Module 5 HEENT -- Health Assessment

BEAST of a flashcard set

Normal Findings of the head:

•  Symmetrical, midline, round

• Normocephalic

• Erect and still

• Absent of pain, tenderness, masses, depressions during palpation

Abnormal Findings of the head:

• Pain

• Tenderness

• Mass

• Depression

• Involuntary movements

• Macro/microcephaly

Nasolabial folds

Folds on the corner of the mouth on each side of the nose

Palpebral fissures

• Distance between eyelids

Expected Findings of the face:

Inspection:

• Round, oval, square (normal shapes)

• Symmetrical 

• Nasolabial folds/palpebral fissures equal

• Relaxed, eye contact

• Smooth & clear skin

• No edema

Palpation:

• No tenderness

• Temporal artery nontender

• TMJ no clicking sounds or limited ROM

Abnormal Findings of the face:

• Asymmetry: Abscess, infection, parotid gland enlargement, neuro disorders

• Mask-like face: Parkinson’s

• Swelling: Periorbital edema: Kidney disease,Cardiac, respiratory, and autoimmune disorders

• TMJ disorder: clicking, popping, grating sound

How do you assess the zygomatic arch?

• Ask pt to open & close mouth

What can an asymmetrical face indicate? (3 things)

• Stroke

• Bell’s palsy

• Migraines (can mimic a stroke)

(Hate that that image is most likely AI)

What can abnormal findings in a facial expression indicate?

• Pain (grimacing)

• Parkinson’s (mask)

• Stroke (drooping)

What can involuntary movements of the face indicate?

• Tourette’s

• Parkinson’s

What is a HEENT finding that can indicate Grave’s Disease?

Exophthalmos

Which disorder is indicated by “moon face”? What is the cause of this?

• Cushing’s Disease

  • Hypercortisolemia

  • Pituitary Disorder

What are the symptoms of Cushing’s Disease?

• Weight gain

• Thin arms and legs

• Round face

• Fatty hump

What is a common HEENT sign of Lupus?

• Butterfly rash across the face

Where does edema first start in the face?

• Periorbital edema (under eyes)

Normal Findings of the nose

• Symmetrical 

• Straight and midline septum

• Same skin color

• No lesions, swelling, or deformity

Abnormal Findings of the Nose

• Asymmetry

• Deviated septum

• Swelling/inflammation

• Redness, bruising, lesions

• Tenderness/swelling while palpating

• Nasal drainage

What would you be suspicious of if a patient has difficulty smelling?

• Olfactory nerve disorder

Where is the most common site of nosebleeds?

• Kiesselbach plexus

What does patency of the nose mean?

• Nasal passageway is not occluded

What is Xerostomia?

• Dry mouth with decreased saliva

Name some types of meds that cause Xerostomia (dry mouth)

• Antihistamines (Benadryl)

• Decongestants

• ACE Inhibitors

• Antidepressants

Normal lip findings

• Symmetrical

• Upper lip is everted

• Pink, moist

• No lesions, swelling, or cracking of the skin

Abnormal lip findings

• Lips are inverted

• Swelling, erythema, lesions, cracking

• Pallor

• HSV-1

Patient-centered important consideration when examining the mouth

• Give pt a break! This is not easy or fun for them

Why is dental hygiene important to know?

• For surgery! High risk of infection

Normal Teeth Findings

• White-Ivory teeth color

• Clean, free of debris

• Smooth edges

• 32 or 28 teeth (wisdom teeth removal)

Abnormal Teeth Findings

• Loose, broken, painful teeth

• Malocclusion of the teeth

• Color: tea/coffee (guilty of this lol), smoking, aging

Should dentures be removed when inspecting the buccal mucosa? Why or why not?

• YES!

• See if pt can remove it

• See if the dentures left sores

Normal Buccal Mucosa Findings

• Pink, smooth, moist

• No lesions, swelling, or bleeding

• Tight margin around each tooth

• No tenderness

Abnormal Buccal Mucosa Findings

• Red, inflamed, bleeding

• Lesions

• Tenderness w/ palpation

• Aphthous stomatitis (canker)

• Gingivitis

• Gingival hyperplasia

• Periodontal disease

• Thrush

What does aphthous stomatitis mean?

