerance to glare delayed pupillary reaction to light yellowing of lesne thin gray rings surrounding the cornea loss of lateral third eyebrows decrease in lens opacity
