Head and Neck By InnaKorda, MD, Institute of Nursing, TSMU Anatomy review Anatomy Anatomy Salivary Glands Anterior and Posterior Triangles Anatomy Lymphatics Anatomy - Lymphatics History Headaches? Any unusually frequent or unusually severe headaches? A severe headache for a person whos never had headaches should warrant further attention When - onset, duration Where Tension headaches tend to be occipital or frontal Migraine headaches supraorbital, retro orbital, or frontotemporal Cluster headaches pain around the eye, temple, forehead, and cheek. Pain unilateral. Character Throbbing (pounding, shooting) migraine Aching (constant pressure, dull) tension headache Intensity - mild, moderate, or severe Precipitating factors Associated factors Vision changes, N&V, pain with bright light, neck stiffness, fever, Alleviating factors Other illnesses Medications History Head injury? When History of head injuries or other medical conditions? Location LOC Loss of Consciousness? Dizziness? Lightheadedness or spinning? Vertigo is true rotational spinning due to neurologic dysfunction (vestibular apparatus) Objective perception that room spins Subjective perception that person is spinning Neck pain? When, where, precipitating and alleviating factors Acute onset of stiffness along with headache and fever occurs with meningeal inflammation Limitations to ROM? Lumps or swelling? Tenderness? Acute infection Lumps If over 40, suspect malignancy until proven otherwise Smoker? How long? Packs per day? Chew tobacco? Increased risk of tumors Assessment - Head Size and shape Normocephalic Hydrocephalus enlargement of head, increased circumference Pagets disease Enlargement and softening of bone Acromegaly abnormal enlargement of skull and facial bones Temporal artery Palpate above zygomatic bone, between eye and top of ear Temporomandibular joint Anterior of ear, between mandible and temporal bone Palpate joint as person opens mouth. Normally smooth movement Abnormal crepitations, limited ROM, tenderness acromegaly TMJ Assessment - Face Symmetry of eyebrows, mouth Changes in skin Tics or twitches Tightened facial muscles - pain Stroke vs Bells Palsy Bells Palsy CN VII paralysis Unilateral Thought to happen due to herpes simplex virus Person cannot wrinkle forehead, raise eyebrow, close eye, or show teeth on affected side Stroke Acute neurological deficit due to obstruction of cerebral vessel, as in atherosclerosis, or rupture in a cerebral vessel Paralysis of lower facial muscles, but upper half of face not affected. Still able to wrinkle forehead and close eyes Fetal Alcohol Syndrome Down Syndrome Trisomy 21 Characteristics Upslanting eyes Flat nasal bridge and nose Protruding tongue Short broad neck with webbing Small hands Assessment - Neck Symmetry head and neck muscles ROM Ask person to touch chin to chest, turn head to right and left, try to touch each ear to shoulder, extend head backwards Note limitation of movement Muscle strength Test strength by resisting movement CN XI Accessory n. Trapezius m. Thyroid gland Enlargement of lower neck may be bilateral or a unilateral lump Diffuse enlargement or nodular lump Palpating the Thyroid Gland Posterior approach Anterior approach Place fingers inferior and lateral of thyroid cartilage and ask the person to swallow Usually, you cannot palpate the normal adult thyroid Enlarged lobes are also tender to palpation Hypothyroidism Mild deficiency called hypothyroidism. Severe deficiency called myxedema. In infancy called cretinism. S/S: Face is pale, puffy, and expressionless Skin is cold and dry Hair is brittle, hair loss Lowered heart rate and temp Lethargy, fatigue, intolerance to gold Impaired mentality Goiter! Cause Hashimotos disease Autoimmune disease where antithyroid antibodies block thyroid hormone production Iodine deficiency in diet Surgical removal of thyroid Hyperthyroidism Graves disease Most common. More common in women. S/S Rapid heartbeat, dysrhythmias, angina Rapid thought flow and rapid speech, nervousness, and insomnia Increased BMR, appetite Goiter + Exophthalmos Cause Thyroid Stimulating Immunoglobulins (TSIs) mimic the effects of TSH on thyroid function Toxic nodular goiter (Plummers disease) Result of thyroid adenoma Exophthalmos is missing Exophthalmos Lymph Nodes Lymph nodes Beginning with the preauricular lymph nodes, palpate the 10 groups of lymph nodes in a routine order Lymphadenopathy - enlargement of lymph nodes due to infection, allergy, or neoplasm Trachea Normally, the trachea is midline Palpate for any tracheal shift by placing index finger in the sternal notch Trachea pushed to unaffected side in aortic aneurism, a tumor, pneumothorax Trachea pushed to affected side with large atelectasis, pleural adhesions, fibrosis Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysms Developmental Considerations - Infants Skull Should be round and symmetrical Caput succedaneum elongation of skull at birth resolves Cephalohematoma hemorrhage due to trauma at birth resolves in few weeks (Fig 13-17) Fontanels anterior and posterior. Normally close by 2 years Depressed dehydration Bulging increased ICP Transillumination done if abnormal head size or intracranial lesion is suspected Hydranencephaly thinning or absence or cerebral cortex cephalohematoma transillumination Question 1 A magnetic resonance imaging (MRI) is prescribed for a client with Bells palsy. Which nursing action is included in the clients plan of care to prepare for this test? 1. Keep the client NPO for 6 hours before the test 2. Remove all metal-containing objects from the client 3. Shave the groin for insertion of a femoral catheter 4. Instruct the client in inhalation techniques for the administration of gas Question 2 AA nurse has an order to obtain a sputum culture from a client admitted to the hospital with a diagnosis of pneumonia. The nurse avoids which action when obtaining the specimen? 1. Placing the lid of the culture container face down on the bedside table 2. Obtaining the specimen early in the morning 3. Having the client brush teeth before expectoration 4. Instructing the client to take deep breaths before coughing Question 3 A nurse employed in a long-term care facility is planning the client assignments for the shift. Which of the following clients would the nurse most appropriately assign to the nursing assistant (NA)? 1. A client requiring BID dressing changes 2. A client requiring frequent ambulation 3. A client on a bowel management program requiring rectal suppositories and a daily enema 4. A client with diabetes mellitus requiring daily insulin and reinforcement of dietary measures Question 4 AA client with a subarachnoid hemorrhage has been placed on subarachnoid (aneurysm) precautions. The nurse ensures that the client is provided with which of the following? 1. Daily stool softeners 2. Bright lights 3. Television and radio 4. Enemas as needed Question 5 Which assessment is most important for the nurse to make before advancing a client from liquid to solid food? 1. Food preferences 2. Appetite 3. Presence of bowel sounds 4. Chewing ability Question 6 A nurse prepares a nursing care plan for a client with Graves disease who is to receive radioactive iodine therapy. Which of the following statements would be most appropriate for the nurse to include in the teaching plan for this client? 1. The radioactive iodine is designed to destroy the entire thyroid gland with just one dose 2. It takes 6 to 8 weeks after treatment to experience relief from the symptoms of the disease 3. The high levels of the radioactivity prohibit contact with family for 4 weeks after initial treatment 4. Following the initial dose, subsequent treatments must continue lifelong