Head, Face Neck Regional Lymphatics | NURS 122

the __________ is formed by vertebrae, ligaments, and muscles, providing support for the head and allowing for movement

head

what are the skulls bones?

1. two frontal bones

2. two parietal bones

3. two temporal bones

4. one occipital bones

what are the facial bones?

1. frontal (fused)

2. nasal

3. zygomatic

4. ethmoid

5. lacrimal

6. sphenoid

7. maxillary

8. mandible (moveable)

nasolabial fold

smile lines

palpebral fissures

the eye slit

sternocleidomastoid

muscle of the neck that attached to the mastoid process of the temporal bone and superior nuchal lines

• extends from the upper sternum and medial third of the clavicle to the mastoid process

trapezius

muscle of the shoulder and upper back

• large, flat triangular muscle

• act to rotate the scapula upwardly adduct, raise, lower or retract the shoulder

• extends from the scapula, the lateral third of the clavicle, and the vertebrae to the occipital prominence

Which bones compose the face?

Select all that apply.

• Hyoid

• Ethmoid

• Lacrimal

• Thyroid

• Zygomatic

• Ethmoid

• Lacrimal

• Zygomatic

photophobia

abnormal sensitivity to light, especially by the eyes

dysphagia

difficulty swallowing

exophthalmos

protrusion of the eyeballs usually due to increase volume of the orbital contents caused by tumor or swelling

what is the different state of consciousness that a student nurse should ask when inquiring about a patient’s consciousness after an injury to the head/neck?

1. immediately

2. 5 minute later

3. duration of unconsciousness

4. combative

5. confusion

6. alert

7. dazed

of course a lot of these are based on bystander and what is reported

REVIEW the different associated symptoms of a head/neck injury…

• Photophobia

• Phonophobia (sensitivity to sounds)

• Nausea, vomiting, diarrhea

• Insomnia

• Tinnitus

• Headache, neck pain

• Tenderness, warmth, redness

• Breathing pattern change

• Blurred or double vision

• Ear/nose drainage

• Impaired movement of extremities

• Fever

• Swelling

• Voice distortion

• Hearing loss

• Dysphagia

• Irritability

• Exophthalmos

what are some of the common aggravating factors associated with head/neck injury?

1. light

2. sound

3. movement

what are some of the common alleviating factors associated with head/neck injury?

1. sleep

2. medication

3. position change

4. alternative measures (e.g., heat packs, neck brace)

what are some different types of medications that can be use to treat a head/neck injury (and review how they help…)?

1. analgesics - relieves pain (e.g., acetaminophen)

2. muscle relaxants - reduce muscle spasms and tension in the neck

3. anticonvulsants - treat nerve-related pain or seizures from head trauma

4. beta-blockers - manage symptoms like headaches or high blood pressure post-injury

5. NSAIDs - reduce inflammation and pain

6. narcotics - provide strong pain relief for severe pain

7. thyroid preparations - used if injury affects thyroid functions

review some of the characteristics that a patient might use to describe their symptoms post head/neck injury…

1. throbbing

2. pounding

3. boring

4. dull

5. nagging

6. pressure

7. pain with movement

8. relieved by movement

9. constant

10. intermitten

11. cramping

12. radiation

what are some medical predisposing factors for head/neck injuries?

1. seizures

2. hypoglycemia

3. poor vision

4. syncope

5. dizziness

what are some lifestyle/health states predisposing factors for head/neck injuries?

1. fever

2. fatigue

3. stress

4. food

5. fasting

6. alcohol

7. allergies

8. menstruation

what are some injury/work factors predisposing factors for head/neck injuries?

1. injury

2. strain

3. traumatic brain injury

4. poor work position

what key medical-surgical history should the nurse ask about for head/neck complaints?

think "HEAD-NECK":

• Head/neck trauma

• Epilepsy (seizure disorder)

• Altered thyroid function

• Dural issues (subdural hematoma, lumbar puncture)

• Neck radiation or surgery (tumors/goiter)

• Episodes of chronic headaches (migraines, vascular)

• Conditions like fever, fatigue, or stress

• Key surgeries or treatments

what are some conditions that have genetic prevalent among family members that is related to head and neck injury?

1. headaches (type and character)

2. thyroid dysfunction

3. graves diseases

Which question should the nurse ask a patient with a headache to assess aggravating and alleviating factors as part of the history of present illness?

