PA Exam HEENT Flashcards
Traumatic Brain Injury
risk factors age related:
○ Age newborn to _____years old; teenagers, especially between 15-___years old; adults over _____
risk factors age related:
4
19
65
● Risk Factors: Traumatic Brain Injury
○ ________accidents involving automobiles, motorcycles, bicycles, and pedestrians; violence, such as firearm assaults and child abuse or self-inflicted wounds; falling; excessive alcohol ingestion; infants and elderly being cared for by caregivers
● To assess for risk, determine the _____of the individual, _____and _____ health status, and lifestyle. Assess for the following factors:
○ Infants and toddlers: Environmental risks (for _____); lack of parental knowledge of shaken baby syndrome; caregivers’ risk of _______baby syndrome
○ Children and teens: Knowledge and use of protective equipment in sports and bicycle use; knowledge and use of safety practices when driving
Transportation
age, physical, mental
fall, shaken
● Education:
○ Buckling your child in the car using a child safety seat, booster seat, or seat belt (according to the child’s height, weight, and age). Know the stages:
■ Birth through age 2
■ Between ages 2 and 4/until _____lb
■ Between ages 4 and 8 or until ___ ft _____ in tall
■ After age 8 and/or 4 ft 9 in tall
40 lbs
4 ft 9 inch
scoring headaches
■ Answers
Never (____ points each);
Rarely (____points each);
Sometimes (____points each);
Very often (____points each)
Always (____points each)
■ If you score ____or more: headaches are having a very severe impact on your life
■ If you scored ____: your headaches are having a substantial impact on your life
■ If you scored ____: your headaches seem to be having some impact on your life
■ If you scored ____ or less: your headaches seem to be having little to no impact on your life at this time.
■ ____ or higher: talk to your doctor
never: 6
rarely:8
sometimes: 10
very ofter 11
always: 13
■ If you scored 56-59: your headaches are having a substantial impact on your life
■ If you scored 50-55: your headaches seem to be having some impact on your life
■ If you scored 49 or less: your headaches seem to be having little to no impact on your life at this time.
■ 50 or higher: talk to your doctor
● Equipment: Small cup of ______, stethoscope, penlight, gloves in presence of _______
water, drainage
● Instruct client to remove any wig, hat, hair ornaments, pins, rubber bands, jewelry, and head or neck scarves. Ask client to sit in _______ position with the back and shoulders held back and straight. Explain the importance of remaining ______ during most of the inspection and ______ of the head and neck. Explain the need for the client to move and bend the neck for examination of muscles and for palpation of the thyroid gland. Be aware that some clients may be anxious as you palpate the neck for lymph nodes, especially if they have a history of _____ that cause lymph node enlargement. Tell the client what you are doing and share assessment findings.
upright, still, palpation, cancer
-Head and Face-
Inspection and Palpation: Inspect for size, shape, and configuration
● Normal: head size and shape vary, especially in accordance with ethnicity. Usually the head is symmetric, round, erect, and in ____ and appropriately related to _______ size (normocephalic). No lesions are visible.
● Abnormal: an abnormally small head is called _________. The skull and facial bones are larger and thicker in __________. Acorn-shaped, enlarged skull bones are seen in ________ disease of the bone.
Inspect for involuntary movement
● Normal: head should be held still and upright
● Abnormal: neurologic disorders may cause a ___________ jerking movement. An involuntary ________ movement may be seen in clients with _____ insufficiency. Head tilted to one side may indicate _______ vision, ______ deficiency, or _________ of the sternocleidomastoid muscle.
Palpate the head: note consistency (wear gloves to protect yourself from possible drainage)
● Normal: the head is normally hard and smooth, without lesions
● Abnormal: lesions or lumps on the head may indicate recent _______ or a sign of ______
Inspect the face: inspect for symmetry, features, movement, expression, and skin condition. If ______ of one side of the face is noted, assess for ______ signs of stroke using assessment tool ______ recognizing symptoms of stroke.
→OLDER ADULT CONSIDERATION: in older clients, facial wrinkles are ______ because subcutaneous fat ______ with age. In addition, the _____ face may shrink, and the mouth may be drawn _____ as a result of _______ of ______ bone, also an age-related process.
