Head, Face, Neck, Nose, Mouth, Throat Assessments and Nutritional Considerations Flashcards
Steps to assessing the head?
Inspect the head
- note the size and shape
- should be round, symmetrical, and in proportion to the rest of the body
- normocephalic
- palpate scalp and skull
- should be round and symmetrical
- palpate the temporal artery which is just anterior to the TMJ
- palpate the TMJ
- should have no crepitation and moves smoothly and without tenderness
Steps to assessing the face?
Inspect the face
- can do this by striking a little conversation: “have you been having any headaches recently?”
- facial symmetry - eyebrows, palpebral fissures, nasolabial folds, sides of mouth
- note any tics, edema, and lesions
- there should be no abnormal facial structures
Steps to assessing the neck?
Inspect the neck
- should hold the head upright
- accessory neck muscles (SCM and traps) should be symmetrical
- there should be no enlargement of thyroid or salivary glands
- note the brisk pulsation of carotid artery on both sides of neck
Steps to assessing the lymph nodes?
- palpate the lymph nodes bilaterally and verbalize each one
- use a gentle circular motion
- they should normally be unpalpable
- if palpable, they are non-enlarged, moveable, discrete, soft, and nontender
- to access deep cervical chain, ask pt to turn towards the side being examined
- to access supraclavicular node, ask pt to hunch forward
- if pt voices any tenderness, inspect for inflammation in the region being drained by lymph node
- palpate the trachea by inserting a finger in the sternal notch and sliding it to each side of trachea
- space should be equal, indicating no deviation
- verbalize why you would auscultate the thyroid
- to auscultate for a bruit - soft pulsatile, whooshing, blowing sound
what are the lymph nodes of the neck in the correct order?
- preauricular
- posterior auricular
- occipital
- submental
- submandibular
- jugulodigastric or tonsillar
- superficial cervical
- deep cervical chain
- posterior cervical
- supraclavicular
Steps to asses the Nose?
- inspect the nose
- should be symmetrical, midline, and in proportion to other features
- inspect for deformity, asymmetry, inflammation, or lesions in the external nose
- test patency of nose by occluding one naris and asking pt to inhale through the other
- inspect the nasal cavity
- use short-wide tipped speculum
- nasal mucosa should be red and moist
- turbinates should also be red and moist
- no swelling, redness, discharge, or foreign bodies in the nasal cavity
- nasal septum should not deviate
- palpate the sinus areas
- use firm pressure over maxillary and frontal sinuses
- ## should be non-tender
Steps to asses the mouth?
- inspect the mouth
- use tongue blade to retract structures
- lips - moist, pink, and free of lesions
- teeth - white, straight, evenly spaced, clean and free from decay;
- ask pt to bite down. teeth should be aligned, with the top slightly overriding the bottom,
- gums - pink, with tight and well-defined margins at the teeth
- tongue - slightly rough due to papillae, and may have a white coating
- ventral surface - smooth and vascular; saliva is present
- sides of tongue - no lesions
- space under the tongue - free of white patches, nodules, or ulcerations; indicators of malignancies
- buccal mucosa - pink, no nodules or lesions, smooth, and moist
- Stensen’s duct may be visible and should not be inflamed
- may find leukoedema in pts of African or South Asian descent; benign
- palate - hard palate is pink and has bony ridges, may have torus palatinus; soft palate is pinker
- uvula - raises when pt says “ahh” → functioning vagus nerve
- breath - not pungent
Steps to assess the throat?
- tonsils - should be grade 2+ or 1+
- posterior pharyngeal wall - pink, no lesions, no exudate
