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Head and neck assess

QuestionAnswer
if the head is tilted to one side thats an indicator of unilateral hearing or visual loss
horizontal jerking or bobbing is.. a tremor
what is hydrocephalus buildup of cerebrospinal fluid in the ventricles.. infants larger head
what is acromegaly adults with enlarged jaws and facial bones caused by excessive secretion of growth hormone
Examination of the eyes include visual acuity, visual fields,extraocular movements,external and internal eyes movements.
assessing near vision ask client to read printed material
if assessing distant vision use snellen chart.
checkin light perception shine penlight in eye. shutoff light
to test extraocular movements put the fingers up and down side to side
what is cataracts increased opacity of the lens. blocks the rays from entering the eye. develop slowly and progressivly after age 35 or sudden trauma
what is glaucoma intraocular structural damage resulting from elevate intraocular pressure. obstruction of the outflow of aqueous humor causes it
what is macular degeneration blurred central vision. progressive degeneration of the center of the retina. most common over age 50. most common blindness in adults
what is strabismus crossed eyes impairment of the extraocular muscles or nerves
what is retinopathy leading cause of blindness. noninflammatory eye disorder resulting in changes in retinal blood vessels.
what is hyperopia far sightedness.. a refractive error in which ray of light enters the eye and focus behind the retina. cant see close
what is myopia near sightedness.. a refractive error in which rays of light enter the eye and focus in front of the retina. cant see distance
what is nystagmus involuntary rhythimal oscillation of the eyes by periodicaly stopping the movement of the finger
Bulging eyes are exophthalmos
an abnormal drooping of the lid over the pupil is called ptosis caused by edema or impairment of third cranial nerve
ectropin older adults lid margins are turned out
entropion older adults lid margins are turned in
sty acute suppurative inflammation
the lacrimal gland is responsible for tear production
The presense of redness indicates...in the sclera conjuctivities or allergies
bright red blood in a localized area surrounded by normal appearing conjunctiva indicates subconjunctival hemorrhage
a thin white ring along the margin of the iris arcus senilis.. common in aging uncommon under age 40
pupis are normally 3-7 cmm
dilated pupils result from glaucoma/trauma/neurological disorders/eye meds or withdrawl from opioids
inflammation of iris or use of drugs constricted pupils
directly illuiminated pupil constricts vise verzsa
if pupil is normal all tests PERLLA
DEEPER INTO THE EYE FROM AN ADVANCED NURSE ophthalmoscope
inspect and palpate the external ear inspect middle ear with otoscope
test inner ear by hearing acuity
external ear structure consists of auricle.outer ear canal. tympanic membrane
the middle ear air filled cavity containing bony ossicles. malleus. incus. stapes
eustachian tube connected the middle ear to the nasopharynx. pressure between atmosphere and middle ear is stabilized through this tube
inner ear cochlea. vestibule.semicircular canals.
otoscope observing deep into external and middle ear
cerumen yellow wax in ear
reddened canal infection or inflammation
what is conduction hearing loss interrupts sound waves as they travel from the outer ear to the cochlea of the inner ear because the sound waves arent transmitted through the outer and middle ear structures
sensorineural loss involves inner ear, auditoy nerve, or hearing center of the brain
mixed loss combintation of sensorineural loss and conduction loss
what is ototoxicity injury to auditory nerve resulting from high maintenance doses of antiobitocs
what is a tuning fork used for 256-512 hertz most commonly used allows for hearing by bone conduction with that of air conduction
what is webers test hold at base and tap against heel of palm place above head see if the client hears in both ears
What is the rinne test place stem of tuning fork against client mastoid process. vibrate it go next to ear and ask if she hears it vibrating still
when assessing integrity of nose and sinuses what do u do inspect and palpatation!
penlight allows for gross examination of each naris when inspecting external nose.. observe shape. color. skin. size.
close one naris and breath and vise versa! when illuimanting the naris check for mucosa. color. lesions. discharge. sweling and evidence of bleeding.
sinus infection yellowish green discharge
allergies clear discharge
what is excoriation local skin breakdown characterized by redness and skin sloughing in the nose.. maybe b y a nasogastric tube
deviated septum obstructs breathing and interferes with passage of nasogastric tube
What is a polyp tumor like growth or purulent drainage
Examination of sinus's Involves palpation
frontal and maxillary facial areas palpating the sinuses, thumb up and under clients eyebrow
assess the oral cavity use a penlight and tongue depressor
inspect the lips for... color texture hydration contour and lesions
pallor lips = anemia with cyanosis caused by respitory or cardio problems
cherry coated lips= carbon monoxide poisoning
any lesions such as nodules or ulcerations= infection.irratation or skin cancer
symmetrical smile= normal facial nerve function
note color of teeth.alignment. presence of caries
chalky white on the teeth= cavities
brown or black discoloration= formation of caries
yellow stain tobacco use
brown stain coffee tea cola
inspect mucosa for color. hydration. texture. lesions.ulcers.abrasions.cycsts.
thick white patches in buccal mucosa leukoplakia, precancerious lesions. alcks and smokers
spongy gums that bleed= periodontal disease and vitamin c deficiency
gingivitis swollen gums. mobile teeth. pockets of debris at tooth margin
varicosities swollen tortuous veins common in older adults. rarely caused issues
exostosis bony growth between 2 palates
examination of pharyngeal infection.inflammation or lesions
Created by: ziogas