Health Assessment Lecture 4 PDF

Health Assessment Lecture 4 Assessment of Head and Neck 1  Subjective Data  Headaches  Head injury  Dizziness  Neck pain, limitation of motion  Lumps or swelling  History of head or neck surgery 2...

Health Assessment Lecture 4 Assessment of Head and Neck 1  Subjective Data  Headaches  Head injury  Dizziness  Neck pain, limitation of motion  Lumps or swelling  History of head or neck surgery 2  Headaches  Timing: (onset, duration, frequency)  Location: (frontal, temporal, behind eyes, like a band around the head, in the sinus area, or in the occipital area). o Tension headaches: tend to be occipital, frontal, or with bandlike tightness. o Migraines headaches (vascular): supraorbital, or frontotemporal. o Cluster headaches: pain around eye, forehead, cheek. 3  Headaches  Quality- Character: throbbing (pounding, shooting)- migraine headaches.  Severity (mild, moderate, or sever)  Medications- contraceptives, bronchodilaters, nitrates produce headaches.  Associated factors (nausea & vomiting, vision changes, neck pain, stomach problem)  Aggravated and relieving factors  Effort to treat & coping strategies 4  Head Injury  Onset  Setting: were you wearing a helmet or hard hat  Before injury: dizzy, lightheaded, seizure  After injury  Location: where did you hit your head  Discharge from nose and mouth  History of illness  Associated symptoms  Effort to treat 5  Dizziness  Determine exactly what the person means by dizziness. Was it (feelings of lightheaded, swimming sensation, feeling of falling) or spinning sensation (Vertigo).  Neck Pain  Onset  Location  Associated symptoms  Precipitating factors 6  Lumps or swelling in neck  Any recent infection? Any tenderness? acute infection.  Any difficulty swallowing (Dysphagia)?  Do you smoke? Increase risk of respiratory & oral cancer.  Ever had a thyroid problem?  Hx of head and neck surgery 7  Inspect and Palpate the Skull  Size and Shape: To assess the shape: palpate the scalp  Head size and shape vary with ethnicity.  The skull normally feels symmetric, smooth, round, normocephalic with no visible lesions.  Normocephalic: a round symmetric skull that is appropriately related to body size.  Deformities include: Microcephaly (small head), Macrocephaly (abnormal large head). 8  Palpate the Temporal Artery  Normal Findings: temporal artery is elastic and nontender.  Abnormal Findings: artery feels hardened, thick, tortuous, and tender ( seen with inflammation [temporal arteritis])  Palpate the Temporomandibular Joint  Normal Findings: smooth movement, no limitation or tenderness.  Abnormal Findings: crepitation, limited ROM, tenderness. 9  Inspect the Face  Facial Expression:  Inspect face & noting facial expression  Normal Findings: Facial expressions are appropriate to situation and to behavior.  Abnormal Findings: tense, rigid muscles indicate anxiety.  A flat affect indicate depression.  Excessive smiling inappropriate. 10  Inspect the Face  Facial Structures:  Facial structures vary somewhat among races  Normal Findings: Symmetric (eyebrows, palpebral fissures, nasolabial folds & sides of the mouth).  Abnormal Findings: asymmetry (central brain lesion or cranial nerve VII damage). Exophthalmos, pigmentation, periorbital edema, involuntary movements (tics) or excessive blinking. 11  Inspect the Face  Facial Structures 12  Symmetry:  Normal Findings: head position is centered in the midline & held erect, symmetrical accessory muscles  Abnormal Findings : Head tilt-with muscle spasm, rigid head & neck occur with arthritis.  Range of Motion (ROM):  Normal Findings: motion is smooth and controlled.  Abnormal Findings : pain at any movement, limited movement from cervical arthritis, Arthritic neck rigid  Test muscle strength & carotid artery pulsation.  Note enlargement of the salivary and thyroid glands 13  Lymph Nodes:  Use gentle pressure & palpate with both hands  If any nodes are palpable, note their location, size, shape, mobility, consistency, tenderness.  Normal Findings: the salivary glands are not palpable, lymph nodes; soft, discrete, nontender, movable.  Abnormal Findings : lymphadenopathy is enlargement of lymph nodes larger than > 1 cm due to infection, allergy, or neoplasm. 14 Lymph Nodes 15  Lymph Nodes: 1- Preauricular: in front of the ear 2- Posterior auricular: superficial to the mastoid process 3- Occipital: at the base of skull 4- Submental: midline behind tip of mandible 5- Submandibular: halfway between tip & angle of the mandible 6- Jugulodigastric: under the angle of the mandible 7-Superficial cervical: overlying the sternomastoid muscle 8- Deep cervical: deep under the muscle 9- Posterior cervical: in the posterior triangle along the edge of the trapezius muscle 10- Supraclavicular: just above and behind the clavicle 17  Trachea:  Normal Findings: the trachea is midline, the space symmetric on both sides.  Abnormal Findings :  Trachea is shifted toward the affected side; e.g., Atelactasis, Pleural adhesions, or Fibrosis  Trachea is pushed to the unaffected (healthy) side (e.g., Pneumothorax, Aortic aneurysm, tumor, & unilateral thyroid lobe enlargement) 18  Thyroid Gland  Anterior approach (thumbs are used in palpation).  Posterior approach (fingers of one hand are used to palpate while fingers of the other hand push the thyroid against the other hand).  Normal Findings: Normally the thyroid glands are not palpable.  If palpable, check consistency, symmetry, enlargement, tenderness, presence of nodules. 19  Thyroid Gland- Anterior Approach Thumbs are used in palpation 20  Thyroid Gland- Posterior Approach 21  Thyroid Gland  If thyroid gland is enlarged, auscultate it for a bruit (present with hyperthyroidism).  Bruit: soft, pulsatile, blowing sound  Heard best with the bell of stethoscope.  Abnormal Findings : enlarged lobes that are easily palpated before swelling, or are tender to palpate , or presence of nodules or lumps. 22 23