“Does your headache worsen with loud noises?”

“How long has this headache been going on?”

“When did the pain begin?”

“Are you seeing any spots or floaters?”

“Does your headache worsen with loud noises?”

Which medical-surgical history question should the nurse ask a patient with headaches?

“What have you been taking for your headache?”

“How long have you experienced headaches?”

“Have any of your siblings needed sinus surgery?”

“Have you ever been diagnosed with migraines?”

“Have you ever been diagnosed with migraines?”

→ episode of chronic headaches (e in NECK)

What personal/social history question should the nurse ask the patient with neck pain?

“What makes the pain worse?”

“Have you had an injury to your neck?”

“When did the pain begin?”

“What type of physical activity or sports do you participate in?”

“What type of physical activity or sports do you participate in?”

what are some factors that student nurse should look for when inspecting the head and scalp?

1. symmetry

2. tenderness

3. movement

4. sutures/fontanels

5. hair texture/distribution

what are some factors that student nurse should look for when inspecting the neck?

1. tracheal positions

2. tracheal tug

3. movement of hyoid bone and cartilage with swallowing

4. lymph nodes

5. symmetry

6. fullness

what are some factors that student nurse should look for when inspecting the thyroid gland?

1. size

2. shape, configuration

3. consistency

4. tenderness

5. nodules

6. thrills

shouldn’t be visible or palpable if healthy

The nurse should begin the examination of the head by assessment of which physical characteristics of the patient?

Select all that apply.

• Inspection of Thyroid gland

• Inspection of Tracheal position

• Inspection of neck muscles

• Inspection of head position

• Inspection of facial features

• Inspection of head position

• Inspection of facial features

Which structures of the neck should the nurse palpate for smoothness and tenderness?

Select all that apply.

• Scalp skin

• Hyoid bone

• Trachea

• Thyroid cartilage

• Cricoid cartilage

• Thyroid cartilage

• Cricoid cartilage

• Hyoid bone

How should the nurse describe the fontanels of a healthy infant on assessment?

Select all that apply.

• Flat

• Soft

• Tense

• Hard

• Bulging

• Depressed

• Flat

• Soft

review the expected finding during inspection of the head…

• Head upright, midline, still

• Variations in face shape depending on race, gender, age, build

• Slight asymmetry of facial features

• Symmetrical skull size, shape

• Balding pattern in male patients

• Salivary glands symmetrical without enlargement

review the expected findings during palpation of the head…

• Symmetrical and smooth

• Bones indistinguishable

• Ridge of sagittal fissure may be palpable

• Hair smooth, evenly distributed

• Salivary glands symmetrical without enlargement, tenderness

• No thrill felt over temporal arteries

NOTE: The nurse may also auscultate the temporal arteries and would expect no bruits on auscultation.

review the expected findings during inspection of the neck…

• Bilateral symmetry of sternocleidomastoid and trapezius muscles

• Trachea midline

• Smooth neck movement with flexion, extension, rotation, and lateral repositioning

review the expected findings during palpation of the neck…

• Trachea in midline position

• Hyoid, thyroid, and cricoid cartilage should be smooth and should move during swallowing

• Lymph nodes not palpable

• Thyroid gland symmetrical

  • Small lobes

  • Gland rises freely with swallowing

  • Right lobe may be up to 25% larger than left

  • Tissue firm and pliable

• No palpable thrill over carotid arteries

NOTE: The nurse may also auscultate the carotid arteries and would expect no bruits on auscultation.

review the abnormal findings for inspection of the head and face…

• Head tilted

• Horizontal jerking/bobbing

• Tics/nodding

• Edema, puffiness

• Unexpected alopecia

• Coarsened features (e.g., enlarged forehead, nose, prominent veins)

• Prominent eyes (exophthalmos)

• Hirsutism

• Lack of expression

• excessive blinking

• Excessive perspiration

• Pallor

• Pigmentation variations

• Facial nerve weakness/paralysis

• Scalp lesions, scabs (crusts), parasites, nits, scales, tenderness

• Random areas of baldness

• Ptosis

• Nasal malalignment

review the abnormal findings for palpation of the head and face…

• indentations or depressions

• elevations

• hair: splitting, cracked ends, coarse, dry, brittle or fine/silky

• thickening, hardness, tenderness, thrill of temporal arteries

• salivary glands

  • Asymmetrical

  • Tender

  • Enlarged

  • Nodules

review the abnormal findings when inspecting the neck…

• Asymmetry

• Torticollis (twisting of the head toward the sternocleidomastoid muscle)

