week 8: head, neck, eyes, ears, nose, mouth

Question 1

what is the skull

Answer 1

Protects brain/sensory organs
Includes bones of the cranium, face
Bones, sutures, orbit, upper/lower jaw

Question 2

parts of the face

Answer 2

Facial expression, expresses mood
Facial muscles (CNV Trigeminal; mastication)
Salivary Glands (Parotid, Submandibular, Sublingual)
Temporal Artery (anterior to the ear)

Question 3

parts of the neck

Answer 3

Sternocleidomastoid Muscle (Rotates head) and Trapezius (Shoulder Elevation)
Controlled by CN XI - Spinal Accessory
Thyroid Gland
Highly vascular endocrine gland
Synthesizes/Secretes Thyroxine (T40) and Triiodothyronine (T3)
Butterfly; has 2 lobes between tracheal/sternomastoid muscles
Hyoid Bone: Floating bone, top of the neck
Thyroid Cartilage (above thyroid, cricoid, has Adam’s apple)
Cricoid Cartilage (between thyroid and thyroid cartilage)

Question 4

parts of the lymphatic system

Answer 4

Extensive throughout head/neck, major part of the immune system
Detects and eliminates foreign substances
Lymph nodes: Small oval clusters of lymphatic tissue
Engulfs pathogens, prevents harmful substances from entering circulation
You have to palpate all of them:
3 Around the Ear (Preauricular -> Posterior Auricular -> Occipital) -> 4 around the Jaw (Submental, Submandibular, Jugulodigastric/Tonsillar, Parotid), 4 around the Neck (Superficial Cervical, Deep Cervical Chain, Posterior Cervical, Supraclavicular,)
Use two fingers, light-to-medium touch

Question 5

sinuses

Answer 5

Hollow areas in bones that help with voice resonance, lightens skull weight
Present at birth; in Frontal, Maxillary, Ethmoid, and Sphenoid bones

Question 6

carotid artery

Answer 6

Common Carotid; branches into internal/external carotids up head, palpate one at a time

Question 7

pediatric fontanelles

Answer 7

In children, the sutures are not fully formed yet.
Anterior, Posterior, Sphenoid, Mastoid Fontanelles
Skull is not yet fused when born; allows for birth, growth of the brain
Posterior closes by 1-2 months, Anterior closes by 9 months - 2 years
Normally film, slightly concave
Shrunken = Dehydration
Bulging = Increased ICP (edema, bleed, not good)
They also look like they have no neck; it’s shorter, no control of neck muscles yet

Question 8

nose

Answer 8

First segment of respiratory system; warms, moistens, filters air in nasal cavity
Has the sinuses inside
Shaped like a triangle with 2 oval openings at the base; divided in half by the septum

Question 9

mouth

Answer 9

First segment of the digestive system; also an airway for respiratory system
Bordered by the lips, palate, cheek, tongue
Contains teeth, gums, tongue, salivary glands (parotid, submandibular, sublingual)
Adults have 32 permanent teeth; children have up to 20 deciduous (baby) teeth
Age in months - 6 = number of teeth
Don’t give bottle while lying down = pools in mouth, tooth decay
Xerostomia: Decreased saliva production

Question 10

throat

Answer 10

(Pharynx)
Area behind the mouth and nose
Separated from the mouth by the tonsils (check for these), uvula

Question 11

eyelids

Answer 11

Palpebra; protects the eye from foreign substances with eyelashes
Canthus; Where they meet (medial/lateral), Caruncle (has sebaceous glands)

Question 12

conjunctiva

Answer 12

Transparent protective mucous membrane, between eyelids, eyeball
Bulbar (on eyeball) and Palpebral (on the eyelid)

Question 13

extraocular muscles

Answer 13

There are 6. Controlled by CN’s III, IV, VI (Most are 3, other than LR6, SO4)

