Head and Neck Physical Exam PDF

PHYSICAL EXAMINATION OF HEAD AND NECK NUR 3204  OBJECTIVES Review anatomy and physiology of Head and Neck Review related history of present, past, family and personal and social history. Outline related examination techniques of Inspection, auscultation, pa...

PHYSICAL EXAMINATION OF HEAD AND NECK NUR 3204  OBJECTIVES Review anatomy and physiology of Head and Neck Review related history of present, past, family and personal and social history. Outline related examination techniques of Inspection, auscultation, palpation and percussion.  A&P The skull is composed of 7 bones ( 2 – F; 2 – P; 2 –T; 1- O) Cavities of facial skull – eyes, nose, mouth Bony structure of face – Frontal, Nasal, Zygomatic, Ethmoid, Lacrimal, Sphenoid, and maxillary bones and movable mandible Cranial nerve – V & VII Temporal artery – major artery  Salivary glands: Parotid, Submandibular, Sublingual Salivary glands Parotid – anterior to ear, above mandible Submandibular –medial to mandible Sublingual – anterior, floor of the mouth  NECK Neck is formed by the cervical vertebrae, ligaments, sternocleidomastoid and Trapezius muscles. Posterior triangle – is formed by the trapezius and sternocleidomastoid muscle and the clavicle: posterior cervical lymphnodes Anterior triangle – medial border of the sternocleidomastoid muscles, the mandible, and the midline.  Hyoid bone, cricoid cartilage, trachea, thyroid and anterior cervical lymphnodes The common carotid artery, internal jugular vein  NECK - ANATOMICAL REVIEW NECK – LYMPHATIC GLANDS NECK – ANATOMICAL REVIEW  HISTORY OF PRESENT ILLNESS Head Injury: Independent observer’s description of event State of consciousness after injury – immediately and 5 mts later, duration of unconsciousness; combative, confused, alert, or dazed Predisposing factors: seizure disorder, hypoglycaemia, poor vision, light headedness  Associated symptoms: head or neck pain, laceration, Altered LOC, changed breathing pattern, blurred or double vision, discharge from Ear &Nose, N/V, ability to move extremities Medications: prescription, non prescriptions  HEADACHE Onset Duration Location Character Severity Visual Pattern Episodes Change in LOC Associated symptoms Medications  Onset: Early morning, during the day, during the night; gradual versus abrupt. Duration: minutes, hours, days, weeks; relieved by medication or sleep; resolves spontaneously; occurs in cluster, headache free periods Location entire head, unilateral specific site (neck, sinus or behind eyes) Character: throbbing, pounding, boring, dull or constant pressure. Severity same or different with each event (gradation 1-10) Visual prodromal event: Scotoma, hemianopia; distortion of size, shape or location.  Pattern: Worse in the morning or evening, worse or better as the day progresses, occurs only during sleep. Episodes closer together or worsening, lasting longer Change in level of consciousness as pain increases Associated Symptoms: Nausea, vomiting, diarrhea, photophobia, Increase lacrimation, Precipitating factors: fever, fatigue, stress, food additives, prolonged fasting. Efforts to treat: sleep, pain medication, anticonvulsants, antiarrhythmics, beta blockers, contraceptives or Anti depressants  STIFF NECK Neck injury or strain, head injury, swelling of neck Fever, bacterial or viral infection Limitation of movement, pain in movement, pain relieved by movement, continuous or cramping pain, radiation pattern to arms, shoulders, hands or down the back Predisposing factors: unilateral vision or hearing loss Efforts to treat: heat, pain medication, physical therapy Medication: prescription, non prescription, alternative or complementary.  THYROID PROBLEM Change in temperature preference: more or less clothing, different from patient from patients family Swelling in neck; interference with swallowing; redness, pain with touch, swallowing or hyperextension of the neck, difficulty buttoning shirt Change in texture of hair, skin or nails; increased pigmentation of the skin at pressure points  Change in emotional instability: increased energy, irritability, nervousness or increased lethargy, or disinterest Increase prominence of eyes, puffiness in periorbital area, blurred or double vision Tachycardia, palpitations Change in menstrual flow Medications: thyroid preparations, prescriptions, non prescriptions, alternative or complementary  PAST MEDICAL HISTORY Head trauma, subdural hematoma, resent lumbar puncture Radon or radium treatment around head and neck Headaches: migraine, vascular Surgery for tumor Thyroid dysfunction, surgery  FAMILY HISTORY Headaches: types, character, similarity to patient’s Thyroid dysfunction  PERSONAL AND SOCIAL HISTORY Employment: risk of heat injury, use of helmets, exposure to toxins or chemicals Stress: tension; demands at homework or school Potential risk of injury: participation in sports, handrails available, use of seat belts, unsafe environment. Nutrition: recent weight gain or lose, food intolerances, eating habits Use of alcohol Use of street drugs  EXAMINATION OF THE HEAD Inspection When examining the head and neck, begin first by inspecting the head position and facial features. The patient head should be held upright and still. facial features such as the eyelids or eyebrows should be inspected for shape and symmetry with rest, movement and expression. When asymmetry is present, note whether all features on one side of the face are affected or only a portion of the face. Note any change in the shape of the face or any unusual features such as edema or puffiness. Inspect the skull for size, shape and symmetry.Inspect the scalp systematically for lesions, scabs or tenderness.  PALPATION The skull should be palpated in a gentle rotary movement progressing systematically form front to back. The skull should be symmetric and smooth. When palpation the scalp should move freely over the skull and no tenderness, swelling or depression should be expected. Palpate the patients hair noting the texture, colour and distribution. Hair should be smooth, symmetrically distributed and have no split or cracked ends. Palpate the temporal arteries and note their course. The temporomandibular joint space bilaterally. The Salivary glands should also be palpates for asymmetry or enlargement Percussion is not routinely performed, unless sinusitis is indicated. Auscultation of the skull is not routinely performed unless a vascular anomaly is indicated.  EXAMINATION OF THE NECK Inspection: Inspect the neck in the usual anatomic position, in slight hyperextension, and as the patient swallows. Look for bilateral symmetry of the sternocleidomastoid and trapezium muscle, alignment of the trachea, landmarks of the anterior and posterior triangles, and subtle fullness at the base of the neck. Note any apparent masses, webbing, excess folding, unusual shortness, or asymmetry. Observe for any distention of the jugular vein or prominence of the carotid arteries. Evaluate Range of motion of the head and neck. Movement should be smooth and painless.  PALPATION Palpate the trachea for midline position. Place the thumb, along each side of the trachea, in the lower portion of the neck. Compare the space between the trachea and the sternocleidomastoid muscle on each side. Identify the hyoid bone and the thyroid and cricoid cartilages. They should be smooth and non tender and should move under your finger when the patient swallows. When palpating the cartilaginous rings of the trachea in the lower portion of the neck should be distinct and non tender. Inspect and palpate the lymph nodes in the neck  The thyroid gland has to be inspected, palpated and auscultated. Checking for symmetry or asymmetry. When palpation is being done, the thyroid is checked for size, shape, configuration, consistency, tenderness and the presence of any nodules. Handbook: Page 60  REFERENCE Seidel, Henry M. (2006). Mosby’s guide to physical examination, 6th edition. Louis, MO: Mosby. Seidel, Henry M. (2006). Physical Examination Handbook, 6th edition. Louis, MO: Mosby.