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NURS 202 > Lecture 5: Head and Neck, Including Regional Lymphatic System > Flashcards

Lecture 5: Head and Neck, Including Regional Lymphatic System Flashcards

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1
Q

Head - Structure and Function

A
  • Cranial bones
  • Sutures
  • Facial bones
  • Facial muscles
  • Salivary glands
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2
Q

Neck - Structure and Function

A
  • Neck muscles
  • Anterior and posterior triangles
  • Thyroid glands
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3
Q

Lymphatics - Structure and Function

A
  • Preauricular
  • Posterior auricular (mastoid)
  • Occipital
  • Submental
  • Submandibular
  • Tonsillar
  • Superficial cervical
  • Deep cervical
  • Posterior cervical
  • Supraclavicular
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4
Q

Developmental Considerations: Infants and children

A
  • Fontanelles
  • Head growth
  • Lymphatic system
    Skull: head circumference, caput succedaneum, cephalhematoma
    Face: symm, appearance, swelling
    Neck: muscle development and head control
  • Special considerations
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5
Q

Developmental Considerations: Pregnant women

A
  • Slight enlargement of thyroid gland
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6
Q

Developmental Considerations: Older adults

A
  • Sagging facial skin
  • Presence of senile tremors, concave cervical curve, dizziness on range of motion
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7
Q

Subjective Data: Health History

A
  • Headache
  • Head injury
  • Dizziness
  • Neck pain or limitation of motion
  • Lumps or swelling
  • History of head or neck surgery
  • Thyroid problems
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8
Q

Additional Health History Q’s: Infants and children

A
  • Prenatal drug exposure
  • Type of delivery
  • Growth pattern
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9
Q

Additional Health History Q’s: Older adults

A
  • Dizziness
  • Neck pain
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10
Q

Objective Data: Physical exam

A

Head - Inspect and palpate the skull
Size and shape (normocephalic)
- Macrocephalic, microcephalic
- Fontanelles in infants
Temporal area
- Temporal artery
- Temporomandibular joint
Head - Inspect the face
Facial structures
Sinuses

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11
Q

Physical Exam Neck: Inspect and Palpate

A
  • Symm
  • ROM
  • Lymph nodes
  • Trachea
  • Thyroid gland (posterior approach, anterior approach, auscultate for bruit)
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12
Q

Pediatric Facial Differences

A
  • Fetal alcohol syndrome
  • Down’s syndrome
  • Atopic (allergic) facies)
  • Allergic salute and crease
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13
Q

Eye External Anatomy (Eye)

A
  • Eyelids
  • Palpebral fissure
  • Limbus
  • Canthus
  • Caruncle
    (Look @ directions of movement slide)
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14
Q

Visual Pathways and Visual Fields (Eye)

A
  • Refraction of light rays
  • Crossing of fibres at optic nerve
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15
Q

Visual Reflexes (Eye)

A
  • Pupillary light reflexes
  • Fixation
  • Accommodation
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16
Q

Developmental Considerations: Older Adults (Eye)

A
  • Presbyopia
  • Macular degeneration
  • Cataracts
  • Glaucoma
  • Diabetic retinopathy
  • Decreased tear production
  • Decreased adaptation to darkness
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17
Q

Developmental Considerations: Infants/children (Eye)

A
  • Limited eye function at birth
  • Farsighted until age 7-8
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18
Q

Subjective Data: Health History (Eye)

A
  • Vision difficulty
  • Pain
  • Strabismus, diplopia
  • Redness, swelling
  • Watering, discharge
  • History of ocular problems
  • Glaucoma
  • Glasses or contact lenses
  • Self-care behaviours - eye protection, last eye exam
  • Meds
  • Vision loss
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19
Q

Additional Health History Q’s: Infants and children (Eye)

A
  • Mother’s vaginal infection during delivery
  • Developmental milestones
  • Routine vision testing
  • Safety measures
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20
Q

Additional Health History Q’s: Older Adults (Eye)

