Head, Face, Neck, and Regional Lymphatics

headache (HA)

is a leading cause of acute pain and lost productivity, as well as a leading reason for seeking care in outpatient offices, urgent care centers, and emergency departments.

primary or secondary

headaches are classified as _______

primary headache

tension, migraine, cluster

secondary headaches

a new HA first occurring in close timing to another disorder

- can result from trauma or injury, substance use or withdrawal, infection, cranial or intercranial disorders, neuropathies and cranial nerve injuries, and mental health disorders.

migraine

supraorbital, retro-orbital, frontotemporal, throbbing, twice per month each lasting 1 to 3 days

- severe

- triggers: alcohol stress, menstruation, chocolate or cheese

- s/s: nausea, vomiting, and visual disturbances

tension

located in occipital, frontal

- viselike character

- s/s: anxiety and stress

cluster headaches

around the eye, temple, forehead, cheek

- once or twice per day, each lasting to 2 hours for 1 to 2 months

- excruciating pain

- triggers: alcohol ingestion and daytime naps

- s/s: unilateral, same side; eye reddening and tearing, eyelid dropping, rhinorrhea, and nasal congestion

red flag HAs

thunderclap headaches, new headaches in those over 50, headaches with fever or stiff neck, and headaches accompanied by neurological symptoms are all

dizziness

Provide a description of "feeling" in patient's own words

• Associated with change of position, nausea, and/orvomiting

red flag

is a severe HA in an adult or child who has never had one before.

presyncope

a light-headed, swimming sensation or feeling of fainting or falling caused by decreased blood flow to brain or heart irregularity causing decreased cardiac output.

vertigo

is true rotational spinning often from labyrinthine-vestibular disorder in inner ear. With objective vertigo the person feels like the room is spinning; with subjective vertigo the person feels like he or she is spinning

disequilibrium

is a shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits.

Normocephalic

is the term that denotes a round symmetric skull that is appropriately related to body size. Be aware that "normal" includes a wide range of sizes.

Microcephaly

abnormally small head; macrocephaly, abnormally large head (hydrocephaly, acromegaly)

skull

placing fingers in person's hair is assessing the shape of a person's _____

symmetric and smooth

The skull normally feels ______

- Note lumps, depressions, or abnormal protrusions.

protrusions

Cranial bones that have normal _________ are the forehead, the side of each parietal bone, the occipital bone, and the mastoid process behind each ear. There is no tenderness to palpation.

temporal artery

Palpate the ______ above the zygomatic (cheek) bone between the eye and top of the ear.

- Tenderness and a hard band to palpation with temporal arteritis.

temporomandibular joint

The ______ is just below the temporal artery and anterior to the tragus.

- Palpate the joint as the person opens the mouth and note normally smooth movement with no limitation or tenderness.

abnormal

Crepitation, limited ROM, or tenderness in the TMJ is considered _____.

cranial nerve XI spinal accessory

Test muscle strength and the status of _______ by trying to resist the person's movements with your hands as the person shrugs the shoulders and turns the head to each side.

enlargement

note enlargement of the salivary and lymph glands. Normally, no _______ is present.

- Note a swollen parotid gland when the head is extended; look for swelling below the angle of the jaw. Also note thyroid gland enlargement. Normally, none is present.

thyroid enlargement

a unilateral lump; or diffuse and looks like a doughnut lying across the lower neck

lymph nodes

Using a gentle circular motion of your finger pads, palpate the

true

true or false: Normally, the salivary glands are not palpable

preauricular lymph nodes

When symptoms warrant, check for parotid tenderness by palpating in a line from the outer corner of the eye to the lobule of the ear.) Beginning with the ________ in front of the ear, palpate the 10 groups of lymph nodes in a routine order.

closely packed

Many nodes are _______, so you must be systematic and thorough in your examination. Once you establish your sequence, do not vary or you may miss some small nodes.

parotid enlargement

_______ has been found with AIDS. See discussion of enlarged lymph nodes, lymphadenopathy

both hands

Use gentle pressure because strong pressure could push the nodes into the neck muscles.

It is usually most efficient to palpate with _______, comparing the two sides symmetrically.

supraclavicular node

Search for the _________ by having the person hunch the shoulders and elbows forward this relaxes the skin.

true

true or false: Cervical nodes often are palpable in healthy persons, although this palpability decreases with age. Normal nodes feel movable, discrete, soft, and nontender.

lymphadenopathy

means enlargement of the lymph nodes (>1 cm) from infection, allergy, or neoplasm.

any tracheal shift

placing your index finger on the trachea in the sternal notch and slipping it off to each palpates for ______

- the space should be symmetric on both sides

- note any deviation from the midline

tracheal shift

The trachea is pushed to the unaffected (or healthy) side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax.

• The trachea is pulled toward the affected (diseased) side with large atelectasis, pleural adhesions, or fibrosis.

tracheal tug

is a rhythmic downward pull that is synchronous with systole and occurs with aortic arch aneurysm.

thyroid gland

is difficult to palpate

- Tilt the head back to stretch the skin

- Inspect the neck as the person swallows. - tissue moves up with a swallow and then falls into its resting position.

behind

to palpate the thyroid gland move ______ the person. Ask the person to sit up very straight and then to bend the head slightly forward and to the right. This relaxes the neck muscles on the right side. Use the fingers of your left hand to push the trachea slightly to the right.

- Curve your right fingers between the trachea and the sternomastoid muscle, retracting it slightly, and ask the person to swallow

- The thyroid moves up under your palpating fingers with the trachea and larynx as the person swallows

abnormal

enlarged lobes that are easily palpated before swallowing or are tender to palpation in the thyroid gland are considered _______

bruit

If the thyroid gland is enlarged, auscultate it for the presence of a ______. This is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope, not present normally

bruit

occurs with accelerated or turbulent blood flow, indicating hyperplasia of the thyroid (e.g., hyperthyroidism).

Hyperthyroidism

excessive activity of the thyroid gland

- goiter, eyelid retraction, exophthalmos

hypothyroidism

Myxedema

- Puffy edematous face

- Periorbital edema

- Coarse facial features

- Coarse hair and eyebrows

aging adult

Facial bones and orbits appear more prominent

- Facial skin sags resulting from decreased elasticity, decreased subcutaneous fat, and decreased moisture in skin

- Missing teeth

lower face looks unusually small, with mouth sunken in

- Maintain patient safety perform ROM and position changes slowly minimize potential for dizziness

twisted and prominent

in aging adults Temporal arteries may look ______

isolated head tremors

- Mild rhythmic tremor of head may be normal _____ are benign and include head nodding and tongue protrusion

concave curve

Neck may show an increased _______ to compensate for kyphosis

parkinson syndrome

A deficiency of the neurotransmitter dopamine and degeneration of the substantia nigra of the basal ganglia in the brain. The immobility of features produces a face that is flat and expressionless, "masklike," with elevated eyebrows, staring gaze, oily skin, and drooling.