Ppt07

Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Chapter 7

The Head and Neck

Chapter 7

The Head and Neck


Common or Concerning SymptomsCommon or Concerning Symptoms

Head Headache, history of head injuryEyes Visual disturbances, spots (scotomas), flashing

lights, use of corrective lenses, pain, redness, excessive tearing, double vision (diplopia)

Ears Hearing loss, ringing (tinnitus), vertigo, pain, discharge

Nose Drainage (rhinorrhea), congestion, sneezing, nose bleeds (epistaxis)

Oropharynx Sore throat, gum bleeding, hoarseness, Neck Swollen glands, goiter


Head – Inspection and PalpationHead – Inspection and Palpation

• Inspect

– Hair distribution, quantity

– Scalp – scaling, nevi

– Skull – size, contour

– Face – expression, contours

– Skin – color, pigmentation, hair distribution, lesions

• Palpate

– Hair texture

– Skull – lumps

– Face – sinuses

– Skin – texture, temperature


Eyes - InspectionEyes - Inspection

• Position and alignment of eyes

• Eyebrows - quantity, distribution

• Eyelids– Width of palpebral

fissures– Edema, color, lesions– Condition and direction

of eyelashes– Adequacy of closed

eyelids

• Lacrimal apparatus

– Lacrimal gland and sac for swelling

• Conjunctiva and sclera– Color, vascular pattern

• Cornea and lens - opacities

• Iris – markings clearly defined

• Pupils – size, shape, symmetry, reaction to light (direct and consensual)


Eyes – Techniques of ExaminationEyes – Techniques of Examination

• Visual acuity

– Central vision: Snellen eye chart; position patient 20 feet from the chart

o Patients should wear glasses if needed

o Test one eye at a time

– Near vision: hand-held card (can also use to test visual acuity at the bedside); hold 14 inches from patient’s eyes


Eyes – Techniques of Examination (cont.)Eyes – Techniques of Examination (cont.)

• Visual fields

– Screening

o Both eyes at same time; start in the temporal fields

– Further testing

o If a defect is found, test one eye at a time

• Extraocular movements/six cardinal directions of gaze

– Normal conjugate movements

– Nystagmus

– Lid lag

– Convergence


Tips for Using the OphthalmoscopeTips for Using the Ophthalmoscope

• Darken the room and have the patient look off in the distance

• Switch the ophthalmoscope light and turn the lens disc to the large round beam of white light

• Turn lens disc to the 0 diopter

• Hold the ophthalmoscope in your right hand to examine the patient’s right eye with your right eye; hold it in your left hand to examine the patient’s left eye with your left eye

• Stand directly in front of the patient, 15 inches away, and start at an angle of 15 degrees lateral to the patient’s line of vision

• Shine the beam of light onto the pupil and look for an orange glow; this is the red reflex

• Follow the red reflex and move inward towards the nasal aspect of the visual field


Ears – Inspection and PalpationEars – Inspection and Palpation

• Inspection

– Auricle for redness, lesions

– Ear canal

o Discharge, foreign bodies, redness, swelling

– Tympanic membrane

o Color, contour

• Palpation

– Auricle for lumps, tenderness


Ears - HearingEars - Hearing• Auditory acuity

– Test one ear at a time

– Whisper test, standing 1-2 feet behind patient, softly say “nine-four,” “baseball”

• Air and bone conduction– Weber

o Lateralization of sound to impaired ear; suspect unilateral conductive hearing loss

– Rinneo Compare time of air vs. bone conduction

o If bone conduction is equal or greater than air conduction, then suspect conductive loss


Nose and Sinuses – Inspection/PalpationNose and Sinuses – Inspection/Palpation

• Inspection

– Anterior and inferior surface – asymmetry or deformity

– Inside of nose

o Mucosa – color, swelling, bleeding, exudate, ulcers, or polyps

o Septum – deviation, inflammation, or perforation

o Turbinates – use otoscope to view middle and inferior turbinates

• Palpation of sinuses – frontal and maxillary


QuestionQuestion

When using the otoscope to inspect inside the nose, which of the following structures is not visible?

a. Inferior turbinate

b. Middle turbinate

c. Superior turbinate

d. All of the above


AnswerAnswer

c. Superior turbinate

By directing the speculum posteriorly, you should be able to see the inferior and middle turbinates.


Mouth and Pharynx - InspectionMouth and Pharynx - Inspection

• Lips

– Note color, moisture, lumps, ulcers, cracking,or scaliness

• Oral mucosa

– Note color, ulcers, and nodules

• Gums and teeth

– Note color, presence, and position of teeth

• Roof of mouth

– Note color

• Tongue and floor of mouth

– Note color and texture, ulcers, nodules

• Pharynx: soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx

– Note color, symmetry, presence of exudate, swelling, ulceration, or tonsillar enlargement


Neck – Inspection and PalpationNeck – Inspection and Palpation

• Inspection– Symmetry, masses, scars, enlarged glands or lymph

nodes– Trachea – position, alignment– Thyroid gland - symmetry

• Palpation

– Lymph nodes (size, shape, delimitation, mobility, consistency, tenderness)

o Preauricular, posterior auricular, occipital, tonsillar, submandibular, submental, superficial cervical, posterior cervical, deep cervical chain, supraclavicular


Neck – Thyroid GlandNeck – Thyroid Gland

• Flex neck slightly forward

• Place fingers of both hands with index fingers just below the cricoid cartilage

• Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)

• Displace trachea to the right and palpate laterally for the right lobe of the thyroid; repeat on the left side

• Note the size, shape, and consistency

• Identify any nodules or tenderness

• If enlarged, listen over lateral lobes to detect a bruit


QuestionQuestion

When palpating the thyroid, which of the following is true?

a. Flex the neck slightly backward

b. Place the index fingers just above the cricoid cartilage

c. The thyroid isthmus may not be palpable

d. A bruit auscultated over the lateral lobe is expected


AnswerAnswer

c. The thyroid isthmus may not be palpable

• Ask the patient to swallow and feel for the thyroid isthmus rising up under your finger pads (not always palpable)

– Flex the neck slightly forward

– Place fingers of both hands with index fingers just below the cricoid cartilage

o If enlarged, listen over lateral lobes to detect a bruit

Ppt07

Documents

lippincott williams

thyroid isthmus

index fingers

finger pads

eyes techniques

thyroid

time

symmetry