Transcript Head, Neck, and Regional Lymphatics

Head, Neck, and Regional Lymphatics
Health assessment
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Lectures objectives
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Identify the anatomic structures of the
head and neck.
Identify the lymph nodes of the head
and neck.
Describe the system-specific health
history for the head and neck.
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Lectures objectives
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Demonstrate the physical assessment of the
head and neck.
Describe normal findings in the physical
assessment of the head and neck.
List common abnormalities found in physical
assessment of the head and neck.
Explain pathophysiology of common
abnormalities found in physical assessment of
the head and neck.
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Landmarks of the face.
Bones of the skull
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Overview
The integration of body systems and regions
begins with the head and neck .
The head provides a means of identifying
individuals through the uniqueness of hair,
eyes, and facial characteristics .
With assessment of the head and neck, clues
to the client’s nutritional status, airway
clearance, tissue perfusion, metabolism, level
of activity, sleep, rest, stress, and self-care
abilities will be identified.
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Anatomy and Physiology
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The skull is made up of the bones of the cranium and the face .
The cranium includes frontal, parietal, temporal, and occipital bones .
The muscles of the face play a role in expression of emotions and assist in neck
movement .
Movement of the facial muscles is controlled by cranial nerves V and VII .
The carotid arteries provide the blood supply to the head; the temporal artery
supplies blood to much of the face .
The neck is supported and made mobile by vertebral processes and the
sternocleidomastoid and trapezius muscles .
The hyoid bone, superior to the larynx, is the only bone in the body that does
not directly articulate with another bone. It serves as a movable base for the
tongue, and an attachment for muscles of the neck .
The thyroid gland is in the middle of the neck anterior to the trachea. The
isthmus is the center, and the two lobes lie on either side of the trachea .
The nine sets of lymph nodes drain the head and neck.
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Health History
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Determine presence/absence of ageand gender-specific diseases of the
head and neck
Common chief complaints
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Neck pain or stiff neck
Hoarseness
Neck mass
Headache
Head injury
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Evaluating Chief Complaint
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Determine the following characteristics
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Quality
Associated manifestations
Aggravating factors
Alleviating factors
Setting
Timing
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Past Health History
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Medical conditions
Surgeries
Medications
Injuries or accidents
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Family Health History
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Determine if family history of
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Thyroid disease
Headache
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General Approach to Head
and Neck Assessment
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Greet patient, explain assessment techniques
Environment
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Quiet
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Warm
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Private
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Adequate lighting
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Upright sitting position
Compare right and left sides
Systematic approach
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EQUIPMENT
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Tape measure ◆ Stethoscope ◆
evaluation of thyroid gland)
Cup of water (for
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Assessment of the Head
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Inspection
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Shape
Symmetry
Palpation
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Contour
Masses
Depression
Tenderness
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Inspection and Palpation
of the Scalp
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Inspect
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Normal findings
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Lesions or masses
Scalp is shiny, intact, without lesions or
masses
Abnormal findings
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Bleeding, lesions, masses, hematomas
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Assessment of the Face
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Inspection
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Shape
Symmetry
Normal findings
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Symmetrical features
Palpebral fissures equal
Shape can be oval, round, or slightly
square
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Assessment of the Face
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Abnormal findings
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Deformed or absent structures
Asymmetry
More or less pronounced facial features
Diseases which may alter facial features:
Bell’s palsy, A temporary disorder affecting
cranial nerve VII and producing a unilateral
facial paralysis
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acromegaly An enlargement of the
skull and cranial bones due to increased
growth hormone
hydrocephalus The enlargement of the head
caused by inadequate drainage of
cerebrospinal fluid, resulting in abnormal
growth of the skull
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Mandible
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Palpate and auscultate the temporomandibular joint when the client opens
and closes the mouth
Normal findings
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No discomfort, joint articulates smoothly without
clicking or crepitus
Abnormal findings
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Pain, tenderness, crepitus
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Neck
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Inspection
Palpation
Normal findings
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Full ROM, pain free, symmetrical muscles,
no masses
Abnormal findings
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Limited ROM, pain, asymmetrical muscles,
masses
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Thyroid Gland
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Inspection
Palpation
Auscultation
Normal findings
Symmetrical movement with
swallowing
Adam’s apple more pronounced in
males
Abnormal findings
No masses, tenderness, or
Mass
enlargement
Enlarged gland
Absent bruit
Goiter
Asymmetrical enlargement
Presence of a nodule or bruit
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hyperthyroidism The excessive production of thyroid
hormones, resulting in enlargement of the gland,
exophthalmos (bulging eyes), fine hair, weight loss,
diarrhea, and other alterations.
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hypothyroidism Metabolic disorder causing enlarged
thyroid due to iodine deficiency.
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Lymph Nodes
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Inspection
Palpation
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Location
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Preauricular
Postauricular
Occipital
Submental
Submandibular
Anterior and posterior cervical chains
Tonsilar
Supraclavicular
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Lymph Nodes
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Normal findings
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Unable to palpate or see nodes
Abnormal findings
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Enlarged nodes
Able to palpate or see nodes
Tenderness
Firm, hard nodes
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Position of the thumbs to evaluate the midline position of the
trachea
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Cushing syndrome. Facies include a rounded or “moon-shaped” face with
thin, erythematous skin. Hirsutism may also be present, especially if the
condition is caused by an adrenal cancer
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Hyperthyroid facies. Note fine, moist skin with fine hair, prominent eyes and lid retraction,
and staring or startled expression
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Down syndrome. Note depressed nasal bridge, epicanthal folds,
mongoloid slant of eyes, low-set ears, and large tongue
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Hydrocephalus, with characteristic enlarged head, bulging fontanel,
dilated scalp veins,
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Early acromegaly. Note the coarsening of features with broadening
of the nasal alae and prominence of the zygomatic arches
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Left facial palsy. Facies include asymmetry of one side of the face, eyelid
not closing completely, drooping lower eyelid and corner of mouth, and
loss of nasolabial fold.
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