Health Assessment Midterm

• Head & neck region

  Vital for survival as it houses the brain & several endocrine glands that control body functions

  
• Systems integrated in the head & neck

  • Musculoskeletal system permits movement of the neck & face while the bones protect the brain, spinal cord & eyes
• Assessment of the head

  1. Inspect skull size, shape, and configuration

  2. Palpate head for consistency (nodules or masses and depression)

  3. Inspect the symmetry of facial movements

  4. Inspect facial features

  5. Inspect eyes for edema and hollowness

  6. Palpate for temporomandibular joint range of motion (TMJ ROM)

  
• Normal skull


  Round and is of normal size or head circumference, Normocephalic, In proportion with gross body structure, Frontal, parietal, and occipital prominences, Smooth skull contour
• Deviations from normal skull

  Disproportionate, Asymmetric parietal and temporal prominences; with more prominent nose and forehead; longer mandible, Increased head circumference, Square-head, Bulging/depressed bone, Abnormal increase in head size in young children: may indicate Hydrocephalus, Inconsistently large head size in adolescents or adults: may indicate Acromegaly, Abnormally small head may indicate Microcephaly
• Normal palpation of head


  Smooth, uniform consistency; absence of nodules or masses
• Deviations from normal palpation of head

  Sebaceous cysts, Local deformities from trauma, Masses, Nodules
• Normal facial movements


  Symmetric facial movements, Raise or lower both eyebrows, Blink both eyes, Close both eyes tightly, Smile and show the teeth, Frown, Puff the cheeks
• Deviations from normal facial movements

  Asymmetric facial movements, Drooping of lower eyelid (Ptosis) and mouth, Involuntary facial movement
• Normal facial features


  Symmetric facial features, Eyebrow hair is equally distributed, Palpebral fissures equal in size
• Deviations from normal facial features

  Asymmetric features, Hirsutism – increased facial hair; thinning of eyebrows; exophthalmos, Cushing's Syndrome – moon face with reddened cheeks and increased facial hair, Scleroderma – thinning of facial hair, Bell's Palsy – twitching and weakness of the facial muscles
• Normal eyes


  No edema, Eyes not sunken
• Deviations from normal eyes

  Periorbital edema, Sunken eyes, cheeks and temples (indicative of dehydration, starvation, and illness)
• Normal temporomandibular joint range of motion (TMJ ROM)


  No edema, Eyes not sunken
• Deviations from normal TMJ ROM

  Abnormal, Swelling, Tenderness, Crepitation (clicking sound)
• Anatomy of the Thyroid and Parathyroid Gland

  
• Lymph nodes


  Filter lymph before it is returned to the blood. Harmful materials that are filtered: Bacteria; viruses; cancer cells & cell debris
• Lymphatic system


  Network of tissues & organs that get rid of the body's toxins, waste & other unwanted materials. Primary function - to transport lymph, a fluid containing infection-fighting white blood cells, throughout the body
• Inspection of the neck

  1. Inspecting the neck from the neutral position

  2. Inspecting the neck when hyperextended

  3. Deviations from normal (Enlargements, Lymphadenopathy, lymphoma, or other malignancy, Torticollis – deviation of neck to one side caused by spasmodic contraction of neck muscles, Enlarged, visible thyroid, Goiter or malignant mass)

  4. Normal findings (Neck erect, midline, no lumps, bulges, or masses, Thyroid not visible. No masses, swelling, or hypertrophy in the mid to lower half of the anterior neck)

  
• Palpation of the neck


  1. Use light palpation and check for masses or areas of tenderness

  2. Normal findings (Supple, non-tender, no masses)

  3. Deviations from normal (Masses: Lymphadenopathy, malignancies, thyroid masses)
• Palpating lymph nodes


  1. Occipital nodes

  2. Post-auricular nodes

  3. Pre-auricular nodes

  4. Tonsillar nodes

  5. Submandibular nodes

  6. Submental nodes

  7. Superficial cervical nodes

  8. Posterior cervical nodes

  9. Deep cervical nodes

  10. Supraclavicular nodes

  11. Infraclavicular nodes
• Normal lymph nodes


  Lymph nodes normally not palpable especially the deep and clavicular nodes. If a node is palpable, normal characteristics include small, 1 cm, mobile, soft, non-tender, and usually superficial.
• Deviations from normal lymph nodes

