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NURS 202 > Lecture 5: Head and Neck, Including Regional Lymphatic System > Flashcards

Lecture 5: Head and Neck, Including Regional Lymphatic System Flashcards

1
Q

Head - Structure and Function

A
  • Cranial bones
  • Sutures
  • Facial bones
  • Facial muscles
  • Salivary glands
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2
Q

Neck - Structure and Function

A
  • Neck muscles
  • Anterior and posterior triangles
  • Thyroid glands
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3
Q

Lymphatics - Structure and Function

A
  • Preauricular
  • Posterior auricular (mastoid)
  • Occipital
  • Submental
  • Submandibular
  • Tonsillar
  • Superficial cervical
  • Deep cervical
  • Posterior cervical
  • Supraclavicular
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4
Q

Developmental Considerations: Infants and children

A
  • Fontanelles
  • Head growth
  • Lymphatic system
    Skull: head circumference, caput succedaneum, cephalhematoma
    Face: symm, appearance, swelling
    Neck: muscle development and head control
  • Special considerations
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5
Q

Developmental Considerations: Pregnant women

A
  • Slight enlargement of thyroid gland
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6
Q

Developmental Considerations: Older adults

A
  • Sagging facial skin
  • Presence of senile tremors, concave cervical curve, dizziness on range of motion
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7
Q

Subjective Data: Health History

A
  • Headache
  • Head injury
  • Dizziness
  • Neck pain or limitation of motion
  • Lumps or swelling
  • History of head or neck surgery
  • Thyroid problems
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8
Q

Additional Health History Q’s: Infants and children

A
  • Prenatal drug exposure
  • Type of delivery
  • Growth pattern
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9
Q

Additional Health History Q’s: Older adults

A
  • Dizziness
  • Neck pain
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10
Q

Objective Data: Physical exam

A

Head - Inspect and palpate the skull
Size and shape (normocephalic)
- Macrocephalic, microcephalic
- Fontanelles in infants
Temporal area
- Temporal artery
- Temporomandibular joint
Head - Inspect the face
Facial structures
Sinuses

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11
Q

Physical Exam Neck: Inspect and Palpate

A
  • Symm
  • ROM
  • Lymph nodes
  • Trachea
  • Thyroid gland (posterior approach, anterior approach, auscultate for bruit)
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12
Q

Pediatric Facial Differences

A
  • Fetal alcohol syndrome
  • Down’s syndrome
  • Atopic (allergic) facies)
  • Allergic salute and crease
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13
Q

Eye External Anatomy (Eye)

A
  • Eyelids
  • Palpebral fissure
  • Limbus
  • Canthus
  • Caruncle
    (Look @ directions of movement slide)
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14
Q

Visual Pathways and Visual Fields (Eye)

A
  • Refraction of light rays
  • Crossing of fibres at optic nerve
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15
Q

Visual Reflexes (Eye)

A
  • Pupillary light reflexes
  • Fixation
  • Accommodation
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16
Q

Developmental Considerations: Older Adults (Eye)

A
  • Presbyopia
  • Macular degeneration
  • Cataracts
  • Glaucoma
  • Diabetic retinopathy
  • Decreased tear production
  • Decreased adaptation to darkness
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17
Q

Developmental Considerations: Infants/children (Eye)

A
  • Limited eye function at birth
  • Farsighted until age 7-8
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18
Q

Subjective Data: Health History (Eye)

A
  • Vision difficulty
  • Pain
  • Strabismus, diplopia
  • Redness, swelling
  • Watering, discharge
  • History of ocular problems
  • Glaucoma
  • Glasses or contact lenses
  • Self-care behaviours - eye protection, last eye exam
  • Meds
  • Vision loss
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19
Q

Additional Health History Q’s: Infants and children (Eye)

A
  • Mother’s vaginal infection during delivery
  • Developmental milestones
  • Routine vision testing
  • Safety measures
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20
Q

Additional Health History Q’s: Older Adults (Eye)

A
  • Movement and visual difficulty
  • Glaucoma testing
  • Cataracts
  • Dryness of eyes
  • Decreased activities
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21
Q

Physical Exam (Eye)

A

Preparation: Position
Equipment: Snellen eye chart, handheld visual screener, opaque card or occluder, penlight, applicator stick, ophthalmoscope
Central visual acuity: Snellen eye chart, near vision
Visual fields: Confrontation test

