Chapter 14: Head, Neck, and Lymphatics Assessment

Ch. 14 & 17 HNEENT 1: Head, Neck, Nose, and Throat + Lymphatics Stroke Alert Assessment of HNEENT: · Homeostasis and Regulation - gas exchange - perfusion - fluid and electrolytes - nutrition · Protection and Movement - Sensory perception - mobility - tissue integrity - pain - immunity - inflammation Chapter 14: Head, Neck, and Lymphatics Assessment (includes scalp, cranium, lymphatics, parathyroid and thyroid) Focused Health History · Assessment of risk factors ↳ risk assessment and health promotion ↳ reducing the risk of injury ↳ preventing complications ↳ promoting the early detection of masses or issues w/lymph nodes · personal history · medications · family history · surgical history · review of systems (common head/neck symptoms) ↳ headache ↳ facial pain ↳ limited ROM ↳ lumps or masses ↳ S & S of hypo/hyperthyroidism Physical Assessment · Gather equipment (gloves, stethoscope, glass of water) · ensure patient comfort, dignity, and safety · have the client sit at the edge of the examining table facing you with head at eye level · have client remove wig/hairpiece/head covering as appropriate · instruct patient about the assessment procedures and to tell you if anything is uncomfortable · physical examination ↳ inspection ↳ palpation ↳ auscultation Urgent Assessment · patients with acute head injuries and neurologic changes ↳ stabilization of head and neck to prevent further neurologic injury · immobilize spine to prevent spinal injury · Neck pain associated with fever and headache could signify serious illness like meningitis · facial paralysis, facial drooping, sudden numbness/tingling, loss of consciousness and lacerations to the head and face (highly vascular) require urgent assessment · Enlarged lymph nodes larger than 1 cm, fixed, irregular, or hard should be assessed immediately · Hyperthyroid symptoms: hypermetabolism, tachycardia, diarrhea, anxiety, fever, weakness, heat intolerance, diaphoresis, tremor, psychosis, coma, death Inspection & Palpation: Head ① Inspection: Skull, scalp, face · Shape · size · profile · symmetry* · swelling · scars · hair distribution ② Palpation: · nerve distribution (numbness, tingling, pain) · lumps and bumps Infants · feel sutures + fontanelles ↳ posterior closes by 2 months, anterior by 24 months ↳ bulging fontanel: increased intercranial pressure ↳ depressed fontanel: dehydration · normo-cephalic shape · measure head circumference Inspection & Palpation: Face · assess light touch, pain, and temperature in the different nerve regions ↳ assesses nerve functioning · Trigeminal (V) and facial (VII) nerves Inspection & Palpation: Neck ① Inspection: · Shape . size · symmetry · swelling Identify these by touch · flexibility ② Palpation: · carotid artery (auscultate before palpate! ) · lymph nodes (size, shape, mobility, location) ↳ if not enlarged they should not be felt · thyroid (consistency, size, lumps, goiter, nodules) ③ Auscultation · carotid arteries for bruits (prior to palpation) · enlarged thyroid for bruits (continuous sound over isthmus) - - Meningitis (clinical triad): · Headache (+/- nausea & vomiting) · Photophobia · Nuchal rigidity (stiff neck) Inspection & Palpation: Lymphatics · preauricular · posterior auricular · occipital · tonsillar · submandibular · submental · anterior cervical · posterior cervical · supraclavicular Submandibular · palpable, tender, and warm lymph nodes usually indicate an infection ↳ anterior cervical: pharyngitis ↳ posterior cervical: mononucleosis ↳ posterior auricular: otitis media ↳ left supraclavicular (Virchow node): abdominal cancer ↳ right supraclavicular: thoracic malignancies, Hodgkin’s lymphoma Virchow node / Sentinel node Goiter = enlarged thyroid gland - Normal: thyroid should be under the adams above apple the collarbone Expected Findings · hair is evenly distributed, clean, (colour) · scalp is symmetrical, intact without tenderness, masses, lesions or differences in firmness ·skull shape is symmetrical, normocephalic, and intact · infant: ie. anterior fontanelle soft, flat, slightly pulsatile · neck has full range of motion, symmetrical, non tender, spinous process most prominent · lymph nodes nonpalpable (possibly in children tho), nontender · carotid arteries no bruits, pulse regular, 2+, equal bilaterally, elastic · if thyroid is palpable: symmetrical, smooth, rubbery, non-tender, and barely palpable (isthmus) · parathyroids non-palpable - - - - - - - and