Mod-4 Feb-01 - HEENT Flashcards
Cranial Nerve 5 tests - 2
Muscles to close, open jaw
Trigeminal - 3 places, 2 sides, pain, light touch, dull - 6 touches
Cranial nerve 7 tests, motor only - 8
Raise eyebrows
Smile
Show teeth
Puff out cheeks
Frown
Close eyes tight, lightly try to pry open
Mouth open, close, jut in, jut out, side 2 side
Chart: Full ROM, movement symmetrical and strong, listen for crackling jaw - crepitus
Eyes focused interview questions - 10
Recent changes Last eye exam Contact lenses, glasses History of diabetes, hypertension, glaucoma, cataracts Current/history of eye infection Injury to eye Eye surgery Symptoms - blurred/double vision, burning/itching/pain How do you care for your eyes Exposure to irritants
Inspect eyes, no light - 10
Pull up/down eyelids, conjunctiva clear and moist
Brows, eyelashes, eyelids similar in thickness, symmetry
Lens clear
Sclera white
Iris round
Pupil color, size, shape, symmetry
Accommodation - far/near large/small, cross when close
Assess peripheral vision, wiggly fingers, 12 total ways in
Extra ocular vision - 6 cardinal, follow smoothly both eyes, no nystagmus, CN III, IV, VI
2 eye exams
Doc able to follow with smooth eye movement
Inspect eyes with light - 3+1
Light on pupil, scratches, cloudy
Light on side, normal and consensual (4) contraction
Chart PERRLA Pupils Equal Round Reactive Light Accommodate
Corneal light reflect - same spot both eyes, 12 inches from face
Eye vision tests - 3
Distance - 20 ft, read over 1/2 line try one harder. Both, left, right. Keep glasses on Near - same but hold where newspaper 14 inches Doc OU (Both), OS (Left), OD (Right)
Eyes palpate - 3
Lacrimal sacs, eyelids, eyeballs
Head and Face Focused Interview Questions - 6
Headaches Dizziness, seizures Lumps, bumps, sores, swelling Infection Change in hair Head injury, trauma to face
Ears focused interview questions - 8
Changes in hearing Problems, illness, injury to ear Discharge Dizziness Ringing Pain How do you care for your ears Exposed to loud noises
Facial landmarks, visual checks - 8
Palpebral fissure - symmetry, straight Nasolabial fold - symmetry Lateral Canthus to Pinna - Straight Size appropriate for body Shape round Erect, midline, symmetry Facial movements smooth, symmetrical Skin intact, color consistent with rest of body
Ears inspect/palpate - 7
Symmetry
In line
Proportion
Palpate internal/external ear, tragus, pinna, mastoid process - pain, tender, hot/cold, no bumps
We already talked, so they basically work
Go behind 1-2 feet, they cover one ear, whisper one 2-3 syllable word
Doc cranial 8 intact
Nose and sinuses focused interview questions - 4
Nasal discharge
Nosebleeds
Injury or surgery
Changes in your sense of smell
Nose sinuses inspect/palpate - 9
Inspect midline, symmetric, straight, equal size nares, proportion, drainage, inflammation
Palpate entire lateral surface, no tenderness, swelling
Light - meatus midline, straight, intact
- mucosa dark pink, smooth
- turbinates pink and moist, not blue, red, yellow
- No swelling, foreign bodies
palpate frontal and maxillary sinuses - may report pressure, no pain, tenderness
Test cranial nerve 1 olfactory - 2 familiar smells, one each side, also assesses patency
Mouth and throat focused interview questions - 9
Problems swallowing Pain, sores, lesions Bleeding gums Change in your sense of taste Do you wear dentures, partials, retainers How do you care for your teeth Last dental exam Hoarseness or loss of voice Smoke pipe, cigarette, cigar, chew, snuff
Mouth inspect and palpate - 12
Gloves if they cannot follow directions
Symmetric lips, color, moisture, no lesions, cracked
Light - gums, top/bottom/left/right hard/soft palate, lift tongue, teeth free of debris or decay
Tongue moist, papilla present, pink
Hard/soft palate intact
Gums, floor - pink, moist, smooth
Say ahh, uvula rises
Posterior pharynx and tonsil area - ahh
Swallow (water?)
Stick out tongue (midline), move side to side
Push tongue against cheek (feel pressure)
3 swabs, salt, sugar, sour - client ID