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22
Q

External Inspection (Eye)

A

General: Periorbital edema
Eyebrows
Eyelids and lashes: Ptosis, xanthelasma
Eyes: Exophthalmos

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23
Q

How to inspect cornea (Eye)

A

Shine light from side

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24
Q

How to inspect conjunctiva and sclera (Eye)

A

Have patient look up; pull down lower lids gently

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25
Q

Extraocular Muscle Function: Inspect (Eye)

A
  • Diagnostic positions test
  • Patient follows the movement of an object 12 inches away
  • Normal: tracking with both eyes
  • Nystagmus only normal at extreme lateral gaze
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26
Q

Accomodation (Eye)

A
  • Have patient focus on examiners finger or pen
  • Move object toward patients nose
  • Observe for convergence and pupillary constriction
27
Q

Pupillary Light Reflex (Eye)

A
  • Part of neuro (cranial nerve) exam
  • Dark room, shine light from side
  • Measure pupils in mm, before and after light: resting should be 3-5mm, brisk response vs sluggish response or fixed
  • Consensual response - opposite pupil also constricts
28
Q

PERRLA (Eye)

A

Pupils
Equal
Round
Reactive to
Light and
Accommodation

29
Q

Assess Visual Acuity (Eye)

A

Snellen Eye Chart:
- 20ft away
- Top # is distance from chart
- Bottom # is distance at which someone at which someone with normal vision could read the line
20/20 is normal vision
20/30 is nearsighted
- The higher the bottom number, the worse the nearsightedness is

30
Q

Developmental (Eye)

A
  • Children 2 and a half to 3 yrs - test by showing cards with familiar objects
  • Children 3-8 yrs - tumbling E chart
31
Q

Use of Ophthalmoscope (Eye)

A
  • Functions as appendage of examiner’s eye
  • Shine light to patient’s eye, find red reflex, then follow in to view ocular fundus
32
Q

Diseases to the eye

A
  • Cataract
  • Arcus Senilis
33
Q

Ear Structure/function

A

External ear: External auditory canal, tympanic membrane
Middle ear: malleus, incus, and staples, eustachian tube
Inner ear: Vestibule and semicircular canals (bony labyrinth), cochlea

34
Q

How does the ear work and what is it used for?

A
  • Used for hearing and balance
  • Sound waves through external auditory canal to tympanic membrane: Translucent pearly grey, separate external and middle ear
  • Auditory canal lined with glands that secrete cerumen
35
Q

Middle and inner ear

A

Middle: Contains malleus, incus, stapes - conduct sound vibrations, reduce amplitude of loud noises, equalizes air pressure via Eustachian tube to prevent tympanic membrane rupture
Inner: Vestibule and semicircular canals (balance), cochlea (hearing)
- Information travels to brain via cranial nerve V11

36
Q

Developmental: Infants/children

A

Shorter, horizontal Eustachian tube: Pathogens move from nasopharynx to middle ear, increased incidence Otitis Media if bottle fed lying down

37
Q

Developmental: Older adults

A
  • Cilia course and stiff, impacted cerumen
  • Presbycusis - gradual hearing loss
38
Q

Cultural and Social Considerations

A
  • Increased incidence of otitis media in: Aboriginal children, premature infants, infants with down syndrome, infants bottle fed in supine position
  • Cerumen: genetically determined; dry and wet cerumen
  • Hearing loss third most common chronic condition in older adults: audism; discrimination based on hearing ability
39
Q

Promoting Health (Ears)

A
  • Earbuds placed directly in the ear canal
  • No distortion in sound (digital)
  • Listeners tend to listen for hours
  • 60-60 rule recommended
  • Use larger headphones/noise cancelling headphones
40
Q

Health History (Ears)

A
  • Earaches (otalgia)
  • Infections
  • Discharge (otorrhea)
  • Hearing loss
  • Environmental noise
  • Tinnitus
  • Vertigo
  • Self-care behaviours
    For infants:
  • Ear infections
  • Hearing loss
  • Injury
41
Q

Physical Exam (Ears)

A

Preparation: Position, cleaning the ear canal
Equipment: Otoscope with bright light, pneumatic bulb attachment
External ear - Inspect and palpate: Size, shape, condition, tenderness, external auditory meatus

42
Q

Otoscopic Exam

A

Otoscopic Examination:
- Position of head and ear
- Method of holding and inserting otoscope
External canal:
- Colour
- Swelling
- Lesions/foreign bodies
- Discharge (colour, odour)