• Excessive posterior skinfolds

• Unusually short

• Jugular vein distention

• Thyroglossal duct cyst (movable mass in the neck)

• Branchial cleft cyst (mass along anteromedial border of sternocleidomastoid muscle)

• Prominence of carotid arteries

• Webbing

• Edema

• Masses

• Pain, or limited movement with range of motion

• Nuchal rigidity (neck stiffness - resist passive flexion)

review the abnormal finding when palpating the neck…

• Trachea deviated to the right or left

• Tenderness

• Tracheal tug synchronous with pulse

• Lymph nodes

  • Enlarged

  • Matted

  • Tender

  • Fixed

  • Warm

• Thyroid gland

  • Asymmetry

  • Enlargement

  • Visible

  • Tender

  • Coarse tissue

  • Gritty sensation

• Thrill palpated over carotid arteries

Which finding should the nurse note as normal on palpation of the head?

Tender salivary glands

Distinguishable bones

Thrill over temporal arteries

Palpable ridge of sagittal fissure

Palpable ridge of sagittal fissure

Which finding should the nurse note as normal on inspection of the neck?

Skinfolds

Pulsations

Symmetry of the muscles

Slightly displaced trachea

Symmetry of the muscles

Which findings would be considered abnormal on palpation of the head?

Select all that apply.

• Slight depressions

• Asymmetrical salivary glands

• Thrill over temporal arteries

• Thick hair

• Nontender salivary glands

• Slight depressions

• Asymmetrical salivary glands

• Thrill over temporal arteries

Which findings would be considered abnormal when the neck is assessed?

Select all that apply.

• Edema

• Webbing

• Nuchal rigidity

• Midline placement of trachea

• Upward movement of the thyroid gland on swallowing

• Edema

• Webbing

• Nuchal rigidity

torticollis

shortening or excessive contraction of the sternocleidomastoid muscle

Which information suggestive of a thyroid condition would be documented under family history?

Tachycardia

Neck pain on palpation

Spouse with Graves disease

Father with Graves disease

Father with Graves disease

The nurse notes that a 36-year-old patient has a mass in his neck at the midline. The patient reports a family history of lymphoma and a history of smoking two cigarettes a day. The patient complains of difficulty swallowing and pain when turning the head. Which should the nurse document as objective data related to the neck assessment?

Difficulty swallowing

Pain when turning head

Mass in neck

Family history of lymphoma

Mass in neck (OBJECTIVE!)

A 63-year-old patient reports a headache that began 3 days ago. The patient describes the headache as constant and severe. The patient denies photophobia or nasal discharge. The patient reports a personal and family history of migraine headaches. Which should the nurse document as part of the history of present illness?

Select all that apply.

• Onset 3 days ago

• Constant and severe pain

• No photophobia or nasal discharge

• Family history of migraines

• Personal history of migraines

Onset 3 days ago (CORRECT)

Onset of the headache is subjective data and is part of the history of present illness.

Constant and severe pain (CORRECT)

Report of pain is subjective data and is part of the history of present illness.

No photophobia or nasal discharge (CORRECT)

The patient’s report of no photophobia and no nasal discharge is subjective data and is part of the history of present illness.

Family history of migraines

The patient’s family history of migraines is subjective data but is part of the family history, not history of present illness.

Personal history of migraines

The patient’s personal history of migraines is subjective data but is part of past medical history, not history of present illness.

what is the functions of the thyroid?

release thyroxine (T3) and triiodothyronine (T4) which helps stimulate how fast cells metabolize

where is the thyroid gland normally located in a person?

located just below a person’s adam’s apple

what gland and structure of the brain does the thyroid glands work with?

hypothalamus and pituitary

what is the function of the lymph nodes?

filter pathogens from the lymph preventing unwanted substances from entering the body’s circulation

what are the four areas that lymph nodes are accessible for examination?