Question 14

sclera

Answer 14

the white

Question 15

cornea

Answer 15

outer covering the helps bend light into pupil

Question 16

pupil

Answer 16

dark, round hole - lets light in

Question 17

lens

Answer 17

focuses light

Question 18

retina

Answer 18

actually receives light, has photoreceptors

Question 19

optic disc

Answer 19

where the optic nerve is

Question 20

macula/fovea centralis

Answer 20

super high visual acuity point

Question 21

ear

Answer 21

sensory organ for hearing and balance; conducts sounds waves

Question 22

external ear

Answer 22

Auricle/Pinna: The swirly ear part of your ear.
External Auditory Meatus: The ear hole
External Auditory Canal: The tube that conducts sound into your ears.
Lined with glands that secrete cerumen (earwax)
Lymph fluid from external ear drains into parotid, mastoid, superficial cervical lymph nodes

Question 23

tympanic membrane

Answer 23

Eardrum; separates the external and middle ear
Is oval, concave, pulled in by the malleus (hammer)
Normally pearly grey***, translucent, malleus is visible, “annulus” is the ring around it

Question 24

middle ear

Answer 24

Air filled area inside temporal bone; has the ossicles
Malleus, Incus, Stapes which conduct sound from the tympanic membrane
Eustachian Tube: Connects to middle ear; allows for passage of air, equilibrates pressure when swallowing yawning
Functions: Hearing, Protects inner ear by dampening loud sounds, air pressure equalizing
Infection Drainage (via Eustachian tube) (?)

Question 25

inner er

Answer 25

Contains the bony labyrinth; made of several parts Vestibular Apparatus: The vestibule, semicircular canals = balance Hearing Apparatus: The cochlea = use it for hearing Pathways are either air conduction (using ears) or bone conduction (vibrations, our own voices)

Question 26

pediatrics ears

Answer 26

Children have shorter, horizontal eustachian tubes; prone to infection when they move from nasopharynx to the middle ear

Question 27

older adults ears

Answer 27

Stiff, coarse cilia and impact on cerumen: Presbycusis: Gradual hearing loss; nerve degeneration

Question 28

subjective assessment: nose

Answer 28

Any nasal discharge/runny nose? (rhinorrhea) Is it watery, bloody, like pus, mucus? Any unusually frequent or severe colds? (upper respiratory infections) Any sinus pain or sinusitis? Treatment? Any trauma or broken your nose? When? Any nosebleeds (epistaxis)? How often? Colour? Nostrils? Causes? Treatment? Any allergies? What are you allergic to? Symptoms? Any altered smell? Change/decrease? (CN I - Olfactory)

Question 29

subjective data: mouth and throat

Answer 29

Any sores or lesions in your mouth/on the tongue/gums? How long? Had it before? SIngle/multiple? How’d you get it? Treatment? Any sore throat? How frequently do you get it? Have it now? When did it start? Causes? Any bleeding gums? How long have you had it? Any toothaches? Sensitivity to hot/cold? Lost teeth? Sugar, Bruxism (grinding teeth) Any hoarseness or voice change? Lump in your throat? For how long? Any dysphagia (difficulty swallowing)? Any altered sense of taste? Do you smoke or consume alcohol? How many per day? Trying to quit? Self Care; Tell me about your dental care: dentist frequency, brush/floss, dentures/appliances

Question 30

subjective assessment: neck and thyroid

Answer 30

Do you have any thyroid problems? Do you have any hormonal problems?