A
  • Movement and visual difficulty
  • Glaucoma testing
  • Cataracts
  • Dryness of eyes
  • Decreased activities
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21
Q

Physical Exam (Eye)

A

Preparation: Position
Equipment: Snellen eye chart, handheld visual screener, opaque card or occluder, penlight, applicator stick, ophthalmoscope
Central visual acuity: Snellen eye chart, near vision
Visual fields: Confrontation test

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22
Q

External Inspection (Eye)

A

General: Periorbital edema
Eyebrows
Eyelids and lashes: Ptosis, xanthelasma
Eyes: Exophthalmos

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23
Q

How to inspect cornea (Eye)

A

Shine light from side

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24
Q

How to inspect conjunctiva and sclera (Eye)

A

Have patient look up; pull down lower lids gently

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25
Extraocular Muscle Function: Inspect (Eye)
- Diagnostic positions test - Patient follows the movement of an object 12 inches away - Normal: tracking with both eyes - Nystagmus only normal at extreme lateral gaze
26
Accomodation (Eye)
- Have patient focus on examiners finger or pen - Move object toward patients nose - Observe for convergence and pupillary constriction
27
Pupillary Light Reflex (Eye)
- Part of neuro (cranial nerve) exam - Dark room, shine light from side - Measure pupils in mm, before and after light: resting should be 3-5mm, brisk response vs sluggish response or fixed - Consensual response - opposite pupil also constricts
28
PERRLA (Eye)
Pupils Equal Round Reactive to Light and Accommodation
29
Assess Visual Acuity (Eye)
Snellen Eye Chart: - 20ft away - Top # is distance from chart - Bottom # is distance at which someone at which someone with normal vision could read the line 20/20 is normal vision 20/30 is nearsighted - The higher the bottom number, the worse the nearsightedness is
30
Developmental (Eye)
- Children 2 and a half to 3 yrs - test by showing cards with familiar objects - Children 3-8 yrs - tumbling E chart
31
Use of Ophthalmoscope (Eye)
- Functions as appendage of examiner's eye - Shine light to patient's eye, find red reflex, then follow in to view ocular fundus
32
Diseases to the eye
- Cataract - Arcus Senilis
33
Ear Structure/function
External ear: External auditory canal, tympanic membrane Middle ear: malleus, incus, and staples, eustachian tube Inner ear: Vestibule and semicircular canals (bony labyrinth), cochlea
34
How does the ear work and what is it used for?
- Used for hearing and balance - Sound waves through external auditory canal to tympanic membrane: Translucent pearly grey, separate external and middle ear - Auditory canal lined with glands that secrete cerumen
35
Middle and inner ear
Middle: Contains malleus, incus, stapes - conduct sound vibrations, reduce amplitude of loud noises, equalizes air pressure via Eustachian tube to prevent tympanic membrane rupture Inner: Vestibule and semicircular canals (balance), cochlea (hearing) - Information travels to brain via cranial nerve V11
36
Developmental: Infants/children
Shorter, horizontal Eustachian tube: Pathogens move from nasopharynx to middle ear, increased incidence Otitis Media if bottle fed lying down
37
Developmental: Older adults
- Cilia course and stiff, impacted cerumen - Presbycusis - gradual hearing loss
38
Cultural and Social Considerations
- Increased incidence of otitis media in: Aboriginal children, premature infants, infants with down syndrome, infants bottle fed in supine position - Cerumen: genetically determined; dry and wet cerumen - Hearing loss third most common chronic condition in older adults: audism; discrimination based on hearing ability
39
Promoting Health (Ears)
- Earbuds placed directly in the ear canal - No distortion in sound (digital) - Listeners tend to listen for hours - 60-60 rule recommended - Use larger headphones/noise cancelling headphones
40
Health History (Ears)
