Assessment of the Head, Assessment of the Head, Face & NeckFace & Neck

Dr. Sara MitchellDr. Sara Mitchell

Georgia Baptist College of Georgia Baptist College of NursingNursing

Of Mercer UniversityOf Mercer University

Main bones of the craniumMain bones of the cranium

____________________

____________________

____________________

____________________

Major structures of the neckMajor structures of the neck

____________________________________ ____________________________________ ____________________________________ ________________ &________________ &

__________________________ ______________________________ ______________________________

Midline structures of the Midline structures of the neckneck

__________________________________________________________________ __________________________________________________ ____________________________________ ____________________________________ ____________________________________

Assessment of the headAssessment of the head

InspectInspect hairhair scalpscalp skullskull faceface skinskin

PalpatePalpate scalpscalp skullskull temporal arterytemporal artery

How to Examine the Hair and How to Examine the Hair and ScalpScalp

Assessment of the faceAssessment of the face

CN V - __________CN V - __________ motor functionmotor function sensory functionsensory function

CN Vll - ________CN Vll - ________ motor functionmotor function sensory functionsensory function

CN lX & X - CN lX & X - ___________ & _______________ & ____

CN Xl - ___________CN Xl - ___________ CN Xll - __________CN Xll - __________

Assessment of the cranial Assessment of the cranial sinusessinuses

The paranasal The paranasal sinuses are air sinuses are air filled cavities that filled cavities that warm, moisten, warm, moisten, filter air, and aid in filter air, and aid in voice resonancevoice resonance

Assessment of sinusesAssessment of sinuses

How to Examine CN V: Trigeminal How to Examine CN V: Trigeminal Nerve Nerve – – SensorySensory

How to Examine CN V: Trigeminal How to Examine CN V: Trigeminal Nerve Nerve – – MotorMotor

CN VII: Facial MotorCN VII: Facial Motor

The MouthThe Mouth

A part of A part of face through face through which food which food passes into the passes into the body, being body, being within the within the tongue, gums, tongue, gums, and teethand teeth

The oral pharynxThe oral pharynx

Composted of three Composted of three functional partsfunctional parts ____________________________________ ____________________________________ ____________________________________

Functions includeFunctions include __________________________ __________________________ __________________________

Oropharynx

Oral mucosa AssessmentOral mucosa Assessment

InspectInspect lipslips oral mucosaoral mucosa gums & teethgums & teeth roof of mouthroof of mouth tongue & floor of mouthtongue & floor of mouth pharynxpharynx

TonsilsTonsils

Strep TonsillitisStrep Tonsillitis

Peritonsillar Abscess

Hand Foot Mouth DiseaseHand Foot Mouth Disease

The TongueThe Tongue

Contains the strongest Contains the strongest muscle in the bodymuscle in the body

Innervated by the __________Innervated by the __________ or twelfth cranial nerve or twelfth cranial nerve (CN (CN XII)XII)

Sweet & salty tastes are Sweet & salty tastes are perceived on the anterior perceived on the anterior two thirds of the supplied by two thirds of the supplied by a division of the ________a division of the ________ or or cranial nerve seven cranial nerve seven (CN VII)(CN VII)

Sour & bitter tastes are Sour & bitter tastes are perceived at the posterior perceived at the posterior aspect of the tongue which aspect of the tongue which is innervated by the is innervated by the _____________ or ninth _____________ or ninth cranial nerve (cranial nerve (CN IXCN IX))

Assessment of tongueAssessment of tongue

InspectInspect General appearanceGeneral appearance MucosaMucosa

PalpatePalpate Lateral marginsLateral margins All white lesionsAll white lesions

Normal tongue variantsNormal tongue variants

Geographic tongue Black hairy tongue

Fissured Tongue

The salivary glandsThe salivary glands

There are three There are three major salivary major salivary glandsglands ________________________________ ________________________________ ________________________________

____________ arises ____________ arises from the parotid glandfrom the parotid gland

___________ duct arises ___________ duct arises from the from the submandibular glandsubmandibular gland

The NeckThe Neck

Assessment of the neckAssessment of the neck The neck can tilt to one side or the other about The neck can tilt to one side or the other about

45 degrees. (The lumbar spine, by comparison, 45 degrees. (The lumbar spine, by comparison, can only tilt to between 15 and 20 degrees.) can only tilt to between 15 and 20 degrees.)

* The neck can extend, or bend backwards, about * The neck can extend, or bend backwards, about 70 to 90 degrees. (By comparison the low back 70 to 90 degrees. (By comparison the low back can flex only 40 to 60 degrees.) can flex only 40 to 60 degrees.)

* The neck can flex, or bend forward, about 80 to * The neck can flex, or bend forward, about 80 to 90 degrees. (The low back can only extend 20 to 90 degrees. (The low back can only extend 20 to 25 degrees.) 25 degrees.)

Our necks need to use their mobility in order to Our necks need to use their mobility in order to maintain it. They work best when they can maintain it. They work best when they can consistently move into and out of their full range consistently move into and out of their full range of motion in a gentle - that is, not a jarring - way. of motion in a gentle - that is, not a jarring - way.