Canker sore

When examining the hard/soft palate, what is an abnormal finding that is helpful to see, especially in darker skin tones?

• Jaundice

Normal H/S palate findings

• Transverse rugae

• Irregular ridges are firm, pink to light red, moist

• No tenderness

• Soft palate is pink, moist

• No lesions or ulcerations

• Integrity of H/S palate intact

• Nodular bony ridge down the middle of the posterior hard palate 

Abnormal H/S Palate Findings

• Deep red color, ulcerations, lesions, or growths

• Hard palate is jaundiced

• Torus Palatinus

Normal Tongue Findings

• Pink color & saliva present

• Papillae on dorsal surface

• Midline position

• Ventral surface is smooth, pink, moist

• No lumps or nodules with palpation

• Wharton and Stensen’s ducts visible

Abnormal Tongue Findings

• Cracked, dry, red, presence of ulcers/lesions, bleeding, thick white or yellow coating on tongue

• Leukoplakia

• SCC

What is leukoplakia and who is most at risk?

• Plaque build up under the tongue

• Risk: Smokers, drinkers, HPV, dentures

What is Gingival Hyperplasia and what causes it?

• Overgrowth of gum tissue

• Causes: Poor hygiene, meds (Phenytoin)

What is this?? Explain!

(for the love of all things good please rinse after using an inhaler)

Thrush

• Fungal infection that can grow in your mouth, throat, and other parts of body

• White, raised lesions on tongue and cheeks

Squamous Cell Carcinoma in mouth — What are we looking out for and how?

• Mouth cancer – tongue

• Non-healing ulcer > 2 weeks

• Check lymph nodes and skin – hard, raised edges, bleed easily.

Normal Pharynx/Tonsils Findings

• Uvula rises midline symmetrically

• Throat pink

• Tonsils pink – may partially protrude or be absent

• Presence of gag reflex

Abnormal Pharynx/Tonsils Findings

• Asymmetry of uvula

• Halitosis

• Throat deep red, inflamed, with drainage

• Throat pain

• Dysphagia

• Tonsils protruding with or without drainage

• Tonsilities

• Pharyngitis (sore throat)

What can the absence of gag reflex indicate?

• Brain stem issue

What scale are tonsils graded?

• Tonsil grading scale on a range from 1+ to 4+

• How much space the tonsils take up in the oropharyngeal airway

What is the enlargement of the thyroid gland called?

Goiter

Which lymph node is strongly correlated to cancer when enlarged?

(GOLDEN TICKET QUESTION)

• Superclavicular

How should all lymph nodes feel?

• Small, soft, and mobile

• (If you even feel it at all)

Normal Neck Findings

• Symmetrical

• No swelling

• No pain with ROM

• Full ROM of the neck

Abnormal Neck Findings

• Asymmetrical

• Pain w/ movement

• Unable to turn neck (Impaired ROM)

• Torticollis

Torticollis symptoms

• Stiff neck

• Muscle spasm

• Lateral flexion

Normal Trachea Findings

• Midline

• Symmetrical

Abnormal Trachea Findings

• Deviated laterally, away from midline

Normal Thyroid Findings

• Smooth & straight appearance

• Move up when swallowing

• Lateral lobes may or may not be palpable

• If palpable, lobes are smooth, firm, and nontender

Abnormal Thyroid Findings

• Enlarged

• Asymmetrical

• Does not move during swallowing

• Tenderness

• Lumps

• Texture has variations of firmness

Two ways the thyroid gland can be assessed

• Posterior 

• Anterior

What should you have the patient do while assessing their thyroid?