● Normal: the face is symmetric with a round, oval, elongated, or square appearance. No abnormal movements noted.
● Abnormal: asymmetry anterior to the _______ occurs with parotid gland enlargement from an ________ or tumor. Unusual or asymmetric _______ movements may be from an organic disease or neurologic problem, which should be referred for medical follow-up. Drooping, weakness, or paralysis one one side of the face may result from a stroke (cerebrovascular accident, CVA) and usually is seen with paralysis or weakness of other parts on that side of the body. Drooping, weakness, or paralysis on one side of the face may also result from a neurologic condition known as ____ palsy. A “mask_____like” face marks Parkinson disease; a “_____” face with depressed eyes and hollow _____ is typical of ________ (emaciation or wasting); and a pale, ____ face may result from nephrotic syndrome.
Palpate the temporal artery: located between the top of the ear and the eye.
→OLDER ADULT CONSIDERATION: the strength of the pulsation of the _______ artery may be ________ in the older client.
● Normal: the temporal artery is _____ and not tender
● Abnormal: an acute urgent condition is seen when the temporal artery is _____, ______, and tender with inflammation, as seen with temporal _______ (inflammation of the temporal arteries that may lead to blindness)
Palpate the temporomandibular joint (TMJ): to assess the TMJ, place your _____ finger over the _____ of ______ ear as you ask the client to open the mouth
● Normal: normally there is no swelling, tenderness, or crepitation with movement. Mouth opens and closes fully (3-__ cm between ____ and lower teeth). Lower jaw moves laterally 1-__ cm in each direction.
● Abnormal: limited range of motion, swelling, tenderness, or crepitation may indicate ______ syndrome
Inspection and Palpation: Inspect for size, shape, and configuration
Normal:
Midline
Body size normocephalic
Abnormal:
Microcephaly
Acromegaly
Paget
Inspect for involuntary movement
Abnormal:
Horizontal
Nodding
Aortic
Unilateral
Hearing
Shortening
Palpate the head:
Abnormal:
Trauma
cancer
Inspect the face
Drooping
Other
15-1
OLDER ADULT CONSIDERATION
Prominent
inward
Lower
Inward
Resorption
Abnormal
Earlobes
Abscess
Orofacial
Cerebrovascular (cva)
Neurologic
Bell
Mask
Sunken
Cheeks
Cachexia
Swollen
Nephrotic
OLDER ADULT CONSIDERATION: temporal, decreased
Normal:
Elastic:
hard, thick
arteritis
Palpate the temporomandibular joint (TMJ):
Index, front, each
Normal: 6, upper, laterally, 1-2
Abnormal: crepitation, TMJ (temporomandibular joint)
-The Neck-
Inspection
Inspect the neck: observe the client’s slightly extended neck for position, symmetry, and lumps or masses. Shine a ______ from the side of the neck across to highlight any swelling
● Normal: neck is symmetric, with head centered and without bulging masses
● Abnormal: swelling, enlarged masses–or nodules–may indicate an enlarged thyroid gland, inflammation of _____ nodes, or a _____
Inspect movement of the neck structures: ask the client to ____ a small sip of water. Observe the movement of the thyroid _____, thyroid _____.
● Normal: the thyroid cartilage and _______ cartilage move _____ symmetrically as the client swallows.
● Abnormal: _______ movement or _______ enlargement of the thyroid gland is considered abnormal
Inspect the cervical vertebrae: Ask the client to flex the neck (chin to chest)
● Normal: ____ (vertebrae prominens) is usually visible and ______.
●
→OLDER ADULT CONSIDERATION: In older clients, cervical _______ may increase because of ______ of the spine. Moreover, fat may accumulate around the _____ vertebrae (especially in women). This is sometimes called a “_______ hump”
● Abnormal: ______ or swellings other than the ______ vertebrae may be abnormal
Inspect range of motion:
Assessment Note: Ask the client to turn the head to the right and to the left (chin to shoulder), touch ear to the shoulder, and lift the chin to the ceiling
● Normal: normally, neck movement should be smooth and controlled with ___-degree flexion, ____-degree extension, _____-degree lateral abduction, and 70-degree rotation.
OLDER ADULT CONSIDERATION: Older clients usually have somewhat decreased flexion, extension, lateral bending, and rotation of the neck. This is usually due to ______.