Assessment of the neckAssessment of the neck

InspectionInspection generalgeneral specific (thyroid)specific (thyroid)

Range of motionRange of motion

lumbar spine can only rotate 3 to 18 degrees.)

                                                                                                                                               

Functions Lymphatic Functions Lymphatic SystemSystem

Filters and engulfs bacteria, certain other cells, Filters and engulfs bacteria, certain other cells, foreign particles, or toxins in the lymph nodesforeign particles, or toxins in the lymph nodes

Returns fluid, proteins, and electrolytes from Returns fluid, proteins, and electrolytes from tissue space to the blood.tissue space to the blood.

Absorbs fat and fat-soluble substances from the Absorbs fat and fat-soluble substances from the intestinal tractintestinal tract

Produces lymphocytes in the lymph nodes, Produces lymphocytes in the lymph nodes, tonsils, adenoids, spleen, and bone marrowtonsils, adenoids, spleen, and bone marrow

Produces antibodiesProduces antibodies The lymphatic system is also a pathway for the The lymphatic system is also a pathway for the

spread of malignancyspread of malignancy

Assessment of the lymph Assessment of the lymph nodesnodes

Use a _____________ Use a _____________ to palpate each to palpate each anatomical area anatomical area that housed lymph that housed lymph nodesnodes

All palpable nodes All palpable nodes should be assessed for should be assessed for ______, ______, ______,_________, and ______,_________, and ______________________________..

Common infectious causes of Common infectious causes of cervical lymphadenopathycervical lymphadenopathy

Group A Group A streptococcal streptococcal infection infection

Mononucleosis Mononucleosis (Ebstein Barr Virus, (Ebstein Barr Virus, or EBV) or EBV)

Cytomegalovirus Cytomegalovirus (CMV, closely (CMV, closely related to EBV) related to EBV)

HIV HIV

Unusual infectious Unusual infectious causes includecauses include::

Cat scratch disease Cat scratch disease (usually from a (usually from a kitten) kitten)

Tularemia (ask about Tularemia (ask about hunting rabbits) hunting rabbits)

Anthrax Anthrax Lupus Lupus

The Thyroid GlandThe Thyroid Gland

The largest endocrine The largest endocrine gland in the body and gland in the body and the only one that is the only one that is accessible to direct accessible to direct physical assessment.physical assessment.

Butterfly shaped with Butterfly shaped with a lobe on each side of a lobe on each side of the tracheathe trachea

Normal consistency Normal consistency described as “meaty” described as “meaty” or “rubbery”or “rubbery”

isthumus

Assessment of the thyroid Assessment of the thyroid glandgland•Unusual __________ is Unusual __________ is associated with cancer or associated with cancer or scarringscarring

•____________ or ____________ or sponginesssponginess is is seen with toxic goiterseen with toxic goiter

•____________ is associated ____________ is associated with acute infection or with acute infection or hemorrhagehemorrhage

__________________________________________________________________________________________________________________________________________________________________

Palpation of Thyroid Gland in Client Palpation of Thyroid Gland in Client with Goiterwith Goiter

When auscultating When auscultating the thyroid listen the thyroid listen for the presence of for the presence of a bruit. a bruit.

The finding of a The finding of a systolic or “to-to-systolic or “to-to-fro” thyroid bruit, is fro” thyroid bruit, is highly suggestive highly suggestive of a toxic goiterof a toxic goiter

Causes of Enlarged ThyroidCauses of Enlarged Thyroid

Graves DiseaseGraves Disease Hashimoto’s diseaseHashimoto’s disease Multinodular goiterMultinodular goiter Solitary thyroid nodulesSolitary thyroid nodules Thyroid cancerThyroid cancer PregnancyPregnancy InflammationInflammation

Sternocleidomastoid MuscleSternocleidomastoid Muscle

The The sternocleidomastoid sternocleidomastoid muscle is innerved by muscle is innerved by the ___________or the ___________or eleventh cranial eleventh cranial nervenerve

Anterior to this Anterior to this muscle is the muscle is the anterior anterior triangletriangle bounded by bounded by the clavicle anteriorly the clavicle anteriorly and midlineand midline

How to Examine CN XI: Spinal How to Examine CN XI: Spinal Accessory Accessory – – Trapezius MuscleTrapezius Muscle

Posterior to the Posterior to the muscle is the muscle is the posterior triangleposterior triangle bounded by the bounded by the trapezius muscle trapezius muscle posteriorly and the posteriorly and the clavicle inferiorly.clavicle inferiorly.

