head and neck assessment
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| why do an assessment of the head and neck? | congenital anomalies like hydrocephalus, lymphadenopathy second to infx, allergies, neoplasms, trauma to cervical spine/nerve damage, enlarged thyroid from thyroid hormonal probs and cancer probs, elderly changes
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| elderly changes | less subq tissue make for skinny necks, rom limitations - neck will hunch over. diziness with movement
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| types of diziness | disequilibrium, vertigo, near-syncope
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| disequilibrium | unsteady, worse in dark, need cane or railing
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| vertigo | spinning sensation
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| near-syncope | feeling faint
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| what questions should you ask during interview? | chief complaints, past history, social history, health maintenance activities
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| cheif complaints | pain, swelling, lesions
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| past history | trauma, thyroid swelling, infx, headaches with pain.
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| social hx | substance use, risk activities, abuse risk
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| health maintenance activities | safety devices
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| type of headaches | muscle contraction, vascular, systemic, intracranial, facial/cervical
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| muscle contraction ha | aka tension ha. vise-like. like something squeezing your head
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| vascular ha | vessels in brain are dilated. migraines and cluster has
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| systemic ha | fever
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| intracranial ha | meningitis, anyeurisms
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| facial/cervical ha | sinuses, oral/dental problems
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| migraine ha s/s | 1-2 times a month, last about 1-3 days long. aura, n/v, throbbing sensation, one-sided, photophobia, severely limiting.
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| cluster ha s/s | affects men more than women. occurs in heavy smokers and drinkers, emotions and stress can trigger too. clusters last weeks or months. absent for a period of time. severe but short. centered around one eye (can get teary). may occur at same time of day
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| nursing interventions for has | acknowledge the pain, decrease light and noise, use nonpharmacologic and pharmacologic remidies
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| nonpharmacologic nursing interventions | muscle stretching in face, massage, soothing music, herbals, warm or cool compress
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| pharmacologic nursing interventions | seven types of triptans. cause vasoconstriction. caffiene works too.
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| head and neck cancer warning signs | dysphagia, chronic ulcer, chronic lump in neck.
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| physical exam of head and scalp: inspection | size, shape, symmetry, lesions
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| physical exam of head and scalp: palpation | head for tenderness, symmetry, scalp movement, temporal arteries for hardness, thickening, and tenderness
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| physical exam of head and scalp: ascultation | temporal arteries for bruits
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| abnormal findings of physical exam of head and scalp | craniosynostosis, hydrocephalus, craniotabes, tenderness, lesions
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| hydrocephalus | water on the brain
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| craniosynostosis | early closure of sutures can lead to eye and brain damage
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| craniotabes | second to hydrocephalus. demineralization of cranium. soft or snappy sensation like a ping pong ball
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| lesions | cysts, lacerations from injury, hematomas or blood blisters, lipomas or fatty tumor
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| physical exam of face: inspection | symmetry, shape, facial expressions, facial features, tics
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| tic | muscle contraction that is regular and uncontrolled
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| physical exam of face: palpation | tmj
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| tmj | temporal mandibular joint. clicking, crepitus, pain. is abnormal. jaw stretching exercises encouraged.
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| trigeminal nerve | motor and sensory
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| trigeminal nerve motor test | for masseter and temporalis muscles. clench muscles, chew or bite on tongue blade
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| trigeminal nerve sensory test | test forehead, cheeks, anc chin with cottonball wisps. corneal reflex if pt is onconsciuous
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| corneal reflex | take cottonball wisp along cornea, if pt blinks, trigeminal nerve is intact
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| facial nerve | motor and sensory
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| facial nerve motor test | facial expressions. have pt smile, frown, close eyes, lift brows, puff cheeks. check for symmetry
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| facial nerve sensory test | anterior taste. we don't do in hopspital. put little bit of sugar or salt into pt's hand and have them put it onto the tip of their tongue and tell you what it is.
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| abnormal findings for physical exam of the face. | down syndrome, trigeminal neuralgia, bell's palsy, lesions
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| down syndrome | low-set ears, flattened bridge of nose, mouth small, large tongue, slitted eyes
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| trigeminal neuralgia | aka tic doloreaux. disorder of trigeminal nerve. pressure on nerve root. rxed with carbamazepeine, a nerve block, sometimes use surgery to rx.
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| bell's palsy | disorder of facial nerve. infxs can cause. paralysis, tearing, salivating on one side of face.
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| lesions | hemangioma
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| hemangiomas | on face or tongue. benign tumor of dilated blood vessels
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| physical assessment of neck: inspection | position, posture
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| physical assessment of neck: palpation | ROM, strength, pain.
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| spinal accessory nerve | motor
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| spinal accessory nerve motor test | trapezius and sternocleidomastoid muscle. test trap by putting hands on pt's shoulder and have them shrug. should have symmetry. test sternocleido by putting hands on cheeks and having pt turn to the sides
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| abnormal findings for physical assessment of neck | torticollis, webbing.
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| torticollis | aka wryneck. birth trauma, if untreated it will become fibrotic and will permanently shorten muscle.
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| webbing | excessive posterior cervical skin
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| physical exam of the thyroid gland: palpation | posterior approach. client flexes neck down and to the side. place thumbs on back of neck. displace cartilage on one side with fingers. palpate opposite side while client swallows
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| physical exam of the thyroid gland: ascultation | check enlarged thyroid for bruits
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| physical exam of lymph nodes: inspection | assess for swelling
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| physical exam of lymph nodes: palpation | size, shape, delimitation (does it feel like one or many), mobility, consistency, tenderness
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| lymph nodes in order of palpation | preauricular, postauricular, occipital, submandibular, retropharyngeal, submental, superficial cervical, posterior cervical, deep cervical, subclavicular
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| lymph nodes concerns | nontender, hard, matted, fixed
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| lymph nodes in TB | cold, soft, matted, nontender
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| conjunctivitis will swell what node | preauricular
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| ear infection will swell what node | auriculars and cervicals
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| mono will swell what node | anterior and posterior cervical
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| strep will cause swelling to what node | anterior cervical
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| malignancies in thorax/abd will cause swelling in what node | left supraclavicular aka virchow's
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| hodkin's lymphoma will cause swelling in what node | cervicals
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Created by:
leaman.15