1. head/neck (cervical)

2. arms

3. axillae

4. inguinal

the head and neck usually have ___________ lymph nodes

60-70

lymph nodes typically drain “__________”

downstream - that why looking upstream or above would help the student nurse find the problem

where are the preauricular lymph nodes located?

in front of the ear

where are the posterior auricular (mastoid) lymph nodes/

superficial to the mastoid process

where are the occipital lymph nodes located?

at the base of the skull

where are the submental lymph nodes located?

midline, behind the tip of the mandible

where are the submandibular lymph nodes located?

halfway between the angle and the tip of the mandible

where are the jugulodigastric (tonsillar) lymph nodes located?

under the angle of the mandible

where are the superficial cervical lymph nodes located?

overlying the sternomastoid muscle

where are the deep cervical lymph nodes located?

deep under the sternomastoid muscle

where are the posterior cervical lymph nodes located?

in the posterior triangle along the edge of the trapezius muscle

where are the supraclavicular lymph nodes located?

just above and behind the clavicle, at the sternomastoid muscle

what is the leading cause of acute pain and reason for seeking care?

headaches

true or false: migraines are more common in females than males with peak in midlife

true

headaches are classified by ___________

etiology

true or false: headaches are often misdiagnosed

true

migraines are more common in ________ than ________ (sex) with peak in midlife seen equally

females; males

true or false: chronic migraines are more prevalent among Caucasian and Hispanic populations

true

what are the common location and characteristic of tension headache?

1. location: both sides

2. character: bandlike tightness, non throbbing, nonpulsatile

what are the triggers and associated symptoms of tension headache?

1. triggers: stress, anxiety, depression, poor sleep

2. associated symptoms: fatigue, anxiety, stress, sensation of a band of tightening around head

what are some common treatments for tension headache?

1. abortive - NSAIDs

2. preventive - tricyclic antidepressants

3. nonpharmacologic - reduce stress, biofeedback, cognitive behavioral therapies, physical therapy, message, acupuncture

what are the common location and characteristic of migraine headache?

1. commonly one-sides (but can be on both sides), behind he eyes, temple or forehead

2. character: throbbing, pulsating

what are the triggers and associated symptoms of migraine headache?

1. triggers: hormonal fluctuations, alcohol, caffeine, processed foods, salty foods, hunger, sleep changes, flashing lights

2. associated symptoms: nausea, vomiting, photophobia, phonophobia, family history of migraines

what are the common treatments of migraine headache?

1. nonpharmacologic - lay down, darken room, sunglasses, sleep

2. medications (abortive - NSAIDs, acetaminophen, triptans, preventive - beta-blocker, antidepressants, anticonvulsants, etc)

3. alternatives - acupuncture, cognitive behavioral therapy, lifestyles changes (e.g., exercise, regular sleep patterns, and meals)

what are the common location and characteristics of cluster headache?

1. location: always one sided, behind, or around the eye/temple

2. character: continuous, excruciating, sharp, burning, piercing

what are the triggers and associated symptoms of cluster headache?

1. triggers: worsened by alcohol, histamine, paint, and perfume

2. associated symptoms: nasal congestion, watery eye, eyelid drooping or swelling, facial sweating, feelings of restlessness, nausea, vomiting, phono/photophobia

what are some common treatments for? cluster headache?

1. abortive - inhaled oxygen, parenteral route medication (not by mouth but intradermal/muscular/venous or subcut)

2. preventive - calcium channel blockers, lithium carbonate, anticonvulsants, melatonin, nerve blocks

review all of the important sites for gathering objective data when doing a head/neck assessment…

• Inspect the shape and size of the skull

• Palpate the temporal artery

• Inspect the face and neck (you should always be assessing for symmetry)

• Assess the neck’s range of motion

• Palpate for lymph nodes using gentle pressure

• Inspect the position of the trachea (is it midline?)

if the thyroid is enlarged, auscultate the neck to assessment for a __________ as __________ may occur with hyperthyroidism

bruits

macrophaly

when the infant’s head circumference is significantly larger than average (often exceeding the 97th percentile)

microcephaly

when the infant’s head circumference is significantly smaller than average (often at or lower than the 3rd percentile)

nystagmus

conditions characterized by eyes moving rapidly in a repetitive, uncontrolled movements

what is a goiter and what causes it?

1. goiter is chronic thyroid enlargement

2. often caused by a low diet in iodine (common in regions with low iodine in the soil) but also from a number of autoimmune disease, nodules, pregnancy, or medications

what conditions can cause parotid gland enlargement?

1. blockage of the durect

2. acute viral or bacterial infections

3. autoimmune diseases

4. neoplastic disease (tumors)

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