Transcript HENT student - Mercer University

Assessment of the Head, Face
& Neck
Dr. Sara Mitchell
Georgia Baptist College of Nursing
Of Mercer University
Main bones of the cranium
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__________
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__________
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__________
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__________
Major structures of the neck
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__________________
__________________
__________________
________________ &
_____________
_______________
_______________
Midline structures of the neck
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_________________________________
_________________________
__________________
__________________
__________________
Assessment of the head
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Inspect
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hair
scalp
skull
face
skin
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Palpate
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scalp
skull
temporal artery
How to Examine the Hair and Scalp
Assessment of the face
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CN V - __________
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CN Vll - ________
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motor function
sensory function
motor function
sensory function
CN lX & X ___________ & ____
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CN Xl - ___________
CN Xll - __________
Assessment of the cranial sinuses
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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
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Composted of three
functional parts
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__________________
__________________
__________________
Functions include
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_____________
_____________
_____________
Oropharynx
Oral mucosa Assessment
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Inspect
lips
 oral mucosa
 gums & teeth
 roof of mouth
 tongue & floor of mouth
 pharynx
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Tonsils
Strep Tonsillitis
Peritonsillar Abscess
Hand Foot Mouth Disease
The Tongue
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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
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Inspect
General appearance
Mucosa
Palpate
Lateral margins
All white lesions
Normal tongue variants
Geographic tongue
Black hairy tongue
Fissured Tongue
The salivary glands
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There are three major
salivary glands
________________
 ________________
 ________________
____________ arises
from the parotid gland
___________ duct arises
from the submandibular
gland
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The Neck
Assessment of the neck
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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
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Inspection
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lumbar spine can only rotate 3 to 18 degrees.)
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general
specific (thyroid)
Range of motion
Functions Lymphatic System
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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
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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
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Group A streptococcal
infection
Mononucleosis
(Ebstein Barr Virus, or
EBV)
Cytomegalovirus
(CMV, closely related
to EBV)
HIV
Unusual infectious
causes include:
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Cat scratch disease
(usually from a kitten)
Tularemia (ask about
hunting rabbits)
Anthrax
Lupus
The Thyroid Gland
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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
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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
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Graves Disease
Hashimoto’s disease
Multinodular goiter
Solitary thyroid nodules
Thyroid cancer
Pregnancy
Inflammation
Sternocleidomastoid Muscle
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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
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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
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Ear structure
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external ear
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middle ear
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_______________
_______________
inner ear
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________________l
Assessment of the Ear
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External Ear
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Inspection:
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auricles and
mastoid area for: •
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Tenderness
Swelling
Nodules
video
Internal Ear
Structures - video
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tympanic membrane
hearing
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AC vs. BC
Correct handling of the Otoscope
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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
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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
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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
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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
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Congenital
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Acquired
Adults
 Acquired
The Nose
Assessment of olfactory ability
_______________________________
Nose assessment
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Inspection:
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Nose & parasinuses
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anterior & posterior
surfaces
test for nasal obstruction
inside of nose
mucosa
turbinates
Palpate
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Nasal speculum
sinuses
transillumination
Normal Nasal Turbinates
Assessment of the external nose
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Common condition of
external nose
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Rhinophyma (with or
without rosacea
Differential Diagnoses of abnormal
nasal findings
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URI
Allergies
Epitasis
Polyps
Review of cranial nerves in order
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I: Olfactory - smell
II: Optic: - vision
III: Oculomotor – Most EOM
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IV: Trochlear –superior
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V: Trigeminal –
mastication;
facial & scalp sensation
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XI: Spinal Accessory –
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VI: Abducens – lateral
rectus
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XII: Hypoglossal –
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VIII: Acoustic – hearing &
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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
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Subjective - chief complaint and related history (ask yourself “is this
concern specific to HEENT or related to a systemic illness?”)
Objective  general:
 ENT:
 Neck:
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Assessment -
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Plan -
Our eyes, ears, & nose allow us to
experience the beauty of creation