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NSG2317 - health assessment > HEENT Assessment > Flashcards

HEENT Assessment Flashcards

1
Q

Health History Points

Head, Neck and Face

A
  1. headache
  2. head injury
  3. dizziness
  4. neck pain, limitation of movement
  5. lumps or swelling
  6. history of head or neck surgery
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2
Q

(pre)syncope

A

feeling experienced prior to falling caused by a decreased blood flow to the brain, or a heart irregularity causing decreased cardiac output

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3
Q

True Vertigo

A

a sense of true rotational spinning from a vestibular disorder of the inner ear

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4
Q

Subjective Vertigo

A

person feels like they are spinning

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5
Q

Objective Vertigo

A

person feels like the room is spinning

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6
Q

Physical Exam: The Neck

Head, Face and Neck

A
  1. Inspect and Palpate the Neck
    a. Symmetry - head in midline (erect
    and still), accessory neck
    muscles symmetrical, trachea
    and thyroid midline)
    b. Range of Motion - movements
    are smooth and controlled

CN XI (Spinal Accessory Nerve) - test with resistance exercises

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7
Q

Resistance Exercises Test CN:

A

XI - Spinal Accessory Nerve
(tests muscle strength)

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8
Q

Facial Expressions Test CN:

A

VII - Facial Nerve

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9
Q

Physical Exam: Head and Face

Head, Face and Neck

A
  1. Inspect and Palpate the Skull
    a. general size and shape
    b. temporal area - temporal artery, TMJ (open
    and closed)
  2. Inspect the Face
    a. facial structures - note facial expression
    (appropriateness), eyes are aligned
    normally (no protrusion or sunken
    appearance)

CN XII (facial nerve) - test with facial expressions

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10
Q

Headaches (2 types)

A
  1. Primary - headache is primary issue
    a. tension
    b. migraine
    c. cluster
  2. Secondary - headaches secondary to an injury or disorder
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11
Q

tension headache

A

primary headache
- occipital or frontal
- halo/ band-like tightness around the head

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12
Q

migraine

A

primary headache (vascular)
- supraorbital, retro-orbital, frontotemporal
- associated nausea, vomiting, and visual
disturbances
- chronic, genetic

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13
Q

cluster headache

A

primary headache (vascular)
- produce pain around the eye, temple, forhead,
cheek
- shorter in duration

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14
Q

Health History Points

Eyes

A
  1. Vision Difficulty
  2. Pain in/ around eyes
  3. Watering, Discharge
  4. History of Ocular Problems
  5. Medications
  6. Occupational Work Hazards
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15
Q

Floaters

A

indicate potential retinal detachment

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16
Q

Scotoma

A

blind spot in the visual field surrounded by an area of normal or decreased vision

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17
Q

Glaucoma

A

disorders of the optic nerve and visual pathway characterized by increased intraocular pressure
- causes decreased peripheral vision
- no pain associated

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18
Q

Diplopia

A

double vision

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19
Q

Strabismus

A

deviation in the anteroposterior axis of the eye (cross eye)

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20
Q

Photophobia

A

inability to tolerate light

21
Q

Lacrimation

A

tearing

22
Q

Epiphora

A

excessive tearing

23
Q

Physical Exam: Vision Acuity + Fields

Eyes

A
  1. Snellen Eye Chart (acuity)
  2. Confrontation Test (field) - cover one eye, move
    flickering finger into peripheral field
24
Q

Physical Exam: Extraocular Muscle Function (3 tests)

Eyes

A
  1. Corneal Light Reflex
  2. Cover-Uncover Test
  3. Six Cardinal Planes Test
25
Q

Corneal Light Reflex

A

assess symmetry of eye alignment by shining a light into patient eyes (30 cm away) while they look straight
→ reflection should appear in the same spot
bilaterally

26
Q

Cover-Uncover Test

A

used to detect small degrees of deviated alignment by interrupting the fusion reflex that normally keeps the two eyes parallel

  1. Ask the patient to stare at you nose even when
    their gaze is interrupted → move an opaque
    card over one eye and hold there
    a. Observe uncovered eye for movement →
    normal response is a steady gaze
    - abnormal: the eye jumps to fixate on the
    point (nose) when covered, it was
    misaligned before → test again with
    other eye
    b. Remove the card and observe the
    previously covered eye for movement
    - normal: steady gaze
    - abnormal: the eye jumps to re-establish
    fixation on the point (nose), eye muscle
    weakness exists
27
Q

Six Cardinal Planes Test

A

lead the eyes through the six cardinal positions of gaze to reveal eye muscle weakness upon movement

  1. Have the patient follow your finger or an
    object (30cm away) with their eyes without
    moving their head as you move through the
    cardinal positions
28
Q

Physical Exam: Anterior Eye Structures

Eyes

A
  1. Eyes - aligned in sockets, no protrusion or
    sunken appearance
  2. Conjunctiva - should be moist and glossy
  3. Sclera - white - grey/blue
29
Q

PERRLA

Eyes

A

Pupils Equal and Round - normally round, regular,
and equal size (3-5mm resting)

Reactive to Light - observe pupil dilation and
construction in response to light
a. direct light reflex - constriction of observed
eye
b. consensual light reflex - constriction of
opposite eye

Accommodation - test the eye’s ability to change focus (near vs far)
a. far = dilation
b. near = constriction