Question 31

subjective assessment: head

Answer 31

Any unusually frequent/severe headaches? How often, what kind of pain, how long, Tx? Any history of head injuries? When? Knocked out? How? Where? Symptoms after? Tx? Experienced any Dizziness? Faint? Confused? Lightheadedness/Falling vs. Spinning (vertigo) Any head or neck pain? Limitations to your range of motion? Noticed any lumps or swelling? Recent infection/tenderness? When/Duration/Change in size? History of head/neck surgery? What condition, when, aftermath? *Health Teaching*: Sunscreen, Helmets (bikes/vehicles, sports), Seatbelts

Question 32

inspection and palpation of skull

Answer 32

Size and Shape (Normocephalic: Round, symmetrical, proportioned to body, vs. Micro/Macrocephalic), feel scalp, hair Palpate the temporal artery (temple; between eye and ear) Examine Facial Symmetry, Expression, Presence of structures, abnormalities (tics) CN VII - Raise eyebrows, frown, close eyes tightly, show upper/lower teeth, smile, puff out both cheeks - Do this if you suspect stroke Mastoid (TMJ, CN V Trigeminal)

Question 33

inspection and palpation of nose

Answer 33

Any symmetry, deformity of the nose Any lesions, inflammation Pain or break in contour while palpating Test patency of nostrils: hold one shut, get them to breathe in with other nostril, do both Palpate sinus areas: Below eyebrows (Frontal) and Below cheekbones (maxillary) Pressure with no pain if normal; Pain if infected, allergies

Question 34

inspection and palpation of the lips

Answer 34

Colour, moisture (cyanosis/pallor, cherry red w/ CO) Cracking and lesions (Cheilitis)

Question 35

inspection and palpation of the teeth and gums

Answer 35

Any diseased, absent, loose, misplaced teeth Upper/lower Jaw alignment Colour, Bleeding, Swelling of gums (Normally pink)

Question 36

inspection and palpation of the tongue

Answer 36

Colour, surface characteristics, moisture (pinkish with thin white coating, moist) Palpate any white patches, lesions Ask patient to touch tongue to roof of mouth; examine underside - glistens, moist, veins, “U-shape”, palpate under as well for any problems

Question 37

inspection and palpation of the buccal mucosa/palate

Answer 37

Inspect (inside cheeks) for colour, nodules, lesions Inspect bony ridged palate Look for tonsils and uvula (stick out tongue, depress it, “say ahh”); CN X - Vagus

Question 38

inspection of tongue

Answer 38

Throat: Use a depressor, slightly off centre, halfway back INSPECTION: Note colour, any exudate, lesions Observe tonsils; graded in size from 1+ - 4+ (visible to touching) Don’t test the gag reflex Note any halitosis (breath odour)

Question 39

inspection and palpation of the neck

Answer 39

Symmetry of the neck: Head is central Tracheal Symmetry; run finger down midline - tracheal shifts are bad Palpate the thyroid gland (uncomfortable, requires shifting the trachea with one hand; palpating with the other. Landmark by going below the thyroid cartilage (adam’s apple)) Auscultate as well with bell if enlarged, listen for bruit Palpate the Lymph Nodes (there are 11 groups), order doesn’t really matter, circular motion and touch by pressing light-medium (pushing too hard can push them in) 3 Around the Ear (Preauricular -> Posterior Auricular -> Occipital) -> 4 around the Jaw (Submental, Submandibular, Jugulodigastric/Tonsillar, Parotid), 4 around the Neck (Superficial Cervical, Deep Cervical Chain, Posterior Cervical, Supraclavicular,) Neck Muscle Range of Motion (CN XI; Accessory) - Head rotation and Shoulder shrug + resist

Question 40

subjective for eyes

Answer 40

Any vision difficulties? Decreased acuity, blurring, blind spots Any eye pain? Please describe it (photophobia: sensitivity to light) Any history of crossed eyes or double vision? (strabismus, diplopia) Any redness or swelling in the eyes? Any watering or discharge (excessive tearing?) Do you use corrective lenses/contacts? Self-care/Last eye exam? History of ocular problems/glaucoma/conditions?

