Head and Neck
By Orest Kornetsky
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 who’s 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
Paget’s 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 Bell’s Palsy
Bell’s 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 Hashimoto’s disease
Autoimmune disease where antithyroid antibodies block thyroid hormone production
Iodine deficiency in diet Surgical removal of
thyroid
Hyperthyroidism
Grave’s 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 (Plummer’s 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 Bell’s palsy. Which nursing action is included in the client’s plan of care to prepare for this test?1. Keep the client NPO for 6 hours before the
test2. Remove all metal-containing objects from the
client3. Shave the groin for insertion of a femoral
catheter4. Instruct the client in inhalation techniques for
the administration of gas
Question 2
A 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 table2. Obtaining the specimen early in the morning3. Having the client brush teeth before
expectoration4. 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 changes2. A client requiring frequent ambulation3. 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
A 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 softeners2. Bright lights3. Television and radio4. 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 preferences2. Appetite3. Presence of bowel sounds4. 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 dose2. It takes 6 to 8 weeks after treatment to experience
relief from the symptoms of the disease3. The high levels of the radioactivity prohibit contact
with family for 4 weeks after initial treatment4. Following the initial dose, subsequent treatments
must continue lifelong