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Assessment of the Head, Face & Neck Dr. Sara Mitchell Georgia Baptist College of Nursing Of Mercer University Main bones of the cranium __________ __________ __________ __________ Major structures of the neck __________________ __________________ __________________ ________________ & _____________ _______________ _______________ Midline structures of the neck _________________________________ _________________________ __________________ __________________ __________________ Assessment of the head Inspect hair scalp skull face skin Palpate scalp skull temporal artery How to Examine the Hair and Scalp Assessment of the face CN V - __________ CN Vll - ________ motor function sensory function motor function sensory function CN lX & X ___________ & ____ CN Xl - ___________ CN Xll - __________ Assessment of the cranial sinuses The paranasal sinuses are air filled cavities that warm, moisten, filter air, and aid in voice resonance Assessment of sinuses How to Examine CN V: Trigeminal Nerve – Sensory How to Examine CN V: Trigeminal Nerve – Motor CN VII: Facial Motor The Mouth A part of face through which food passes into the body, being within the tongue, gums, and teeth The oral pharynx Composted of three functional parts __________________ __________________ __________________ Functions include _____________ _____________ _____________ Oropharynx Oral mucosa Assessment Inspect lips oral mucosa gums & teeth roof of mouth tongue & floor of mouth pharynx Tonsils Strep Tonsillitis Peritonsillar Abscess Hand Foot Mouth Disease The Tongue Contains the strongest muscle in the body Innervated by the __________ or twelfth cranial nerve (CN XII) Sweet & salty tastes are perceived on the anterior two thirds of the supplied by a division of the ________ or cranial nerve seven (CN VII) Sour & bitter tastes are perceived at the posterior aspect of the tongue which is innervated by the _____________ or ninth cranial nerve (CN IX) Assessment of tongue Inspect General appearance Mucosa Palpate Lateral margins All white lesions Normal tongue variants Geographic tongue Black hairy tongue Fissured Tongue The salivary glands There are three major salivary glands ________________ ________________ ________________ ____________ arises from the parotid gland ___________ duct arises from the submandibular gland The Neck Assessment of the neck The neck can tilt to one side or the other about 45 degrees. (The lumbar spine, by comparison, can only tilt to between 15 and 20 degrees.) * The neck can extend, or bend backwards, about 70 to 90 degrees. (By comparison the low back can flex only 40 to 60 degrees.) * The neck can flex, or bend forward, about 80 to 90 degrees. (The low back can only extend 20 to 25 degrees.) Our necks need to use their mobility in order to maintain it. They work best when they can consistently move into and out of their full range of motion in a gentle - that is, not a jarring - way. Assessment of the neck Inspection lumbar spine can only rotate 3 to 18 degrees.) general specific (thyroid) Range of motion Functions Lymphatic System Filters and engulfs bacteria, certain other cells, foreign particles, or toxins in the lymph nodes Returns fluid, proteins, and electrolytes from tissue space to the blood. Absorbs fat and fat-soluble substances from the intestinal tract Produces lymphocytes in the lymph nodes, tonsils, adenoids, spleen, and bone marrow Produces antibodies The lymphatic system is also a pathway for the spread of malignancy Assessment of the lymph nodes Use a _____________ to palpate each anatomical area that housed lymph nodes All palpable nodes should be assessed for ______, ______,_________, and _______________. Common infectious causes of cervical lymphadenopathy Group A streptococcal infection Mononucleosis (Ebstein Barr Virus, or EBV) Cytomegalovirus (CMV, closely related to EBV) HIV Unusual infectious causes include: Cat scratch disease (usually from a kitten) Tularemia (ask about hunting rabbits) Anthrax Lupus The Thyroid Gland The largest endocrine gland in the body and the only one that is accessible to direct physical assessment. Butterfly shaped with a lobe on each side of the trachea Normal consistency described as “meaty” or “rubbery” isthumus Assessment of the thyroid gland •Unusual __________ is associated with cancer or scarring •____________ or sponginess is seen with toxic goiter •____________ is associated with acute infection or hemorrhage ___________________________ ___________________________ ___________________________ Palpation of Thyroid Gland in Client with Goiter When auscultating the thyroid listen for the presence of a bruit. The finding of a systolic or “to-to-fro” thyroid bruit, is highly suggestive of a toxic goiter Causes of Enlarged Thyroid Graves Disease Hashimoto’s disease Multinodular goiter Solitary thyroid nodules Thyroid cancer Pregnancy Inflammation Sternocleidomastoid Muscle The sternocleidomastoid muscle is innerved by the ___________or eleventh cranial nerve Anterior to this muscle is the anterior triangle bounded by the clavicle anteriorly and midline How to Examine CN XI: Spinal Accessory – Trapezius Muscle Posterior to the muscle is the posterior triangle bounded by the trapezius muscle posteriorly and the clavicle inferiorly. The Ears Come on, let’s play Ouch! Let Go The Ear Ear structure external ear middle ear _______________ _______________ inner ear ________________l Assessment of the Ear External Ear Inspection: auricles and mastoid area for: • Tenderness Swelling Nodules video Internal Ear Structures - video tympanic membrane hearing AC vs. BC Correct handling of the Otoscope For children under 3 years of age place the pinna should be pulled ____________ For children older than 3 as well as adults, pinna should be pulled __________ The Tympanic Membrane Injected Tympanic Membrane Normal right tympanic membrane Ventilation Tube Rinne’ Test The Rinne’ evaluates air conduction and bone conduction The client who has no conductive hearing loss will hear the sound ______ as long ____ by _____ condition as by ____ conduction ________ The Weber test This test compares bone conduction in both ears and determines whether monaural impairment is neural or conductive. Sound should be heard equally in both ears. Hearing that is ________ is associated with ______ ______ Impact of Hearing Loss Paranoia Withdrawal Depression Anxiety “Oh you men that think that I am malevolent, or misanthropic, how greatly do you wrong me. You do not know the secret cause which makes me seem that way to you… For me there can be no relaxation with my fellow men, no refined conversations, no mutual exchange of ideas. I must live alone, like one who has been banished… What a humiliation for me when someone standing next to me heard a flute in the distance, and I heard nothing…a little more of that and I would have ended my life – it was only my art that held me back” Beethoven Differential Diagnoses for Hearing Loss Children Congenital Acquired Adults Acquired The Nose Assessment of olfactory ability _______________________________ Nose assessment Inspection: Nose & parasinuses anterior & posterior surfaces test for nasal obstruction inside of nose mucosa turbinates Palpate Nasal speculum sinuses transillumination Normal Nasal Turbinates Assessment of the external nose Common condition of external nose Rhinophyma (with or without rosacea Differential Diagnoses of abnormal nasal findings URI Allergies Epitasis Polyps Review of cranial nerves in order I: Olfactory - smell II: Optic: - vision III: Oculomotor – Most EOM IV: Trochlear –superior V: Trigeminal – mastication; facial & scalp sensation XI: Spinal Accessory – VI: Abducens – lateral rectus XII: Hypoglossal – VIII: Acoustic – hearing & IX: Glossopharyngeal – movement; raise eyelids; pupil constriction oblique VII: Facial – facial muscles; taste; saliva & tear secretion equilibrium phonation & swallowing; taste back portion of tongue X: Vagus – talking & swallowing; carotid reflex movement of trapezius & sternomastoid muscle movement of tongue H(E)ENT S.O.A.P. note Subjective - chief complaint and related history (ask yourself “is this concern specific to HEENT or related to a systemic illness?”) Objective general: ENT: Neck: Assessment - Plan - Our eyes, ears, & nose allow us to experience the beauty of creation