● Abnormal: muscle spasms, inflammation, or ______ arthritis may cause stiffness, rigidity, and limited mobility of the neck, which may affect daily functioning.
- Clinical Tip: notify primary care provider and seek emergency care if client has stiff neck along with ____, headache, nausea, vomiting, _____, and/or confusion, which are indicative of meningococcal ________ or meningococcal ________
Palpation
Palpate the trachea: Place your finger in the ______ notch. Feel each side of the notch and palpate the tracheal _____. The first upper ring above the smooth tracheal rings is the ______ cartilage.
● Normal: Trachea is ______
● Abnormal: The trachea may be pulled to the _______ side in cases of large _____, fibrosis, or ______ adhesions. The trachea is pushed to the unaffected side in case of a _____, enlarged thyroid lobe, _______, or with an aortic ________.
Palpate the thyroid gland: Locate key landmarks with your index finger and thumb: _____ bone (arch-shaped bone that does not articulate directly with any other bone; located _____ in anterior neck)
Thyroid _____ (under the hyoid bones; the area that widens at the top of the trachea), also known as the “_____ apple”; Cricoid cartilage (smaller upper tracheal ring under the thyroid cartilage).
To palpate the thyroid, use a posterior approach. Stand behind the client and ask the client to lower the chin to the chest and turn the neck slightly to the right. This will relax the client’s neck muscles. Then place your thumbs on the nape of the client’s neck with your other fingers on either side of the trachea below the ________ cartilage. Use your left fingers to push the trachea to the _______. Then use your right fingers to feel deeply in front of the sternomastoid muscle.
● Normal: Unless the client is extremely thin with a long neck, the thyroid gland is usually _____ palpable. However, the _____ may be palpated in midline. If the thyroid can be palpated, the lobes are _____, firm, and nontender. The right lobe is often ______% larger than the left lobe.
→ OLDER ADULT CONSIDERATION: If palpable, the older client’s thyroid may feel more nodular or irregular because of fibrotic changes that occur with aging; the thyroid may also be felt ________ in the neck because of age-related structural changes.
● Abnormal: in cases of _______ enlargement, such as hyperthyroidism, _______ disease, or an endemic ______, the thyroid gland may be palpated. An enlarged, tender gland may result from thyroiditis, multiple nodules of the thyroid may be seen in metabolic processes. However, rapid enlargement of a single nodule suggests a _________ and must be evaluated further.
Auscultation
___________ the thyroid only if you find an enlarged thyroid gland during inspection or palpation: place the _____ of the stethoscope over the ________ lobes of the thyroid gland. Ask the client to hold their _______ (to obscure any tracheal breath sounds while you auscultate)
● Normal: no bruits are auscultated
● Abnormal: a soft, blowing, or ________ sound auscultated over the thyroid lobes is often heard in _________ because of an increase in ________ flow through the thyroid arteries
Inspection The Neck
penlight
thyroid
lymph
tumor
Inspect movement of the neck structures
swallow
cartilage
gland
NORMAL:
cricoid
upward
Abnormal:
asymmetric
generalized
Inspect the cervical vertebrae:
Normal: C7, palpable
OLDER ADULT CONSIDERATION:
Curvature, kyphosis, cervical, dowager’s
Abnormal: prominence, C7
Inspect range of motion:
NORMAL :
45 flexion, 55 extension, 40 lateral abduction
OLDER ADULT CONSIDERATION:
arthritis.
ABNORMAL:
cervical
Clinical Tip:
Fever, photophobia,
meningococcal meningitis
meningococcal septicemia
Palpate the trachea:
Sternal, rings, cricoid
NORMAL: midline
ABNORMAL: affected, atelectasi, pleural
Unaffected, tumor, pneumothorax,
Aneurysm
Palpate the thyroid gland
Hyoid
High
Cartilage
posterior
adam’s
cricoid
right
Normal:
Not
Isthmus
Smooth
25
OLDER ADULT CONSIDERATION:
fibrotic
lower
Abnormal:
Diffuse
Graves
Goiter
Malignancy
Auscultate
Bell
Lateral
Breath
Normal:
Abnormal: swishing, hyperthyroidism
