Health Assessment: HEENT Latest Update Rated A+ 2022/2023

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Health Assessment: HEENT Latest Update Rated A Subjective data of the head and neck: headaches Answer- -ask pt if headaches are present or absent -ask pt about the location of the headache Subjec... tive data of the head and neck: occipital OR frontal Answer- -vise-like pain -a TENSION headache Subjective data of the head and neck: supraorbital OR frontotemporal Answer- -throbbing pain -associated with visual disturbances Subjective data of the head and neck: vascular headache/migraine Answer- -can be heightened by stress -heightened by menstrual cycle -heightened with eating cheese and chocolate (foods) Subjective data of the head and neck: cluster headaches Answer- -unilateral -excruciating pain -can last 1-2 years, will have a bunch of pain for a month or so and then nothing for a few years Subjective data of the head and neck: history or head injuries and experience of? Answer- - dizziness= feeling of lightheadedness Vertigo Answer- rotational spinning -objective vertigo= room is spinning -subjective vertigo= pt. feels like he or she is spinningSubjective data of the head and neck: presence of neck pain? Answer- -acute onset of neck stiffness is usually r/t meningeal inflammation -stress and tension Subjective data of the head and neck: lumps or swelling in the neck Answer- -salivary or thyroid tumors **smoking, chewing tobacco and alcohol use increases the risk of cancer in the throat and in the thyroid Subjective data of the head and neck: ask about history of Answer- past thyroid problems Head and neck CANCER warning signs: Answer- -lump or sore that does not heal -sore throat that does not go away -trouble swallowing -a change or hoarseness of voice Primary reason for oral cancer? Answer- smoking **second is alcohol use Inspection and Palpation of the Skull: size and shape Answer- normocephalic: is the head size appropriate for the body? Microcephaly: Answer- abnormally small Macrocephaly: Answer- abnormally large *think Charlie BrownInspection and Palpation of the Skull: temporal area Answer- -palpate the temporal artery -palpate the temporomandibular joint (jaw) Inspection and Palpation of the Skull: TMJ Answer- -check for crepitation (poor alignment of teeth) --precursor for headaches -limited ROM -tenderness Abnormalities (head size and contour): hydrocephalus Answer- -obstruction of drainage of CSF which results in excessive accumulation -causes increased intracranial pressure and enlargement of the head **only in infants before the fontanels close Abnormalities (head size and contour): Paget's disease Answer- -increased bone reabsorption and formation which thickens and deforms bones -more likely in men Abnormalities (head size and contour): acromegaly Answer- -seen in head and hands -excessive secretion of GH after puberty which results in an enlarged head Inspect the face: note facial expression and appropriateness of behavior Answer- -hostility and aggression -tense, rigid musculature -marked asymmetry Cranial nerve VII (FACIAL) damage= Answer- Bell's PalsyBell's Palsy Answer- -edema of the face (esp in periorbital/around the eyes) -skin color and pigmentation changes Hyperthyroidism facial expression AnswerCushing's Disease facial expression AnswerScleroderma face AnswerButterfly rash Answer- -seen with lupus Characteristic of a chronic smoker AnswerTesting Cranial Nerves of the Face: CN V (TRIGEMINAL) motor function Answer- -assess muscles of mastication by palpating the temporal and masseter muscles as client clenches teeth -try to separate the jaw -bite down on tongue depressor and attempt to pull it out while they are clenching their jaw (use tongue blade) Testing Cranial Nerves of the Face: CN V (trigeminal) sensory function Answer- -client closes eyes, check for light touch (say now when I touch you) -assess forehead, cheeks, chin -assess corneal reflex Corneal reflex is usually Answer- omitted unless there is a problem with a light touch assessment *not a good test if the patient is a contact wearerTesting Cranial Nerves of the Face: CN VII (FACIAL) motor function Answer- -note mobility and facial symmetry -have client smile, frown, close eyes tightly, lift eyebrows, show teeth, puff out cheeks Why would there be loss of movement? Answer- - secondary to CNS lesion, Bell's palsy -short term= herpes virus/cold sores Testing Cranial Nerves of the Face: CN VII (FACIAL) sensory function