Head and Neck

posterior approach

stand behind pt, have pt bend head forward and slightly to right. Left hand displaces trachea to right. Right fingers curve between trachea and sternomastoid muscle, retracting slightly. Pt takes a sip of water, thyroid moves up under your fingers

lymph node

small-ball shaped organ of the immune system (widely throughout the body, linked by lymphatic vessels) should not be palpable, but if it is, it should be small, soft, and mobile.

assess lymph nodes

1. size and shape

2. mobility

3. consistency

4. tenderness and location

palpate lymph nodes of head and neck 

using finger pads in circular motion

age related changes

1. neck pain and decreased range of motion

2. facial wrinkles (and no sebum for softness)

3. lower face shrink and the mouth may be drawn inward

4. pulsation of temporal artery decreased (+1 is usual for older adult)

5. cervical curvature increase (c7)

6. decreased flexion, extension,

7. thyroid more nodular/irregular

validating and documenting findings 

analysis of data: making clinical judgements

selected client concerns, selected collaborative, medical problems, share data using SBAR

potential disorders

hypothyroidism, hyperthyroidism, headaches, stroke, TBI, Bell’s Palsy (facial)

hypothyroidism

decreased hormone production, underactive, sleepiness, weight loss, bradycardia, 

caused by: autoimmune disorder (Hashimoto’s, thyroiditis), irradiation, surgical removal of thyroid

at risk: females over 50 yo

symptoms of hypothyroidism

chronic fatigue, sensitivity to cold, muscle and joint ache, weight gain with diminished appetite, dry skin, constipation, non-pitting edema, myxedema 

Lab results in hypothyroidism

decrease in T3 and T4, increase in TSH

hyperthyroidism causes

Graves’ Disease, exophthalmos (protuberance of one or both eyes), thickening of the skin on lower extremities, occasionally enlarged goiter, rapid heartbeat, muscular weakness

hyperthyroidism symptoms

weight loss (inc appetite), anxiety, intolerance to heat, sweating, hyperactivity, hair loss, polyuria

hyperthyroidism rare complications 

thyrotoxic storm: 

patient becomes very stressed, inc temp., tachycardia (200 bpm), inc BP, Arrythmia, vomiting, dehydration

Result: coma, death

treatment for hyperthyroidism

temporomandibular disorders (TMD)

result of problems with jaw, jaw joint, and surrounding facial muscles, responsible for chewing and moving the jaw, often incorrectly called TMJ (temporomandibular joint)

Temporomandibular joint

should move smoothly at the joint

causes of TMD

injury, grinding or clenching the teeth, dislocation of the soft cushion or disc between the ball and socket

warm to improve movement 

ice to help with pain

TMD

osteoarthritis, rheumatoid arthritis can cause _______

symptoms of TMD

1. pain or tenderness in face, jaw joint area, neck and shoulders, in or around the ears

Treating TMD

1. apply moist heat or cold packs

2. eat soft foods

controversial treatments 

1. use TENS (transcutaneous electrical nerve stimulation)

2. ultrasound: deep heat that is applied to the TMJ to relieve soreness or improve mobility

3. trigger-point injections: pain meds, anesthetics injected into muscle to help pain and initiate healing

4. radio wave therapy

analyzing data

nursing diagnoses:

1. ineffective health maintenance (r/t=cause AMB=

2. ineffective tissue perfusion

3. imbalanced nutrition

4. activity intolerance

5. constipation

6. disturbed body image

7. impaired swallowing

collaborative problems

headaches

cluster headaches and migraine headaches can both be unilateral

sinus headache

pain is usually behind the forehead and/or cheekbones (look for edema, little bit of puffiness) will tell there is pressure above or below the eyes 

cluster headache

pain is in and around one eye

tension

pain is like a band squeezing the head

migraine

pain, nausea and visual changes are typical of classic frm

TBI (traumatic brain injury)

males: 1.5 times greater than female

leading causes: presence of violence, excessive alcohol intake, motor vehicle accidents, strikes by or against objects, assaults

traumatic brain injury

• major cause of death or disability

• ranges from mild to severe

• second leading cause is MVA or traffic-related incidents

• Falls leading cause for those over 65

• results from bump, blow, jolt, penetrating injury to head

outcomes of traumatic brain injury

firearms: 91% mortality, 11% mortality

80,000 discharged with disabilities: impaired cognition, movement, seizure activity, persistent unconsciousness

TBI: infants and toddlers

environmental risks, lack of parental knowledge of shaken baby syndrome

TBI: children and teens

TBI: adults 

TBI: risk reduction/client education

Spot a Stroke

learn the warning signs and act fast

BE FAST (balance, eyes, face, arm, speech, time to call)

symptoms of stroke

sudden numbness, confusion, trouble seeing, trouble walking, severe headache

symptoms of stroke in posterior circulation 

vertigo, imbalance, one-sided arm or leg weakness