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Head and Neck Head Done poor Not perfectly done Head inspection mark 1. Hair distribution, quantity 2. Skull size, contour 3. Face expressions, and symmetry of structure 4. Skin color. Lesions 5. Hair distribution, lesions, hair loss 6. facial asymmetry, involuntary movements, or edema Palpate the head Done poor Not perfectly done mark 1. Hair texture 2. Skull for lumps and lesions 3. Skin temperature, Texture Neck Inspection and Palpation of the neck 1. Skin color, integrity, shape 2. Symmetry 3. Masses, scars 4. Enlarged glands or lymph nodes 5. Trachea – position (should be midline) 6. Thyroid gland enlargement, consistency, masses, tenderness Done poor Not perfectly done mark Eyes Done poor Not perfectly done Inspection of the eyes mark 1. Symmetry 2. Position and alignment of eyes 3. Eyebrows- Quantity, distribution 4. Eyelids-Edema, color, lesions 5. Conjunctiva and sclera-color, vascular pattern 6. Cornea and lens 7. Iris 8. Pupils Pupils examination Done poor Not perfectly done mark 1. Size 2. Shape 3. Reaction to light 4. Symmetry Examination of the eyes 1. Visual acuity (Snellen eye chart) 2. Visual field by confrontation 3. Extraocular movements 4. Accommodation 5. Using the Ophthalmoscope Done poor Not perfectly done mark 1-Visual acuity (Snellen eye chart) Position patient 20 feet (6 meters) from the chart Patients should wear glasses if needed Test one eye at a time 2-Visual field by confrontation The client should be sitting 60-90 cm from you and at eye level Test one eye at a time The client’s peripheral visual fields are compared to that of the examiner. This test assumes the examiner has normal peripheral vision 3- Extraocular movements The client must keep the head still while following a pen that you will move in several directions to form a star in front of the client’s eyes. Always return the pen to the center before changing direction 4- Accommodation An object held about 10 cm from the client’s nose Ears Inspect and palpate the ears Done poor Not perfectly done mark 1. Auricle for redness, lesions, symmetry 2. Ear canal for discharge, foreign bodies, redness, swelling 3. Use otoscope to see the tympanic membrane 4. Palpation Auricle for lumps, tenderness 5. Palpate the mastoid process for tenderness or deformity Examine the hearing acuity Done perfectly poor Not done mark 1. Whisper test 2. Rinne test 3. Weber test 4. Romberg test 1- Whisper test Ask the client to occlude the other ear or the ear may be occluded by the nurse. Cover your mouth so the client cannot see your lips Standing 30-60cm behind patient, softly say “nine-four,” “baseball” Ask the client to repeat the phrase. 2- Rinne test Compare time of air vs. bone conduction Place the base of the tuning fork on the client’s mastoid process- and note the number of seconds. Then move the fork in front the external auditory meatus (1-2 cm) If bone conduction is equal or greater than air conduction, then suspect conductive hearing loss 3- Weber test Lateralization of sound to impaired ear; suspect unilateral conductive hearing loss 4- Romberg test Ask the patient to remain still and close their eyes (for about 20 seconds). If the patient loses their balance, the test is positive.