Answer- -not tested routinely (only if another test indicates Bell's Palsy) -assess taste by applying sugar, salt, lemon juice on anterior 2/3 of the tongue Inspect the neck: head should be Answer- midline Inspect the neck: neck muscles should be Answer- symmetric Inspect the neck: ROM Answer- -note any limitations in the neck motions Testing Cranial Nerve of the Neck: CN XI (Accessory nerve) motor function Answer- -examine the sternomastoid and trapezius muscles -resist movement as person shrugs shoulders and turns head side to side **movements should be equally strong Palpation of lymph nodes Answer- -palpate using a gentle circular motion of the finger pads Location of lymph nodes AnswerTo palpate the deep cervical chain Answer- turn head to loosen muscle to reach nodeWhat should you note about lymph nodes? Answer- -location -size -mobility -consistency -tenderness Normal nodes feel Answer- movable, discreet, soft, nontender Lymphadenopathy Answer- enlargement of the lymph nodes from infection, allergy or neoplasm Virchow's node Answer- a single, enlarged, nontender left supraclavicular node may indicate cancer in the thorax or abdomen Acute infection: Answer- nodes are bilateral, tender, enlarged and firm but movable Chronic inflammation: Answer- nodes are clumped Cancerous nodes Answer- hard >3 cm unilateral nontender fixed to the underlying tissue, cannot move it around Nodes with HIV: Answer- enlarged firm non-tender movableoccipital node enlargement Thyroid gland assessment Answer- -assess using a posterior or anterior approach When assessing the thyroid, you must assess for Answer- enlargement or nodules Abnormalities of thyroid: Answer- -enlarged lobes that are easy to palpate -tenderness on palpation -presence of nodules or lumps If the thyroid is enlarged, Answer- auscultate for bruits because an enlarged thyroid is going to have increased blood supply Thyroid landmarks Answer- *easy to feel for on patient when you ask them to take a drink of water Abnormalities of the neck: Torticollis Answer- a hematoma in the sternomastoid muscle that results in a tilt of the head to one side *one of the new treatments is botox to relax the muscle Subjective Eye Data: any visual Answer- difficulties? Subjective Eye Data:any floaters, Answer- halos (typical for glaucoma), blind spots, night blindness? Scotoma Answer- -optic nerve damage -blind spotsNight blindness is d/t Answer- vitamin deficiency Subjective Eye Data: presence of Answer- eye pain? Photophobia Answer- inability to tolerate light Subjective Eye Data: history of strabismus? Answer- crossed eyes Subjective Eye Data: presence of diplopia Answer- seeing double (usually when patient is tired) Subjective Eye Data: any redness or Answer- swelling Subjective Eye Data: testing for glaucoma Answer- should be regularly tested if over 40 Subjective Eye Data: use of Answer- glasses or contacts? medications? Subjective Eye Data ELDERLY: visual difficulties when Answer- climbing the stairs or driving? Subjective Eye Data ELDERLY: last time tested for Answer- glaucoma Subjective Eye Data ELDERLY: history of cataracts? Answer- -more common in patients with DM, working in light have higher chances Subjective Eye Data ELDERLY: eyes feel dry? Answer- -decreased tear production may lead to development of blurry eyes Subjective Eye Data ELDERLY: decrease in usual Answer- activities?Objective Eye Data: Test Visual Acuity Answer- -use of the Snellen chart -read 20 feet away; first occlude one eye at a time then both -numerator= indicates distance the person is standing from the chart -denominator= the distance that a normal eye could read that line -normal = 20/20 -Testing CN II 20/30 means... Answer- that a person is standing 20 feet away from the chart but his/her eyes could only see what the normal eye can see at 30 feet 20/200 Answer- legal blindness Test visual fields by CONFRONTATION Answer- -coming from the sides Testing CN V Answer- -inspect the muscle for atrophy or tremors -test touch sensation to their face with a cotton ball O.D. Answer- right eye oculus dextra O.S. Answer- left eye oculus sinistra O.U. Answer- both eyes oculus uterqueObjective Eye Data: myopia Answer- nearsightedness Objective Eye Data: hyperopia Answer- farsightedness Objective Eye Data: color blindness Answer- -deficiency -ishihara plates -genetic, X-linked therefore more common in men Objective Eye Data: hemianopsia Answer- half the visual fie [Show More]

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