Question 41

subjective for ears

Answer 41

Any earaches or other pains in the ears? Shallow, deep in head, hurt? Dull? Trauma? Any ear infections? When? Any discharge from your ears? Bloody? Pus? Odour? Ear pain? Any trouble hearing or hearing loss? When? Exposure to any loud environmental noise? At home or on the job? Any ringing in the ears (tinnitus)? Ever felt vertigo or the room or yourself spinning? Or Dizzy/lightheaded? How do you take care of your ears? How do you clean them? Don’t use Q-tips; use warm water + cloth Last hearing test if you have hearing loss? Hearing aids? Do you protect your ears if you’re around loud things?

Question 42

objective for eyes inspection

Answer 42

General function to move around room Observe presence of eyebrows, their movement Eyelids and Eyelashes - Presence; note any ptosis (drooping), xanthelasma (plaque buildup on inside orbit - they’re cholesterol deposits) Eyeballs themselves; colour of sclera, iris, pupil shape, cornea/lens Any exophthalmos (bulging) or enophthalmos (very sunken in) Conjunctiva/Sclera: Patient looks up, pull down lower eyelids Should be pink lids, few blood vessels, moist/white sclera Note any moisture Any abnormal swelling/lesions

Question 43

snellen eye chart

Answer 43

from 20 feet away; Normal = 20/20 vision Numerator = Distance from chart Denominator = Distance from which a normal eye can read; bigger = worse Children may use Allen test or E chart

Question 44

xtraocular muscles/cardinal gazes

Answer 44

CN III, IV, VI; 6 Directions

Question 45

visual reflex test/accommodation

Answer 45

Finger close = Pupils constrict; Finger far = Dilate

Question 46

pupillary light reflex/constriction

Answer 46

CN II; Dark room, shine light from side Can measure pupil size in mm; resting size = 3-5mm Constriction speed = brisk/sluggish/fixed (none) Consensual Light Reflex (both pupils constrict when light is in one eye)

Question 47

PEERLA

Answer 47

Pupils Equal, Round, Reactive to Light and Accommodation

Question 48

inspecting the ocular fundus

Answer 48

Uses an opthalmoscope Look through the pupil in a dark room; person looks at a distance object Match sides; For their right eye, use your right eye, rest free hand on shoulder/head to orient Observe the red reflex to make sure you’re centre, look at the optic disc, macula, etc.

Question 49

objective ear inspection and palpation

Answer 49

Size (4-10cm) and shape of the auricle/pinna, symmetrical, no swelling Skin condition, colour, lumps, lesions Move the pinna, push on tragus, mastoid for tenderness - it should not hurt Inspect the external auditory meatus for size, swelling, redness Note any discharge, cerumen (some is normal)/colour, lesions, foreign bodies

Question 50

otoscopy

Answer 50

Choose the largest speculum that will fit the canal Pull the ear up and back for adults, straight down for children Insert otoscope into ear upside down, brace hand along cheek for balance, insert slowly Inspect the tympanic membrane for colour, translucency, malleus, note any Otitis media, should be flat and slightly concave at the centre, intact

Question 51

hearing acuity

Answer 51

Whispered voice test: Test one ear while covering the other, cover mouth slightly Whisper two syllable words and get them to repeat it Ex., Tuesday, Armchair, Baseball, Fourteen

Question 52

vestibular test

Answer 52

Romberg Test for balance: Hands at sides, feet together, eyes closed - Positive if they fall

Question 53

DARP Documentation

Answer 53

D: Data Subjective + Objective What you (the nurse) can see, hear, touch, smell Findings that indicate that an action needs to be taken A: Analysis and Action Your interpretation of the patient’s issue/concern/need Summarize the data that informs your action Make some sort of conclusion; things that need to be done immediately or in the future R: Response How the patient/client responds to the care (action/intervention) What happened to the patient as a result of the action Outcomes P: Plan Plan for care, based on observation of patient’s response What else could be done in a given span of time Planned interventions, further assessments, therapeutic interventions, teaching strategies SMART goals: (Specific, Measurable, Attainable, Realistic, Timed - Also specify frequency)