• Sit Upright 

• Drink/swallow water

Comprehensive Eye Exam

• Dilated eye exam to look directly at the retina and internal structures of the eye

Tonometry

• Device to measure Intraocular Pressure

Ptosis — what is it and cause

• Drooping of upper eyelid

• Nerve dysfunction or muscle weakness

Blepharitis

• Inflammation of eyelid margins

Blocked lacrimal duct - Cause, risks, and RN intervention

• Tear ducts not draining

• Increased Risk of Infection

• Warm compress

Conjunctivitis

• Redness and discharge

• Can be viral or bacterial (or allergic i guess too)

• Contagious

Corneal Abrasion

Scratching the eye

Ectropion

eyelid turned outward

Entropion

• Inward turning of the eyelid

• Eyelashes irritate the cornea

Hordeolum — what is it and RN intervention

• Stye

• Warm compress

Glaucoma

Increased fluid pressure within the eyeball, which damages the optic nerve, leading to vision loss or blindness

Macular Degeneration

Deterioration of the macula

Diplopia

Double vision

Nystagmus

Involuntary blurriness and shakiness of the eyes

Normal Eye Findings

• Eyelashes equally distributed; no drainage

• Eyebrows evenly distributed; no scaly or flaky skin; symmetrical

• Cornea clear with no opacities

• Lens transparent with no opacities

• Pupils equal in size

• Iris blue, green, brown, or hazel in color, smooth; controls diameter and size of pupil

• Sclera is white

• Conjunctiva is pink and moist

• Lacrimal duct clear with no swelling

• Palpebral fissures equal bilaterally

• No abnormal involuntary movement

Abnormal Eye Findings

• Ptosis

• Blepharitis

• Blocked lacrimal duct

• Cataract

• Conjunctivitis

• Corneal abrasion

• Ectropion

• Entropion

• Exophthalmos

• Hordeolum

• Scleral jaundice (icterus)

• Pterygium

what is pterygium

Explain the vision ratings

• The higher the denominator means poorer distant visual acuity

•  Normal = 20/20

• If vision is 20/60, the person can read at 20 ft what people with 20/20 vision can read at 60 ft

Assessing with Central Vision Grids

• Are any lines: distorted, broken, blurred, or missing areas/dark areas on the grid?

• Mark areas of abnormality

What is Central Vision grids assessing for?

• Macular Degeneration

Aniscoria

unequal pupils

Mydriasis

Miosis

Pupil does not respond to light

Horner’s Syndrome

Problem w/ parasympathetic nerve supply in 1 side of the face

What side effect can Furosemide (Lasix) have on the ears?

• Ototoxic Tinnitus

Normal Ear Findings

• Equal size & shape bilaterally

• Color same as facial skin

• Symmetrical

• Angle of attachment <10 deg

• NO deformities, inflammation, nodules, drainage

Abnormal Ear Findings

• Asymmetrical

• Lesions

• Cysts

• Drainage

• Cauliflower ear

• Microtia

• Macrotia

What is cauliflower ear?

• Thickened tissue due to repeated trauma

Assessing Hearing (CN VIII) → Conductive vs Sensorineural?

• Conductive hearing loss is when sound is not conducted through the outer ear canal to the eardrum.

• Sensorineural hearing loss occurs when there is damage to the inner ear (cochlea), or to the nerve pathways from the inner ear to the brain.

• Mixed hearing loss includes both conductive and sensorineural hearing loss.

What is the Weber Test?

• Tuning fork placed on top of head to assess hearing

• Normal: Sound quality is heard equally in both ears

• Abnormal: Sound in the bad ear seems softer; damage is probably sensorineural hearing loss.

• Sound in the bad ear seems louder; damage is probably conductive hearing loss.

• If the sound seems equally dull, then the Weber Test is inconclusive

What is the Rinne Test?

• Tuning fork placed on mastoid process

Positive Rinne

• Air conduction is heard longer than bone conduction.

Negative Rinne

• Bone conduction is heard longer than air conduction.

You are documenting that a patient’s head is normal size, shape, symmetry, etc. What vocab term will you use to describe this (and cut down on word count)?

Normocephalic