head/neck/lypmph/eyes Flashcards
physical exam of skull
Inspect skull - general size and contour
note any lumps, deformities, tenderness
palpate temporal artery, temporomandibular joint
inspect face - expression - involuntary movements, symmetry of movement [nerve VII]
inspect neck - ROM
inspect salivary glands, lymph nodes, thyroid
face inverted by what nerves
Cranial nerve V11 - facial nerve
Cranial nerve V - trigeminal
Both are mixed nerves which means they have motor and sensation functions or motor and sensory functions
cranial nerve 5
Motor - ask client to clench teeth and try to push down on chin to separate the jaws.
- clench teeth and palpate masseter muscle strength
Sensory - ask client to close eyes, touch forehead, face and chin with cotton ball 6 different places. Ask client to ID sensation.
the neck
Supported by:
- cervical vertebrae
- ligaments
- major neck and shoulder muscles
sternocleidmastoid and trapezius create the anterior/posterior triangle (landmark)
the thyroid
Vascular and hormonal gland Secretes 3 hormones: - thyroxine T4 - T3 both=cell metabol. - calcitonin
thyroid landmarks
Cricoid cartilage - above thyroid
Thyroid cartilage - above cricoid (adams apple)
Isthmus bottom landmark
lymph 1-5
10 locations in head and neck preauricular - front of ear postauricular - back of ear (mastoid) occipital - base of skull submental - under chin submandibular - follows jaw line
lymph 6-10
Jugulodigastric (tonsillar) - posterior angle of mandible
Superficial cervical - under ear, over upper sternocleidomastoid
Deep cervical - under sternocleid.
Posterior cervical - triangle/edge of trapez.
Supraclavicular - above clavical
movement of eyes
We have 4 straight movement muscles and 2 slanting movement muscles
Movement of the extra ocular muscles is stimulated by three cranial nerves.
Cranial nerves: III, IV, VI
The majority of the motion comes from cranial nerve III innervations.
Internal anatomy: The eye is a sphere that is composed by three concentric coats.
A) sclera ( outer), B) choroid ( middle)
and C) retina ( inner)
eye structure
Outer Layer: tough protective outer layer. Contains the cornea.
Middle layer: contains the choroid, dark pigment , which is highly vascular.
Contains the pupil, lens,, the lens bulges for near objects and flattens for far vision.
The inner Layer: converts light waves into nerve impulses.
The optic disc ( home of the blood vessels in the back of the eye).
eye structure 2
Retinal Vessels: arteries have a thin sliver of light along them ( arterial light reflex).
The MACULA is located temporally . The macula contains the FOVEA CENTRALIS ( the area of sharpest and keenest vision.
signs and symptoms of a concussion
- Headache
- Dizziness
- Feeling dazed
- Seeing “stars”
- Sensitivity to light
- Ringing in ears
- Tiredness
- Nausea, vomiting
- Irritability
- Confusion, disorientation
pregnant woman thyroid
The thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity.
bruit
a soft whooshing sound made over the carotid artery
Posterior Approach to Palpating the Thyroid
Ask the person to sit up very straight and then to bend the head slightly forward and to the right.
Use the fingers of your left hand to push the trachea slightly to the right.
Curve your right fingers between the trachea and the sternomastoid muscle, retracting it slightly, and ask the patient to take a sip of water.
The thyroid moves up under your fingers with the trachea and larynx as the patient swallows
palpitation of thyroid
Usually you cannot palpate the normal adult thyroid. In some patients
eyelids/eyelashes
like two movable shades that further protect the eye from injury, strong light, and dust.
The upper eyelid is the larger and more mobile one.
The eyelashes are short hairs in double or triple rows that curve outward from the eyelid margins, filtering out dust and dirt.
tarsal plates
are strips of connective tissue that give it shape
The tarsal plates contain the meibomian glands, modified sebaceous glands that secrete an oily lubricating material onto the eyelids.
This stops the tears from overflowing and helps form an airtight seal when the eyelids are closed.
conjunctiva
is a thin mucous membrane folded like an envelope between the eyelids and the eyeball
palpebral conjunctiva
lines the eyelids and is clear, with many small blood vessels.
lacrimal apparatus
constant irrigation to keep the conjunctiva and cornea moist and lubricated. The lacrimal gland, in the upper outer corner over the eye, secretes tears
6 muscles attached to the eyeball
(a) superior, (b) inferior, (c) lateral, and (d) medial rectus muscles. two oblique, muscles are the (a) superior and (b) inferior oblique muscles.
sclera
tough, protective, white covering. It is continuous anteriorly with the smooth, transparent cornea, which covers the iris and pupi
cornea
contact with a wisp of cotton stimulates a blink in both eyes, called the corneal reflex.
middle layer of eyes include;
choroid iris pupil lens anterior chamber posterior chamber
inner layer
retina is the visual receptive layer of the eye in which light waves are changed into nerve impulses
optic disc (or optic papilla) is the area in which fibres from the retina converge to form the optic nerve
retinal vessels normally include a paired artery and vein extending to each quadrant, growing progressively smaller in calibre as they reach the periphery.
Age-related macular degeneration (AMD)
leading cause of blindness in Canada and remains the most common cause of legal blindness in people older than 65
cataract formation
lens opacity, which results from a clumping of proteins in the lens
Glaucoma
Glaucoma is the second most common cause of vision loss in older adults in Canada
Screening intervals in asymptomic low-risk patient
Age 19 to 40 years: at least every 10 years
• Age 41 to 55 years: at least every 5 years
• Age 56 to 65 years: at least every 3 years
• Age older than 65 years: at least every 2 years
Screening in symptomatic patients
Any patient noting changes in visual acuity, visual field, colour vision, or physical changes to the eye should be assessed as soon as possible
Screening intervals in high-risk patients
Patients at higher risk for visual impairment (e.g., those with diabetes, cataract, macular degeneration, glaucoma [verified or suspected], or a family history of these conditions) should be assessed more frequently and thoroughly
• Age older than 40 to 50 years: at least every 3 years
• Age older than 50 to 60 years: at least every 2 years
• Age older than 60 years: at least annually
subjective data for eye exam
- Vision difficulty (decreased acuity, blurring, blind spots)
- Pain
- Strabismus, diplopia
- Redness, swelling
- Watering, discharge
subjective data for eye exam
- History of ocular problems
- Glaucoma
- Use of glasses or contact lenses
- Self-care behaviours
- Medications
- Coping with vision changes or loss
