Assessment of the Head, Face & Neck

1. Assessment of the Head, Face & Neck Dr. Sara Mitchell Georgia Baptist College of Nursing Of Mercer University

2. Main bones of the cranium • __________ • __________ • __________ • __________

3. Major structures of the neck • __________________ • __________________ • __________________ • ________________ & _____________ • _______________ • _______________

4. Midline structures of the neck • _________________________________ • _________________________ • __________________ • __________________ • __________________

5. Inspect hair scalp skull face skin Palpate scalp skull temporal artery Assessment of the head

6. How to Examine the Hair and Scalp

7. CN V - __________ motor function sensory function CN Vll - ________ motor function sensory function CN lX & X - ___________ & ____ CN Xl - ___________ CN Xll - __________ Assessment of the face

8. Assessment of the cranial sinuses • The paranasal sinuses are air filled cavities that warm, moisten, filter air, and aid in voice resonance

9. Assessment of sinuses

10. How to Examine CN V: Trigeminal Nerve – Sensory

11. How to Examine CN V: Trigeminal Nerve – Motor

12. CN VII: Facial Motor

13. A part of face through which food passes into the body, being within the tongue, gums, and teeth The Mouth

14. The oral pharynx • Composted of three functional parts • __________________ • __________________ • __________________ • Functions include • _____________ • _____________ • _____________ Oropharynx

15. Oral mucosa Assessment • Inspect • lips • oral mucosa • gums & teeth • roof of mouth • tongue & floor of mouth • pharynx

16. Tonsils Strep Tonsillitis Peritonsillar Abscess

17. Hand Foot Mouth Disease

19. The Tongue • 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)

20. Assessment of tongue Inspect • General appearance • Mucosa Palpate • Lateral margins • All white lesions

21. Normal tongue variants Geographic tongue Black hairy tongue Fissured Tongue

22. The salivary glands • There are three major salivary glands • ________________ • ________________ • ________________ • ____________ arises from the parotid gland • ___________ duct arises from the submandibular gland

23. The Neck

24. Assessment of the neck • 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.

25. Assessment of the neck Inspection general specific (thyroid) Range of motion lumbar spine can only rotate 3 to 18 degrees.)

26. Functions Lymphatic System • 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

27. Assessment of the lymph nodes • Use a _____________ to palpate each anatomical area that housed lymph nodes • All palpable nodes should be assessed for ______, ______,_________, and _______________.

28. Group A streptococcal infection Mononucleosis (Ebstein Barr Virus, or EBV) Cytomegalovirus (CMV, closely related to EBV) HIV Unusual infectious causes include: Cat scratch disease (usually from a kitten) Tularemia (ask about hunting rabbits) Anthrax Lupus Common infectious causes of cervical lymphadenopathy

29. The Thyroid Gland • 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

30. 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 • _________________________________________________________________________________

31. Palpation of Thyroid Gland in Client with Goiter • 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

32. Causes of Enlarged Thyroid • Graves Disease • Hashimoto’s disease • Multinodular goiter • Solitary thyroid nodules • Thyroid cancer • Pregnancy • Inflammation

33. Sternocleidomastoid Muscle • 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

34. How to Examine CN XI: Spinal Accessory – Trapezius Muscle • Posterior to the muscle is the posterior triangle bounded by the trapezius muscle posteriorly and the clavicle inferiorly.

35. The Ears Ouch! Let Go Come on, let’s play

36. The Ear • Ear structure • external ear • _______________ • middle ear • _______________ • inner ear • ________________l

37. External Ear Inspection: auricles and mastoid area for: • Tenderness Swelling Nodules Internal Ear Structures - video tympanic membrane hearing AC vs. BC Assessment of the Ear • video

38. Correct handling of the Otoscope • 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 __________

39. The Tympanic Membrane Injected Tympanic Membrane Normal right tympanic membrane Ventilation Tube

40. Rinne’ Test • 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 ________

41. The Weber test • 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 ______ ______

42. Impact of Hearing Loss • Paranoia • Withdrawal • Depression • Anxiety

43. “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

44. Children Congenital Acquired Adults Acquired Differential Diagnoses for Hearing Loss

45. The Nose

46. Assessment of olfactory ability _______________________________

47. Nose assessment • Inspection: • Nose & parasinuses • anterior & posterior surfaces • test for nasal obstruction • inside of nose • mucosa • turbinates • Palpate • sinuses • transillumination Nasal speculum Normal Nasal Turbinates

48. Common condition of external nose Rhinophyma (with or without rosacea Assessment of the external nose

49. Differential Diagnoses of abnormal nasal findings • URI • Allergies • Epitasis • Polyps

50. I: Olfactory - smell II: Optic: - vision III: Oculomotor – Most EOM movement; raise eyelids; pupil constriction IV: Trochlear –superior oblique V: Trigeminal – mastication; facial & scalp sensation VI: Abducens – lateral rectus VII: Facial – facial muscles; taste; saliva & tear secretion VIII: Acoustic – hearing & equilibrium IX: Glossopharyngeal – phonation & swallowing; taste back portion of tongue X: Vagus – talking & swallowing; carotid reflex XI: Spinal Accessory – movement of trapezius & sternomastoid muscle XII: Hypoglossal – movement of tongue Review of cranial nerves in order