Week 4 - HEENT Flashcards
cranial bones
frontal, parietal, occipital, temporal
sternomastoid
head rotation and flexion
trapezius
moves the shoulders and extends/turns the head
thyroid gland
major endocrine gland responsible for cellular metabolism
- normally not palpable behind the trachea
subjective data: health history
Headache: Unusually frequent, severe? Onset? Had this type before? Location? Character? Mild, moderate, severe? Course and duration? Precipitating factors? Associated factors? Other illnesses? Taking meds? What makes it worse? Treatment? Coping strategies?
Head injury: Onset? Setting? Location? Duration? Associated symptoms? Effort to treat?
Dizziness: Determine what patient means by dizziness. Onset? Associated factors?
Neck pain: Onset? Location? Associated symptoms? Precipitating factors? Related to stress, body mechanics? Coping strategies?
Lumps or swelling: Recent infection, tenderness? Duration? Change in size? History of irradiation of head, neck, upper chest? Difficulty swallowing? Do you smoke? Do you drink alcohol? (rationale: smoking and alcohol together increase the risk for cancer). Thyroid problems?
History of head or neck surgery: Ever had surgery of head or neck? Why? When? How do you feel about the results?
objective data: physical exam
Normal size and shape of head = normocephalic.
Head—Inspect and palpate the skull
Size and shape
Temporal area
Temporal artery
Temporomandibular joint - open/close mouth
Facial structures - symmetry
neck
inspect
- ROM
- symmetry = neck structures and trachea
- ability to shrug shoulders against resistance (CN XI)
Auscultate
- carotid artery = listen for bruit (blowing, swishing sound)
Palpate
- cervical lymph nodes –> lymph vessels detect and eliminate foreign substances from the body. Nodes are small, oval clusters of tissue that are set at intervals along the lymph vessels, like beads on a string.
Thyroid
eye subjective data: health history
Vision difficulty: Any difficulty seeing or any blurring? Sudden onset or slow progression? One eye or both? Constant? Spot in front of eyes? Halos, rings around lights? Blind spots? Night blindness?
Pain: Any pain? Describe. Sudden? Quality? Pain with bright light? Foreign body? Rapid consult with opthamology or emergency dept
Strabismus, diplopia: Crossed eyes? Occurs with eye fatigue? Seeing double?
Redness, swelling: Any infections? Particular time of year? Common, usually benign condition – conjunctivitis. Unless accompanied by eye pain or change in vision.
Watering, discharge: Watering, excessive tearing? Discharge? Colour? How do you remove material?
Ocular problems: History of injury or surgery? Allergies? Glaucoma (family hx? Been tested?)
Glasses or contacts: Do you wear? How effective? Last prescription check? Any problems with contacts? How do you clean them, remove them?
Self-care behaviours: Last vision test? Tested for colour vision? Environmental factors affecting eyes?
Medications: Using eye medications? Systemic/topical?
Vision loss: How do you cope with vision loss? Maintenance of living environment?
eye objective data: physical exam
normal pupil size 3-5 mm
PERRLA
- Pupils are equal, round, react to light and accommodation
inspect external ocular structures
use of ophthalmoscope
+ dioptres (black) = focus on near objects
- dioptres (red) = focus on objects farther away
normal findings of the ocular fundus
- optic disc
- retinal vessels
- general background
- macula
Snellen eye chart
- 20 ft away
- do wear glasses if normally required
- cover one eye and read smallest line that you can
- one mistake allowed
- repeat w/ other eye
nystagmus
a fine oscillating movement around the iris, may indicate weakness or disease
extraocular muscle function/movement
convergence = eyes move inward toward nose
Hirschberg’s test
corneal light reflex
- assessing parallel alignment of the eye axes by shining a light toward the patients’ eyes. The reflection of light should be at exactly the same spot in the two corneas. Asymmetry of the light reflex indicates deviation in alignment as a result of eye muscle weakness or paralysis.
abnormal findings for eyes KNOW THIS
Ptosis = drooping upper lid
unequal pupil size
Miosis = contraction of pupil
Mydriasis = dilation of pupil
Conjunctivitis = pink eye
Glaucoma = intraocular pressure
vertigo
inflammation of the semicircular canals of the inner ear that result in a spinning, whirling sensation
ear structure
outer ear (auricle or pinna), tympanic membrane (translucent, pearly gray membrane), middle ear, inner ear
inner ear
- equilibrium = semicircular canals, vestibule
- hearing = cochlea
ear subjective data: health history
Earaches: Location, character, other symptoms, any related trauma? What relieves it?
Infections: When? How often? How were they treated?
Discharge: Appearance, odor, related to pain?
Hearing loss: Onset, character? In which situations? Family history? Any treatment? Coping strategies?
Environmental noise: Loud noise at home or work? Coping strategies?
Vertigo: Dizziness, room spinning, loss of balance?
Self-care behaviours: How do you clean your ears? Last time hearing was checked?
cues of possible hearing loss
1.Lip reading or watching your face and lips closely rather than your eyes.
2.Frowning or straining forward to hear.
3.Posturing of head to catch sounds with better ear.
4.Misunderstanding your questions or frequently asking you to repeat what you said.
5.Acting irritable or showing startle reflex when you raise your voice (recruitment).
6.Inappropriately loud voice.
7. Speech sounding garbled; possible distortion of vowel sounds.
8. Flat, monotonous tone of voice.
ear objective data: physical exam
external ear - inspect and palpate
- size and shape
- skin condition
- tenderness
- external auditory canal = lesions, discharge
test hearing aculity
- conversational speech
- Whispered voice test (place one finger on the tragus and whisper words approx. 1 foot away from the other ear)
ear objective data: physical exam cont.
Canal color & characteristics – pink, moist.
Cone of light - visible through otoscope, at 5:00 position in right ear and 7:00 position in left ear.
Tympanic membrane – pearly grey.
No discharge present.
*Pull pinna up and back on adults or older children (pull pinna down on infants and < 3yrs of age).
nose, mouth, and nose
Nose
– warms, moistens, and filters inhaled air.
- sinuses = air-filled pockets which lighten the weight of the skull, resonate sound, provide mucus, easily inflamed.
Mouth
– the oral cavity = contains lips, palate, cheeks, tongue, teeth, gums, and salivary glands.
- Salivary glands secrete saliva which lubricates the food bolus, starts digestion, and cleans/protects the mucosa.
Throat
– pharynx is located behind the mouth and nose.
- Separated from the oropharynx by tonsils.
nose subjective data: health history
Discharge: Any discharge? Continuous? Watery, purulent, mucoid, bloody?
Colds: Frequent or severe? How often?
Sinus pain: Any pain or sinusitis? How treated? Chronic postnasal drip?
Trauma: Ever have trauma to nose? Can you breathe through nose? One or both sides obstructed?
Epistaxis: How often? How much bleeding? Colour? One or both nostrils? Aggravated by scratching or picking? How treated? Difficult to stop?
Allergies: Allergic to what? How determined? What makes it worse? Can you avoid exposure? Use inhaler, spray, drops? Which ones? How often? How long have you used?
Altered smell: Any change in sense of smell?