The Ears The Ears

Ouch! Let GoCome on,

let’s play

The EarThe Ear

Ear structureEar structure external earexternal ear

_______________ _______________

middle earmiddle ear ______________________________

inner earinner ear ________________l________________l

Assessment of the EarAssessment of the Ear

External Ear External Ear Inspection:Inspection:

auricles and auricles and mastoid area for:mastoid area for: • •

TendernessTenderness SwellingSwelling NodulesNodules

Internal EarInternal Ear Structures - Structures - videovideo

tympanic tympanic membranemembrane

hearing hearing AC vs. BCAC vs. BC

videovideo

Correct handling of the Correct handling of the OtoscopeOtoscope

For children under 3 For children under 3 years of age place years of age place the pinna should be the pinna should be pulled ____________pulled ____________

For children older For children older than 3 as well as than 3 as well as adults, pinna should adults, pinna should be pulled __________be pulled __________

The Tympanic MembraneThe Tympanic Membrane

Normal right tympanic Normal right tympanic membranemembrane

Injected Tympanic MembraneInjected Tympanic Membrane

Ventilation Ventilation TubeTube

RinneRinne’’ Test Test

The RinneThe Rinne’’ evaluates air conduction evaluates air conduction and bone conductionand bone conduction

The client who has no The client who has no conductive conductive hearing loss will hear the sound hearing loss will hear the sound ______ as long ____ by _____ condition ______ as long ____ by _____ condition as by ____ conduction ________as by ____ conduction ________

The Weber testThe Weber test

This test compares This test compares bone conduction in bone conduction in both ears and both ears and determines whether determines whether monaural impairment monaural impairment is neural or conductive.is neural or conductive.

Sound should be heard Sound should be heard equally in both ears.equally in both ears.

Hearing that is ________ Hearing that is ________ is associated with is associated with ______ ____________ ______

Impact of Hearing LossImpact of Hearing Loss

ParanoiaParanoia WithdrawalWithdrawal DepressionDepression AnxietyAnxiety

““Oh you men that think that I am malevolent, or Oh you men that think that I am malevolent, or misanthropic, how greatly do you wrong me. misanthropic, how greatly do you wrong me. You do not know the secret cause which makes You do not know the secret cause which makes me seem that way to you… For me there can me seem that way to you… For me there can be no relaxation with my fellow men, no refined be no relaxation with my fellow men, no refined conversations, no mutual exchange of ideas. I conversations, no mutual exchange of ideas. I must live alone, like one who has been must live alone, like one who has been banished… What a humiliation for me when banished… What a humiliation for me when someone standing next to me heard a flute in someone standing next to me heard a flute in the distance, and I heard nothing…a little more the distance, and I heard nothing…a little more of that and I would have ended my life – it was of that and I would have ended my life – it was only my art that held me back”only my art that held me back”

Beethoven

Differential Diagnoses for Differential Diagnoses for Hearing LossHearing Loss

ChildrenChildren CongenitalCongenital

AcquiredAcquired

AdultsAdultsAcquiredAcquired

The NoseThe Nose

Assessment of olfactory Assessment of olfactory abilityability_______________________________

Nose assessmentNose assessment Inspection:Inspection:

Nose & parasinuses Nose & parasinuses anterior & posterior anterior & posterior

surfaces surfaces test for nasal test for nasal

obstructionobstruction inside of noseinside of nose mucosamucosa turbinatesturbinates

PalpatePalpate sinusessinuses transilluminationtransillumination

Normal Nasal Normal Nasal TurbinatesTurbinates

Nasal speculumNasal speculum

Assessment of the external Assessment of the external nosenose

Common condition Common condition of external noseof external nose Rhinophyma (with Rhinophyma (with

or without rosaceaor without rosacea

Differential Diagnoses of Differential Diagnoses of abnormal nasal findingsabnormal nasal findings

URIURI AllergiesAllergies EpitasisEpitasis PolypsPolyps

Review of cranial nerves in Review of cranial nerves in orderorder

I: Olfactory - I: Olfactory - smellsmell II: Optic: - II: Optic: - visionvision III: Oculomotor – III: Oculomotor – Most Most

EOM movement; raise eyelids; EOM movement; raise eyelids; pupil constriction pupil constriction

IV: Trochlear –IV: Trochlear –superior superior obliqueoblique

V: Trigeminal – V: Trigeminal – mastication; facial & scalp mastication; facial & scalp sensationsensation

VI: Abducens – VI: Abducens – lateral lateral rectusrectus

VII: Facial – VII: Facial – facial facial muscles; taste; saliva & muscles; taste; saliva & tear secretiontear secretion

VIII: AcousticVIII: Acoustic – hearing & – hearing & equilibrium equilibrium

IX: GlossopharyngealIX: Glossopharyngeal – – phonation & swallowing; phonation & swallowing; taste back portion of taste back portion of tongue tongue

X: VagusX: Vagus – talking & – talking & swallowing; carotid reflex swallowing; carotid reflex

XI: Spinal Accessory – XI: Spinal Accessory – movement of trapezius & movement of trapezius & sternomastoid musclesternomastoid muscle

XII: HypoglossalXII: Hypoglossal – – movement of tonguemovement of tongue

H(E)ENT S.O.A.P. noteH(E)ENT S.O.A.P. note

SSubjective - chief complaint and related history (ask yourself ubjective - chief complaint and related history (ask yourself “is this concern specific to HEENT or related to a systemic “is this concern specific to HEENT or related to a systemic illness?”)illness?”)

OObjective - bjective - general:general: ENT:ENT: Neck:Neck:

AAssessment -ssessment -

PPlan -lan -

Our eyes, ears, & nose allow us to experience the beauty of creation