FOUNDATION: SENSORY PERCEPTION HEENT ASSESSMENT

sensory perception definition

The ability to receive sensory input through various physiological processes in the body and translate the stimulus or data into meaningful information

sensory perception positive consequences

• Improved Quality of Life

• Optimal interaction with environment

• Ability to use and integrate all senses

sensory perception negative consequences

• Patient injury (falls, burns)

• Reduced Quality of Life (anxiety, self-worth)

• Financial burden

Present health status: Health condition

acute or chronic conditions that relate to sensory perception

• headache, hearing difficulty

present health status: medication

Headaches, dizziness, vision changes, tinnitus, and dry mouth (medication side effects)

present health status: allergies

environmental, food, medicine

past medical history

Injuries, Surgery

ears, eye, nose, throat, head

thyroid surgery

Family history

Cancer, cataracts, glaucoma, hearing loss, thyroid conditions

psychosocial health history

• Occupational/recreational/ job risks for injury

• Smoke, alcohol, drug use

problem based history: chief complaints

• Headaches

• Dizziness and vertigo:

• Difficulty with vision: sudden onset = emergency

• Hearing loss

• Tinnitus (ringing in ear)

• Earache (otalgia)

• Nasal discharge/nose bleed (epistaxis)

• Sore throat

• mouth lesions

dizziness

faint light headed

vertigo

environment is moving around them

what are you inspectiing in the head

skull and scalp

facial structures

inspect the head: skull and scalp EO and Variances

• Expected outcomes: Normocephalic, symmetric, scalp intact without lesions

• Variances: Microcephalic, macrocephalic, asymmetry, lesions

inspect the head: facial structures EO and Variances

• Expected outcomes: Pink undertones, no lesions, Symmetric facial features Symmetric facial bones

• Variances: Abnormal skin color or pigmentation, Lesions, abnormal facial hair, asymmetry, edema, abnormal facial movements

what do you test

visual acuity

test visual acuity: Distant vision: Snellen chart or Snellen “E” EO and Variances

• Expected outcomes: 20/30 or better

• Variances: Hesitancy, squinting, vision poorer than 20/30

test visual acuity: Near vision: Handheld vision screener

• Expected outcomes: 20/30 or better

• Variances: Moves card farther away, presbyopia

what do you Inspect in the external ocular structures

Eyebrows, eyelashes, eyelids

what do you Inspect in the external ocular structures: Eyebrows, eyelashes, eyelids EO and V

Expected outcomes: Intact, symmetry, equal distribution of eyelashes and curled outward, no drainage, discharge, or lesions

Variances: Asymmetry in eye size, ptosis (drooping of one eye), exophthalmos (protrusion of the eye), enophthalmos, edema of the eyelid, lesions

what do you Inspect in the ocular structures

corneal light reflex, conjunctive, sclera, cornea, iris

Inspect the ocular structures: Corneal light reflex EO and V

• Expected outcomes: Light reflection symmetrical

• Variances: Light reflection asymmetrical

Inspect the ocular structures: Conjunctiva EO and V

Expected outcomes: pink, clear, some vascularity

Variances: erythema, blood

Inspect the ocular structures: Sclera Eo and V

• Expected outcomes: white

• Variances: yellow, red, bluetone

Inspect the ocular structures: Cornea EO and V

• Expected outcomes: transparent with smooth surface

• Variances: opacities, lesions, ebrasions

Inspect the ocular structures: Iris EO and V

• Expected outcomes: round, consistent color (may be different colors)

• Variances: asymmetry

what you lookin at in pupils

PERRLA

PERRLA

(Pupils Equal and Round, React to Light (both direct and consensual), and Accommodation)

Pupils/ PERRLA EO and V

• Expected outcomes: 2-6 mm, PERRLA

• Variances: < 2mm miosis, > 6 mm mydriasis, anisocoria (pupils 2 different sizes), do not react to light or accommodation

what are you assessing in the eye

six cardinal field of gaze (extraocular muscles – EOMs)

assess six cardinal field of gaze (extraocular muscles – EOMs) EO and V

Expected outcomes: Parallel tracking of the object with both eyes. Mild nystagmus at extreme lateral gaze is normal.

Variances: Nystagmus (consistent beating of the eye)

what do you inspect in the external ear

-alignment and position

-size, symmetry, intactness

inspect the external ear: alignment and position EO and V

Expected outcomes: Pinna should directly align with outer canthus of the eye, vertical position with no more than 10 degrees

Variances: low-set ears, misaligned

inspect the external ear: size, symmetry, intactness EO and V

• Expected outcomes: symmetry, intact, appropriate size

• Variances: asymmetry, lesions, microtia, macrotia, redness, swelling (otitis externa)

how to evaluate auditory function

• Conversation response

• Whispered voice test

inspect the nose EO and V

Expected outcomes: skin smooth and intact, symmetric and midline, no discharge

Variances: lesions, erythema or discoloration, asymmetry, edema, nasal discharge or crusting

Inspect the internal nasal cavity EO and V

Expected outcomes: septum straight, intact and midline, nasal mucosa slightly darker red than oral mucosa

Variances: deviated septum, perforations, edema, erythema

what are you palpating on the face

paranasal sinuses (frontal and maxillary)

Palpate paranasal sinuses (frontal and maxillary) EO and V

• Expected outcomes: no tenderness or pain

• Variances: tenderness, bogginess, or pain

Inspect the mouth and oropharynx EO and V

Expected outcomes: Lips, gingiva, tongue, buccal mucosa, tonsils and posterior pharynx pink, moist and intact. Teeth intact. Tonsils 1-2+ and symmetrical.

• Variances: lips pale or cyanotic, lesions. Missing teeth, cavities or poor hygiene. Lesions on tongue, buccal mucosa, tonsils or oral pharynx. Tonsils 3-4+, asymmetric or with exudate.

• ask about denture, cracked teeth, cavity, tonsil removal

Tonsil Range 0-4+

• 0 = no tonsils

• 1+ = visible

• 2+ = halfway between uvula and tonsilar pillars

• 3+ = nearly touching uvula

• 4+ = touching each other

Inspect the neck EO and V

• Expected outcomes: centered, trapezius and sternocleidomastoid muscles symmetric. Trachea midline.

• Variances: asymmetry, tracheal deviations, lesions or masses, enlarged thyroid

Palpate lymph nodes EO and V

Expected outcomes: May or may not be palpable, if palpable should be soft, mobile, nontender, bilaterally equal.

• Variances: enlarged, tender and firm but moveable may indicate infection

• unilateral, hard, asymmetric, fixed and nontender may indicate malignancy.