HEENT Assessment Flashcards
What is HEENT
Head, Ears, Eyes, Nose, Throat
Subjective data for HEENT assessment
- Present history
- Past history
- family history
- lifestyle
- health practices
Objective data for HEENT assessment
- Inspect
- Palpate
- Auscultate
- Percussion
- mainly INSPECT AND PALPATE
Skull is made up of
two subsections
- cranium and facial bones
Cranium
- houses and protects the brain and major sensory organs
- consist of 8 BONES
Facial bones
- Gives shape to the face
- All immovable except the mandible
- Consists of 14 BONES
Subjective data questions HEAD AND FACE
- Do you have a history of headaches?
- Have you ever had head injuries or loss of consciousness?
- Do you have any jaw or facial pain?
- Have you ever had a seizure?
Normal findings: HEAD
- Skull rounded and symmetrical
- Size of head is typical for family, proportional for body size, and age
- Head is erect and midline
- non-tender, smooth/normal contours, no lesions, scalp mobility
Abnormal findings: HEAD
- Larger or smaller than expected size
- Asymmetry of skull, not rounded
- Masses, tenderness, abnormal contour/bumps
Normal Findings: FACE
- symmetrical appearance and smooth movement of facial features
- facial expression is appropriate for the situation
- no visible lesions and normal hair distribution
- non-tender
- normal muscle tone
- normal TMJ function
Abnormal Findings: FACE
- Asymmetry of the face
- lesions, lumps, abnormal hair distribution
- the irregular or uneven movement of the jaw or popping/cracking
Pediatric variations: HEAD AND FACE
- newborn head is misshapen
- anterior fontanel> 9-18 mo
- posterior fontanel> birth- 2mo
- look for abnormal fontanel
- cradle cap is common
- potential flat spot on head
- observe face when crying
- hold head up> around 4mo
Subjective data questions: EYES
- Have you noticed any changes in eyesight?
- Do you wear glasses or contacts?
- Have you ever had an eye injury?
- Have you ever had eye surgery?
- When was your last eye exam?
Eyelids
two movable structures made up of skin and muscle
Eyelashes
filter dust and dirt
Conjunctivia
the mucous membrane that covers eyelids, is peach and moist
Sclera
White outer coating of the eye
Iris
eye color
PERRLA
pupils equal, round and reactive to light, and accomodation
Extraocular muscles
the six muscles attached to the outer surface of the eyeball
rectus muscles
superior, inferior, lateral and medial
oblique muscles
superior and inferior
How many rectus muscles and oblique muscles control six different directions
- 4 RECTUS
- 2 OBLIQUE
Snellen Chart
- based on age and literacy level
- top number is distance in feet from chart
- bottom number is distance at which a person with normal eyesight can read the same line
Expected/ normal findings: EYES
20/20 vision, 6-7 years or older
Abnormal: EYES
Small fraction: diminished distant vision, near sited
Larger fraction: diminished near vision, far sited
Visual acuity
Eye’s ability to detect the details of an image
What cranial nerves allow to tract movement
CN III, IV, VI
Peripheral vision
boundaries of the eye when the eye is in a fixed position
Expected/abnormal: Peripheral vision
expected: no deficits
abnormal: strabismus, amblyopia> loss of peripheral vision
Extraocular Movements(EOMs)
- inspect for parallel alignment
- 6 cardinal fields of gaze
- test corneal lights reflex
Inspect/ palpate: EYES
- inspect general appearance, eyelids, eyelashes, conjunctiva, sclera, lacrimal ducts and glands, iris and pupils
- palpate external structures
- test distance, near, and color vision, peripheral vision, EOMs, and PERRLA
Pediatric considerations: EYES
- newborn: 20/100 or 20/400
- not able to distinguish color well and other details
- 3 mo: eyes should be aligned and movement coordinated
- 5 yrs: 20/40 or 20/30
- 7 yrs: 20/20
- strabismus is normal until about 4-6 mo
Older adult considerations: EYES
- eyeball appearance can appear sunken in
- lens of eyes begin to lose ability to accommodate to near objects
- color vision declines
- PERRLA reaction becomes slower
- iris pigmentation causes iris to look brownish and pale
- lower lid sags
- conjunctiva may be pale or slight yellowish
Accommodation
the eyes ability to focus on something as it comes closer to the eye
Middle Ear
- conducts sound waves to the inner ear
- compromised of tympanic membrane, eustachin tube, and auditory osicles
External Ear
- collects and conveys sound waves to middle ear
- protects middle ear
- physically can see
Inner ear
- responsible for hearing and equilibrium
- bony labyrinth> cochlea, vestibule, semicircular canals
Subjective data questions: EARS
- Do you have any hearing problems?
