head & Neck Assessment With Vision & hearing Basics

Structures of the Head

•Skeletal structure- cranial and facial bones (22 total)

•Muscles- major muscles enable chewing, talking and smiling

•Blood Supply- carotid & Temporal arteries, external & internal jugular veins

•Cranial Nerves

•Eyes & Ears

•Thyroid

•produces thyroid hormones (T3 & T4)- control metabolic rate

•Parathyroid:

•produce calcitoninà moves calcium into bones

•Trachea:

•Part of upper airway

•The Neck (C1-C7) contains:

•trachea, thyroid/parathyroid glands, lymphatics

Lymphatic System

•Major chain of lymph nodes extend from the lower half of the head down into the neck

•Filter potential pathogens

abt 80 lymph nodes in the head and neck area

Health History Common complaints & ROS

•Headaches

•Head Injury

•Neck pain

•Limited head/Neck movement

•Unusual facial movements (drooping/asymmetry)

•Thyroid disease symptoms

•Swollen lymph Nodes/Illness

Assessment of Risk Factors

•Past Medical history (PMH)

•Family History

•Social History

•Medications

Risk Reduction and health promotion:

•Preventing injury, thyroid screenings, cancer screenings & prevention

•Acute head injuries and neurological changes:

•Stabilization of head and neck

•Keep spine immobilized to prevent spinal cord injury

•Do Not remove immobilization device until the spine is cleared

•Assessment for bleeding, swelling, loss of mobility, and pain

urgent assessment Neck Pain:

•Typically muscle tension or spasm

•Stiff Neck/pain with fever?

•Neck/jaw pain

urgent assessment on lymphatics

•Lymph nodes that are nonpainful, larger than 1 cm, fixed, hard/rubbery?

Hyperthyroidism urgent assessment

•Thyroid Storm/Crisis: hypermetabolic state in many systems

Common to see tachycardia, tachypnea, N/V/D

infection/tumor of thyroid: indicated by swelling

how to collect objective data

gather all equipment

•Introduce self/Identify patient/explain procedure

provide privacy

inspection, palpation, auscultation

Expected Findings for head and facial features 

•Head is centered, proportional to body and without tremors or abnormal movements

•Skull is round without obvious deformity

•Face is symmetrical - Cn v (Trigeminal), CN vii (Facial)

•Neck is centered, symmetrical, trachea is midline

 (FLEXION, EXTENSION, rotation, lateral flexion) - CN XI (Spinal Accessory

ROM for head and neck

(FLEXION, EXTENSION, rotation, lateral flexion)

Abnormal Findings

•Facial asymmetry- stroke or inflammation of CN VII (bell's palsy)

•Increased weight gain in face and neck

•Moon face, buffalo hump (Cushing's syndrome)

•Periorbital edema

eye expected Findings:

•NO ERYTHEMA, EDEMA OR DRY SKIN

•NO PTOSIS

•CONJUCTIVA PINK, LENS CLEAR, SCLERA WHITE

•CN II (Optic)- Visual Acuity

•CN III, IV, VI- Oculomotor, Trochlear, Abducens

eye abnormal findings 

•Ptosis, nystagmus, strabismus

•Red conjunctiva (allergies/irritation)

•Cloudiness of lens- potential cataract

•Yellow/red/pink sclera (not normal)

•Discharge

ear expected findings

•External meatus intact, no drainage

•Ear canal patent, some cerumen normal

•No foreign bodies or discharge 

•CN VIII- Acoustic

ear Abnormal Findings:

•asymmetry

•Foreign bodies, Purulent drainage

rhinne test 

AC>BC typically a 2:1 ratio

Air is usually stronge rthan bone conduction

Weber Test

client should hear sound equally in both ears

tuning fork in the middle of head (equallateral hearing)

temporal artery palpation 

•2-3+ amplitude, regular rate and rhythm, non-tender

scalp palpation

•Symmetrical without tenderness, masses, lesions. NO bulging or depressions of skull

•Palpate carotid arteries

dont do at the same time

thyroid palpation 

•Not usually palpable

•If palpable is smooth, soft, rubbery and symmetrical without tenderness

•Asymmetry, firmness, or tenderness could indicate infection or cancer

Palpation of Lymph Nodes

•Systematic

•Occipital, Postauricular, preauricular, tonsillar, submandibular, submental, anterior cervical nodes, posterior cervical nodes, supraclavicular nodes

•lymph nodes are usually difficult to palpate

If palpable document: location, size, tenderness, mobilit

Auscultation of head and neck locations

•Carotid arteries 

•Enlarged thyroid only

•Auscultate over each lobe using bell of stethoscope

Expected auscultation 

no bruits or vascular sounds audible

abnormal auscultation head and neck

bruit heard- hyperthyroidism

peds eye lifespan considerations

•Newborn near sighted

•Strabismus disappears by 3-4 months.

•Full color vision, distance vision, and object tracking by 6-7 months

peds head considerations 

•Anterior/posterior fontanel assessments

•Head circumference (measure up until 2-3)

posterior fontanelle typically closes by 2 to 3 months of age

anterior fontanelle usually closes between 9 and 18 months

peds ear considerations

•Assess patency/drainage (infection common in peds)

eye older adult considerations

•decreased visual acuity and peripheral vision. Difficulty with near vision (presbyopia), decrease in lens opacity (cataracts)

ear older adult considerations

•hearing loss, excessive cerumen accumulation

thyroid older adult considerations

Hypothyroidism more common in elderly- screening

how to Reduce fatal traumatic brain injuries

•Helmets

•seatbelts

how to Reduce fatal MVA

•Seatbelts

•Cell phone use

•Substance use

Health promotion & Risk Reduction

•Reduce new cases of work-related hearing loss

•Early identification of thyroid abnormalities

•Skin cancer prevention

Common Labs & Diagnostics

•CBC

•CT, MRI

•Thyroid function Tests

Hypothyroid test results

TSH high, t3 nd t4 low

Hyperthyroid test results

•TSH Low, T3 & T4 HIGH