Lecture 5

• Skull

  protects brain and sense organs; includes bones of cranium and face
• face

  facial expressions, facial muscles - cranial nerve VII; eyes, eyebrows, ear, nose, mouth, symmetrical; salivary glands, temporal artery
• sinus

  give voice resonance, lighten the weight of the skull, produce mucus
• neck muscles?

  sternocleidomastoid and trapezius
• Neck major blood vessels

  internal carotid and external carotid
• thyroid gland

  located between trachea and sternocleidomastoid
• lymphatic system

  extensive vessel system; major part of immune system; finds and destroys foreign substances
• lymph nodes

  small oval clusters of lymphatic tissue; eats pathogens, stops harmful substances entering circulation
• head injury (subjective data)

  loss of consciousness (pre or post fall); setting/environment of fall; location of head injury; history of illness; symptoms afterwards; attempts to treat?
• subjective data for head injuries

  any headaches, dizziness, confusion, difference in vision, skin problems, stiffness of neck, lumps or swelling, buises
• tests for head injuries

  racoon eyes, Halo Effect of Leaking, Kerning's Sign (meningitis)
• Past medical history for head injuries

  any neck/head surgery, thyroid problems/hormone treatment
• Health teaching about head injuries

  sunscreen for skin cancer; helmets for injury; stop smoking; seatbelt for coup-coupercoup injury
• Objective data for head

  inspect and palpate skull
• size, shape, contour, symmetry of head - objective data

  normocephalic, macrocephalic, microcephalic, lumps, depressions, protrusions, abnormal frontanelles, hair, no sutures until 6 months, rickets
• Objective data for face

  edema to face, cravial nerve VII symmetry
• Objective data for neck

  trachea midline? look for creptitation, limited ROM, arthritis, tenderness, is thyroid enlarged, are lymph nodes and salivary glands palpable (not supposed to), lymph adenopathy
• Eyes

  6 muscles, three cranial nerves VI, IV, III
• subjective data for eyes

  sudden vision change, floaters, quick appearance of floaters, hard time seeing, pain, photophobia, strabismus, redness and swelling, watering and discharge, use of glasses on contacts, glaucoma
• developmental consideration of infants/kids for eyes

  limited eye function when first born, farsighted until 7-8 yrs olf
• Developmental considerations of aging adults

  presbyopia by 40, decreased adaptation to darkness and tear production
• Objective data for eyes

  clarity of cornea and lens, edema of eyelid, eyebrows, lashes, droopy eye from nerve damage, benign cholesterol build-up
• objective data for eyeballs

  moist, white sclera, pink lids, few blood vessels
• assess alignment of eyes

  hirschberg's test, undercover test
• eye/vision test

  20/20 means can read at 20 ft what the normal could have read at 20 ft. 20/30 means poor vision. needs to see eye doctor. accomodation = adjustment for near vision
• eye test for kids (2 1/2 - 3)


  allen test-seven cards of familiar objets,
• eye test for kids 3-8 or adults with illiteracy

  tumbling E chart
• Assess with 6 cardinal gazes

  follow movement of finger 12 inches away, normal = parallel tracking with both eyes, nystagmus only normal at extreme lateral gaze
• Pupillary light reflex (CN II optic)

  PERRLA = puplis are equal, round and reactive to light and accommodation

  shine light from side (should contract when move light into line of vision)
• Visual reflex of accommodation

  focus on finger and move towards nose, convergence and pupillary constriction should be looked for
• internal structures

  look for red reflex when using ophthalmoscope
• infants/kids ears

  structurally different (shorter, horizontal eustachian tube). pathogens move nasopharynx to middle ear. lymphoid tissue may obstruct
• older adults ears

  cilia coarse and stiff, impacted cerumen (ear wax), gradual hearing loss
• subjective data for ears


  earache, infections/discharge, hearing loss, environmental noise, tinnitus, vertigo
• objective data of external ear

  look at size and shape of pinna, skin condition, tenderness, discharge, odor (pull pinna up and back for adult, down and back for kid)
• objective data for tympanic membrane

  shiny translucent grey colour, retracted and flutters during valsalva manoeuvre or holds the nose and swallows, no perforations, white circle at 5:00 in right ear, 7:00 in left ear
• hearing tests

  whispered voice test and turning fork test
• whispered voice test

  close one ear, cover mouth and whisper two syllable words
• turning fork test

  not reliable
• balance test

  romberg test