  Palpable nodes (1 cm or greater): Malignancy, inflammatory, or infectious process of glands or area they drain.
• Palpating the thyroid


  1. Locate the thyroid isthmus below the cricoid cartilage

  2. Anterior approach (To palpate the right lobe, slide fingers to the right, gently displace the trachea to the right, and palpate the gland as the patient swallows. To palpate the left lobe, slide fingers to the left, gently displace the trachea to the left, and palpate the gland as the patient swallows)

  3. Posterior approach (Have the patient tilt their head to the right, and then gently displace the trachea to the right, slide fingers to the right, and palpate the right thyroid lobe as the patient swallows. To palpate the left lobe, repeat the same technique but have the patient tilt their head to the left, displace the trachea to the left, and palpate the left lobe)

  
• Normal thyroid


  Generally nonpalpable. If some tissue is palpable, consistency is firm, smooth, and meaty, with no nodularity, enlargement, or tenderness.

  
• Deviations from normal thyroid

  Enlarged thyroid – Goiter, Nodular thyroid tissue, Tender thyroid, Exophthalmos – seen in hyperthyroidism, Myxedema – severe hypothyroidism (dull, puffy face, edema around the eyes, coarse hairs)

  
• Auscultation of the thyroid

  If thyroid gland is palpable, have patient hold breath and then listen over the thyroid gland with the bell portion of the stethoscope for bruits.

  
• Normal auscultation of thyroid


  No sounds detected

  
• Deviations from normal auscultation of thyroid

  Increased vascularity of hyperthyroidism
• FAST (signs of stroke)


  F - Face (Has their face drooped?), A - Arms (Can they lift both arms?), S - Speech (Is their speech slurred and do they understand you?), T - Time (Call 911, time is critical)
• Types and characteristics of headaches

  • Sinus Headache (Deep, constant, throbbing, pressure like pain, Occurs before/or after cold, acute sinusitis, acute febrile condition, Occur one area of the face or along eyebrow ridge, below cheekbone, Lasts until the associated condition is improved, Moderately severe, not debilitating, Pain worse w/sudden movements of the head, bending forward, lying down in AM, Associated w/symptoms of sinusitis, nasal drainage, congestion, fever & foul-smelling breath)
  • Cluster Headache (Stabbing pain w/ tearing, eyelid drooping, red eyes, runny nose, Sudden onset, may be precipitated by ingesting alcohol, Localized in eye & orbit radiating to facial & temporal regions, Typically occurs in the late evening or night, Intense, Movement or walking back & forth may relieve the discomfort, Occur more in young males)
  • Tension Headache (Dull, tight, diffuse pain, May occur w/ stress, anxiety & depression (no prodromal), Located frontal, temporal or occipital region, Lasts days, months, or years, Aching, Symptomatic relief by local heat, massage, analgesics, antidepressants & muscle relaxants, Affect women than men)
  • Migraine Headache (Accompanied by nausea & vomiting, sensitivity to light & noise, Visual disturbances, vertigo, tinnitus, numbness w/tingling of fingers & toes, Located around the eyes, temples, cheeks or forehead, may affect one side of face, lasts up to 3 days, Throbbing, severe, Rest may bring relief, More often in women)
  • Tumor-related Headache (Aching, steady, neurologic, mental symptoms, Aggravated by coughing, sneezing, sudden movements of head, Varies with the location of tumor, Occurs in the morning and lasts for several hours, Variable in intensity, Subsides during the day)
• Eyes


  Sensory organs responsible for vision, Vision affects how an individual interacts & communicates with the world, The eye is the structure through which light is gathered to produce vision
• 70 % of all sensory information reaches the brain through the eyes
• External structures of the eye

  • Extraocular Muscles, Lacrimal Apparatus

  
• Anatomy of the eye

  3 layers: Sclera (outermost layer that helps maintain shape of the eye), Choroid (middle vascular pigmented layer), Retina (innermost membrane & sensory portion of the eye)

  
• Sclera


  Helps maintain shape of the eye, Support & protect structures of the eye, Maintains the eye size

  
• Cornea


  Clear, transparent part of sclera & forms anterior 1/6 of the eye, Allows light to enter & refracts light rays entering the eye
• Choroid


  Maintains blood supply to the eye
• Iris


  Circular colored, muscular aspect of the choroid layer & located in the anterior portion of the eye, Responds to light by making the pupil larger or smaller