- Have you had any changes in your hearing?
- Do you have any ear damage?
- Do you have any ear pain?
- Do you have any balance problems?
- Have you ever had ringing in your ear?
Inspect/palpate: EARS
- symmetry in size, note the appearance of piercings
- pinna level with corner of eye
- color and condition of the skin
- drainage, lesions, tenderness
- palpate external ear> condition of skin/color
- tympanic membrane> grey/ pearly/ shiny
Weber test: EAR
- ALWAYS start with
- hearing wand top of patients head
- sound is the same in both ears(negative)
- sound is louder in one ear(negative)
- if test is positive move to rinne test
Rinne Test: EAR
- ONLY perform when weber test is positive
- this test compares AC and BC, normal= AC 2x as long as BC
Gross hearing (whispering test) assess
- assess low tone hearing
Romberg test assesses
BALANCE
Pediatrics consideration: EAR
- 20 week gestation fetus can hear
- infants are more prone to ear infections
- tubes are shorter, wider, horizontal
- infant/toddler> gently pull down
- older child> gently tug up
Older Adult consideration: EAR
- presbycusis
- earwax increases
- longer earlobes
- coarse hair and dry skin
Cerumen
Ear wax
Subjective data questions: NOSE
- Do you have nasal congestion?
- Do you have history of sinus problem?
- Do you have seasonal allergies?
- Do you experience nose bleeds?
- Have you ever broken your nose?
The nose and sinuses are responsible for…..
smell
vaporized molecules trigger what CN?
CN I
Sinuses
- Air filled cavities to decrease weight of the skull
- 4 sinuses( frontal, ethmoid, sphnoid, maxillary)
- lined with ciliated mucous membrane
- Act as resonance chambers during speech
inspect/palpate: NOSE
- inspect external position, size, and shape
- observe and palpate for discharge
- inspect internal structures with otoscope or light
- palpate external structures, frontal and maxillary sinuses
Pediatric consideration: NOSE
- infants 3-6 mo are nose breathers
Older adult consideration: NOSE
- the sense of smell diminishes
Subjective data questions: THROAT/MOUTH/NECK
- Do you have any problems with your teeth?
- When was your last dental exam?
- How often do you brush your teeth?
- Do you have any sores or irritation in your mouth?
- Do you smoke or chew tobacco?
The neck is composed of…
- muscles, ligaments, and cervical vertebrae
- jugular veins are carotid artery
- thyroid gland
- CN XI
- cervical vertebrae
Lymph nodes size and shape may vary T or F
TRUE
Lymph nodes in the neck are usually palpable T or F
FALSE
Inspect/ palpate: NECK
- check symmetry, ROM, and condition
- condition of skin and cervical vertebrae
- Is the neck erect and midline
- look for lesions, lumps, bumps
-check lymph nodes, trachea, and thyroid gland
Palpating lymph nodes
- note size, tenderness, consistency, mobility, and temperature
Palpating the thyroid
- stand behind, having client flex neck forward and to the left
- thumbs at nape of neck
- palpate cricoid cartilage below thyroid cartilage
- push trachea slightly to left with right hand as palpate below cricoid
-TYPICALLY NOT PALPABLE
What color should nasal mucosa be?
PINK
What color is the tympanic membrane
GREY & PEARLY
When do babies typically begin to get their deciduous teeth
6 months
Deciduous teeth are
baby teeth
Subjective data questions: NECK
- Any neck pain or stiffness?
- Any neck masses or lumps?
- Is there any history of thyroid disorders?
- Do you have difficulty swallowing?
Throat structure and function
- behind mouth and nose
- passageway for food and air
- below the nasopharynx is the oropharynx
- tonsil
Mouth structure and function
- structure includes lips, tongue, teeth, gums, uvula, hard and soft palate, salivary glands, and ducts
- beginning of the digestive tract
- airway for the respiratory tract
inspect/palpate: MOUTH
- inspect mouth externally> lip placement, color, condition
-oral mucosa and gums> color, condition - buccal mucosa> color, condition
- inspect teeth and tongue
- inspect oropharynx> say ahh
- palpate lower lip> note tenderness, lesions, mobility
- palpate inside of cheek, tongue, and floor of mouth
Mouth tests
- test gag reflex, touch back of soft palate of tongue with depressor
pediatric considerations: MOUTH
- primary nose breathers
- tonsils typically larger
- deciduous teeth at about 6 months
- permanent teeth about 6 years
older adult considerations: MOUTH