- Earaches (otalgia) - Infections - Discharge (otorrhea) - Hearing loss - Environmental noise - Tinnitus - Vertigo - Self-care behaviours For infants: - Ear infections - Hearing loss - Injury
41
Physical Exam (Ears)
Preparation: Position, cleaning the ear canal Equipment: Otoscope with bright light, pneumatic bulb attachment External ear - Inspect and palpate: Size, shape, condition, tenderness, external auditory meatus
42
Otoscopic Exam
Otoscopic Examination: - Position of head and ear - Method of holding and inserting otoscope External canal: - Colour - Swelling - Lesions/foreign bodies - Discharge (colour, odour)
43
Tympanic Membrane
- Colour and characteristics - Position - Integrity of membrane
44
Testing Hearing
- Test hearing acuity - Vestibular apparatus
45
Development: Infant and young children
- Ear position - Timing of otoscopic exam - Positioning of children - Testing hearing acuity and developmental milestones - Behavioural manifestations
46
Development: Older Adult
- Loss of elasticity if pinna - Eardrum whiter, more opaque, duller - Loss of hearing of high-tone frequencies and consonants in whispered voice test - Isolation in groups
47
Function/Structure: Nose, Mouth, Throat
Nose - 1st segment of resp sys; warms, moistens, and filter air - Shaped as a triangle; 2 oval openings at the base of the triangle (nares); divided in 1/2 by the septum Mouth - 1st segment of digestive system and an airway for resp - Bordered by the lips, palate (soft and hard), cheeks and tongue - Contains the teeth, gums, tongue and salivary glands Throat (pharynx) - Area behind the mouth and nose - Separated from the mouth by the tonsils
48
Structure and Function - Nose
- External nose - Nasal cavity: septum, turbinates, meatus
49
Structure/Function - Paranasal Sinuses
- Frontal - Maxillary - Ethmoid - Sphenoid
50
Structure/Function - Mouth
- Oral Cavity - Hard and soft palates - Uvula - Tongue
51
Structure/Function - Salivary Glands
- Parotid - Submandibular - Sublingual - Teeth and gums
52
Structure/Function - Throat
- Throat (pharynx) - Oropharynx - Tonsils - Nasopharynx
53
Developmental Considerations: Infants and children
- Salivation - Deciduous teeth - Nose: obligate nose breathers - Positioning - Tonsils
54
Developmental Considerations: Pregnant Women
- Nasal stuffiness - Epistaxis - Hyperemic gums - Pregnancy-related gingivitis
55
Developmental Considerations: Older adults
- Diminished smell and taste - Atrophic tissue - Dental changes (malnutrition) - Malnutrition - "Purse string" appearance of mouth - Yellow teeth
56
Cultural Social Considerations (Nose, mouth, throat)
- Increased incidence of dental disease in indigenous peoples - Correlation between socioeconomic variables and dental disease
57
Health History - Nose
- Discharge (rhinorrhea) - Frequent colds (upper resp infections) - Sinus pain - Trauma - Epistaxis (nosebleeds) - Allergies - Altered sense of smell
58
Health History - Mouth and Throat
- Sores or lesions - Sore throat - Bleeding gums - Toothache - Hoarseness/Dysphagia/Altered tate - Smoking, alcohol consumption - Self-care behaviours: Dental care pattern, Dentures or appliances
59
Additional Health History Q's: Infants and children
- Mouth disease - Throat disease - Tooth disease - Self-care behaviours
60
Additional Health History Q's: Older adult
- Mouth dryness (xerostomia) - Teeth/dentures - Mouth care - Taste and smell - Effect on nutrition
61
Promoting Health: Smokeless Tobacco (SLT) and Cancer Risk
Chewing tobacco and snuff (dry or moist) used in Canada - Looking out for oral cancer - Using SLT can lead to oral, esophageal, or pancreatic cancer
62
Physical Exam: Nose
Inspect and palpate - External nose - Nasal cavity: holding the otoscope, nasal septum, turbinates - Have patient block one nostril and snif
63
Physical Exam: Sinus Areas
Palpate - Frontal and maxillary sinuses
64
Physical Exam: Mouth
Inspect - Lips - Teeth and gums - Tongue (test cranial nerve X11) - Buccal mucosa - Palate and uvula

NURS 202 (8 decks)

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