43
Q

Tympanic Membrane

A
  • Colour and characteristics
  • Position
  • Integrity of membrane
44
Q

Testing Hearing

A
  • Test hearing acuity
  • Vestibular apparatus
45
Q

Development: Infant and young children

A
  • Ear position
  • Timing of otoscopic exam
  • Positioning of children
  • Testing hearing acuity and developmental milestones
  • Behavioural manifestations
46
Q

Development: Older Adult

A
  • Loss of elasticity if pinna
  • Eardrum whiter, more opaque, duller
  • Loss of hearing of high-tone frequencies and consonants in whispered voice test
  • Isolation in groups
47
Q

Function/Structure: Nose, Mouth, Throat

A

Nose
- 1st segment of resp sys; warms, moistens, and filter air
- Shaped as a triangle; 2 oval openings at the base of the triangle (nares); divided in 1/2 by the septum
Mouth
- 1st segment of digestive system and an airway for resp
- Bordered by the lips, palate (soft and hard), cheeks and tongue
- Contains the teeth, gums, tongue and salivary glands
Throat (pharynx)
- Area behind the mouth and nose
- Separated from the mouth by the tonsils

48
Q

Structure and Function - Nose

A
  • External nose
  • Nasal cavity: septum, turbinates, meatus
49
Q

Structure/Function - Paranasal Sinuses

A
  • Frontal
  • Maxillary
  • Ethmoid
  • Sphenoid
50
Q

Structure/Function - Mouth

A
  • Oral Cavity
  • Hard and soft palates
  • Uvula
  • Tongue
51
Q

Structure/Function - Salivary Glands

A
  • Parotid
  • Submandibular
  • Sublingual
  • Teeth and gums
52
Q

Structure/Function - Throat

A
  • Throat (pharynx)
  • Oropharynx
  • Tonsils
  • Nasopharynx
53
Q

Developmental Considerations: Infants and children

A
  • Salivation
  • Deciduous teeth
  • Nose: obligate nose breathers
  • Positioning
  • Tonsils
54
Q

Developmental Considerations: Pregnant Women

A
  • Nasal stuffiness
  • Epistaxis
  • Hyperemic gums
  • Pregnancy-related gingivitis
55
Q

Developmental Considerations: Older adults

A
  • Diminished smell and taste
  • Atrophic tissue
  • Dental changes (malnutrition)
  • Malnutrition
  • “Purse string” appearance of mouth
  • Yellow teeth
56
Q

Cultural Social Considerations (Nose, mouth, throat)

A
  • Increased incidence of dental disease in indigenous peoples
  • Correlation between socioeconomic variables and dental disease
57
Q

Health History - Nose

A
  • Discharge (rhinorrhea)
  • Frequent colds (upper resp infections)
  • Sinus pain
  • Trauma
  • Epistaxis (nosebleeds)
  • Allergies
  • Altered sense of smell
58
Q

Health History - Mouth and Throat

A
  • Sores or lesions
  • Sore throat
  • Bleeding gums
  • Toothache
  • Hoarseness/Dysphagia/Altered tate
  • Smoking, alcohol consumption
  • Self-care behaviours: Dental care pattern, Dentures or appliances
59
Q

Additional Health History Q’s: Infants and children

A
  • Mouth disease
  • Throat disease
  • Tooth disease
  • Self-care behaviours
60
Q

Additional Health History Q’s: Older adult

A
  • Mouth dryness (xerostomia)
  • Teeth/dentures
  • Mouth care
  • Taste and smell
  • Effect on nutrition
61
Q

Promoting Health: Smokeless Tobacco (SLT) and Cancer Risk

A

Chewing tobacco and snuff (dry or moist) used in Canada
- Looking out for oral cancer
- Using SLT can lead to oral, esophageal, or pancreatic cancer

62
Q

Physical Exam: Nose

A

Inspect and palpate
- External nose
- Nasal cavity: holding the otoscope, nasal septum, turbinates
- Have patient block one nostril and snif

63
Q

Physical Exam: Sinus Areas

A

Palpate
- Frontal and maxillary sinuses

64
Q

Physical Exam: Mouth

A

Inspect
- Lips
- Teeth and gums
- Tongue (test cranial nerve X11)
- Buccal mucosa
- Palate and uvula

NURS 202 (8 decks)

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