Assessment Of Neck, Thyroid, And Lymph Nodes PDF

Assessment of Neck, Thyroid, and Lymph Nodes NURS 1090  Unit Outcomes Identify importance of assessment of the eyes, ears, head, neck, and lymph nodes. Identify physical assessment changes in the older adult. Demonstrate techniques to assess the eyes, ears, head, neck, and lymph...

Assessment of Neck, Thyroid, and Lymph Nodes NURS 1090  Unit Outcomes Identify importance of assessment of the eyes, ears, head, neck, and lymph nodes. Identify physical assessment changes in the older adult. Demonstrate techniques to assess the eyes, ears, head, neck, and lymph nodes.  Health History Neck Pain or stiffness May indicate muscle strain or spasm, head injury, swollen lymph nodes Patient report of neck lumps Lymph nodes Recent colds, viruses, infections, exposure to radiation or chemicals May cause temporary or permanent lymph node enlargement Lymph nodes may also be enlarged with diseases such as cancer and HIV  Health History Thyroid Change in temperature tolerance, mood swings, change in texture of skin, hair and nails May indicate thyroid disease Does patient have a history of hypothyroidism or hyperthyroidism Does patient take any thyroid medications? History of thyroid surgery? Family history of thyroid disease? Any difficulty swallowing? Physical Assessment Getting started Have patient expose the neck and upper chest May be helpful to have patient seated in chair so nurse can stand behind patient as well as being face to face. Physical Assessment techniques: Inspection Palpation Supplies needed: light source  Neck (Pearson, Volume 3, p.66) Inspect the Neck Each side of the neck is divided into 2 triangles by the sternocleidomastoid muscle extending from behind the ear down to the clavicle. Note overall symmetry or scars Inspect for neck masses Check for mobility and range of motion. Chin to chest, head back Move head so that ear is moved toward the shoulder on each side  Thyroid Gland Lies in the anterior lower neck Over and to each side of the trachea (2 lobes)  Inspection Thyroid Gland Inspect the lower area of the patient’s neck to see if an enlargement of the thyroid gland is visible or nodules, masses or areas of fullness are present at the base of the neck Have patient hyperextend neck for better visualization Offer the patient a sip of water and, while observing the neck, have patient swallow Watch for upward movement of the thyroid gland Normally the thyroid gland cannot be Palpation of Thyroid Gland Often done while standing behind the patient Place your fingers on either side of the trachea below the thyroid cartilage Ask patient to tilt head to the right and swallow As patient swallows, displace the left lobe while palpating the right lobe Repeat to palpate the left Thyroid Gland Palpation (continued) The thyroid may also be palpated from the front by placing fingers on either side of the trachea and gently pressing one side at a time. The thyroid is normally NOT palpable If palpable, lobes should feel smooth, rubbery and free of nodules Shape/symmetry: normal: equal on both sides Tenderness: should be absent Size: Report to HCP if enlarged Nodules: Report to HCP if one or more nodules are palpable  Lymph Nodes An extensive system of lymph nodes are clustered along the lymphatic vessels of the body (approximately 100 nodes) Lymph nodes filter lymphatic fluid and protect the body from foreign antigens Nodes vary in shape and size. Chains of lymph nodes extend from the lower half of the head down into the neck  Lymph Nodes: Characteristics Usually oval or bean shaped and less than 2 cm. and soft. Occur singularly or in closely connected chains. Often embedded in connective tissue and not seen or palpated unless enlarged. Vary in shape and size Lymph Nodes Lymph nodes are palpated for enlargement due to: Infection Inflammation Cancer Some medications and vaccinations  Stand in facing or to the side of the patient Have patient relax and bend Palpatio neck slightly forward n of Use pads of index and middle fingers, palpate in a gentle Lymph rotating motion over the nodes (massaging) Nodes Palpate nodes in a sequence Examine both sides at once **typically done by advanced practitioners  1. Occipital Sequence for base of the skull Palpation of 2. Postauricular Lymph Nodes over the mastoid 3. Preauricular in front of ear 4. Retropharyngeal (tonsillar) at the angle of mandible 5. Submandibular along the base of the mandible 6. Submental midline under chin 7. Anterior cervical along the sternocleidomastoid muscle 8. Posterior cervical along the anterior edge of the trapezius 9. Deep cervical chain deep in the sternocleidomastoid muscle often inaccessible to examination 10. Supraclavicular above the clavicle  Palpation of Lymph Nodes What to assess Location Size and shape Consistency and tenderness Normal findings  Lymph nodes are not easily palpable.  Nonpalpable lymph nodes are normal  Small, non-tender nodes are also common and normal  Palpation of Lymph Nodes Abnormal findings Enlarged, palpable, or tender can be associated with infection and tumors  Expected Age-Related Changes: Older Adult Thyroid Lymph Nodes Diminished Thyroid Diminished Function immune Atrophy of thyroid response gland Lymph node Normally not atrophy visualized Nodules may form and be palpable May feel irregular REMINDER: View ‘Assessment of the Neck’ video on Blackboard to see a demonstration of palpation of the lymph nodes and thyroid. Complete the Eye, Ear, and Neck Assessment Worksheet and Physical Assessments. Submit on Blackboard.