30
Q

Older Adult Considerations - Eyes

Eyes

A
  1. skin loses its elasticity, causing wrinkling and
    drooping
  2. Lacrimal glands involute, causing decreased
    tear production = feeling of dryness and burning
  3. Impaired visual acuity – decreases participation
    in social and leisure activities and increases the
    risk for injuries and accidents (falls)
    a. Pupil size decreases → decreased ability to
    adapt to darkness, more light is needed to
    see
    b. Lens loses elasticity → decreases ability to
    change shape to accommodate for near
    vision
    c. Debris can accumulate in the vitreous
    humor (floaters) because this fluid is not
    continuously renewed
  4. Aging increases the risk of developing:
    a. Macular Degeneration - breakdown of cells
    in the macula of the retina, loss of central
    vision but peripheral vision is unaffected
    → cause of blindness
    b. Cataracts - lens opacity/ cloudiness due
    to proteins clumping in lens
    c. Glaucoma - increased ocular pressure
    damages optic nerve resulting in gradual
    loss of peripheral vision
    d. Diabetic Retinopathy - when a person’s
    blood sugar is too high, this causes the
    blood vessels in the retinal to become
    damaged or blocked and eventually lead
    to vision loss
31
Q

Health History Points

Ears

A
  1. Earache
  2. Infection
  3. Discharge
  4. Hearing Loss
  5. Environmental Noise
  6. Tinnitus
  7. Vertigo
  8. Self-Care Behaviours
32
Q

Otalgia

A

pain in the ear

33
Q

Otorrhea

A

Discharge from the ear → note quality (colour) and odour, relationship with ear pain

34
Q

Physical Exam: External Ear

Ears

A

Palpate and Inspect the External Ear
a. size and shape - same size bilaterally, no
swelling or thickening
b. skin condition - consistent with facial skin
colour, no lumps or lesions
c. tenderness - pinna and tragus should be firm,
no pain
d. External Auditory Meatus - note the size of
opening, swelling, redness, discharge

35
Q

Physical Exam: Otoscope

Ears

A

Inspection with an Otoscope
a. External Canal - note redness or swelling,
foreign bodies, discharge
b. Tympanic membrane - normal eardrum is
shiny and translucent, pearly grey, intact

36
Q

Physical Exam: Auditory Testing

Ears

A

a. Whispered Voice Test - stand an arm’s length away from the patient from behind, mask hearing in opposite ear by pushing the tragus into the auditory meatus (to prevent sound transmission around the head)
- Inability to hear whisper is an indication of
hearing loss (initially high pitched sounds)

37
Q

Older Adult Considerations

Ears

A
  1. Hearing acuity usually declines with age
    • The cilia lining the ear canal become coarse
      and stiff → may impede sound waves
      traveling to the eardrum = decrease in
      hearing
    • Earwax become drier (due to atrophy of
      apocrine glands) → cilia stiffening causes it
      to accumulate and oxidize = decrease in
      hearing
  2. Early losses (which start in young adulthood), involve primarily the high pitched sounds, but gradually, losses extends to sounds in the middle and lower ranges
38
Q

Health History Points

Nose

A
  1. Discharge
  2. Frequent Cold
  3. Sinus Pain
  4. Trauma
  5. Epistaxis
  6. Allergies
  7. Alterned Smell
39
Q

Rhinorrhea

A

discharge from the nose
- note quality (colour), odour

40
Q

Epistaxis

A

nosebleeds

41
Q

Health History Points

Mouth and Throat

A
  1. Sores or Lesions
  2. Sore Throat
  3. Bleeding Gums
  4. Toothache
  5. Sugar Consumption
  6. Bruxism
  7. Hoarseness
  8. Dysphasia
  9. Altered Taste
42
Q

Bruxism

A

teeth grinding

43
Q

Physical Exam: Nose

Nose

A

a. External Structures - should be midline, symmetrical, and in proportion to features
- test patency of nostrils

b. Nasal Cavity - note swelling, discharge, bleeding or foreign body, nasal septum deviation or polyps

44
Q

Physical Exam: Sinuses

Nose

A

press over the frontal sinuses below the eyebrows and over the maxillary sinuses below the cheekbones → patient should feel firm pressure but no pain
- Sinus areas tender to palpation with chronic
allergies and acute infection (sinitus)

45
Q

Physical Exam: Lips, Teeth, Tongue

Mouth and Throat

A

a. Lips - colour, moisture, cracking, lesions
b. teeth/ gums - assess quality of teeth and gums
c. tongue - check for colour, surface characteristic, moisture

46
Q

Physical Exam: Oral Cavity, Pharynx

Mouth and Throat

A

a. Buccal Mucosa - normally pink, smooth and
moist

b. Palate - the anterior hard palate is white with
irregular transverse rugae, the posterior soft
palate is pinker, smooth, and upwardly
movable

c. Uvula - midline

d. Throat - tonsils (colour should be the same as
oral mucosa) → grade
e. Mouth - assess for breath odour

47
Q

Halitosis

A

breath odour

48
Q

Grading for Tonsils

A

1+ = visible (normal)
2+ = halfway between tonsillar pillars and uvula
(normal)
3+ = touching the uvula, midline of throat
(abnormal)
4+ = touching each other (abnormal)
→ medical emergency, can obstruct airway,
difficulty swallowing, pain

49
Q

Older Adult Considerations

Nose, Mouth and Throat

A
  1. Oral Cavity
    a. Soft tissues atrophy and the epithelium
    tissue thinks (cheeks and tongue) = loss of
    taste buds and reduction in taste functioning
    b. Decreased salivary secretion = decreased
    taste functioning, reduces the mouth’s self-
    cleaning property, and decreases
    c. Teeth may wear down, become abraded, or
    fall out due to periodontal disease
    → loss of smell + taste + periodontal
    disease = risk of malnutrition, change of
    eating habits
  2. Nose
    a. Subcutaneous fat is gradually lost during
    later middle adult years, making the nose
    appear more prominent in some people
    b. The sense of smell may diminish
    progressively after the age of 60 years due to
    a decreased number of olfactory nerve fibres

NSG2317 - health assessment (18 decks)

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