Head and Neck

Chapter Overview

  • Chapter 15: Assessing Head and Neck

  • Chapter 18: Assessing Mouth, Throat, Nose, and Sinuses

Focus of the Head and Neck Assessment

  • Anatomical structures involved:
      - Cranium
      - Face
      - Thyroid gland
      - Lymph nodes contained within the head and neck

Cranial Bones

  • Overview of cranial bones:
      - Frontal bone (1)
      - Parietal bones (2)
      - Temporal bones (2)
      - Occipital bone (1)
      - Sphenoid bone (1)
      - Ethmoid bone (1)
      - Total: 8 cranial bones

Sutures of the Skull

  • Key Cranial Sutures:
      - Coronal suture: Between thefrontal and parietal bones.
      - Sagittal suture: Between the two parietal bones.
      - Lambdoid suture: Between the occipital and parietal bones.
      - Squamous suture: Between the temporal and parietal bones.

Fontanels

  • Definition: Soft spots in a newborn's skull where bones have not yet fused.

  • Key Fontanels:
      - Anterior fontanel: Located at the junction of the frontal and parietal bones.
      - Posterior fontanel: Located at the junction of the occipital and parietal bones.

Facial Bones

  • Overview of the 14 facial bones:
      - Nasal bones (2)
      - Lacrimal bones (2)
      - Palatine bones (2)
      - Inferior nasal conchae (2)
      - Maxillary bones (2)
      - Mandible (1)
      - Zygomatic bones (2)
      - Vomer (1)

Structures of the Neck

  • Key Structures:
      - Thyroid cartilage
      - Cricoid cartilage
      - Thyroid gland (consists of lobes and isthmus)
      - Trachea
      - Hyoid bone
      - Sternomastoid muscle
      - Clavicle

Thyroid Gland Assessment

  • Normal findings:
       - The thyroid gland is usually nonpalpable and non-tender.

  • Altered Thyroid Function:
      - Hypothyroidism:
        - Symptoms include increased sensitivity to cold, constipation, fatigue, heavy menstrual periods, pale/dry skin, brittle hair/nails, unintentional weight gain.
      - Hyperthyroidism:
        - Symptoms include weight loss, sweating, anxiety, irritability, hand tremors, insomnia, and rapid/irregular heartbeat.
        - Goiter may also be present.

Neck Muscles and Landmarks

  • Key Muscles:
      - Sternomastoid muscle
      - Trapezius muscle
      - Omohyoid muscle

  • **Triangles of the Neck: **
      - Anterior triangle
      - Posterior triangle

Cervical Vertebrae

  • Key Cervical Vertebrae:
      - Atlas (C1)
      - Axis (C2)
      - Vertebral prominence (C7)

Lymph Nodes of the Head and Neck

  • Major lymph nodes include:
      - Posterior auricular
      - Occipital
      - Retropharyngeal
      - Superficial cervical nodes
      - Posterior cervical nodes
      - Supraclavicular nodes
      - Preauricular nodes
      - Submandibular nodes
      - Submental nodes
      - Deep cervical chain

Direction of Lymph Flow

  • Understanding lymph flow between lymph nodes is critical for assessment, especially in relation to infection or malignancies.

Age-related Changes in Lymph Tissue

  • Children: Lymphatic tissue increases with age, peaking in childhood, then decreases in adolescence.

  • Older Adults: Lymph nodes decrease in size and number with advancing age.

Headaches

  • Types of headaches:
      - Sinus headaches: Characterized by pressure and tenderness over sinus cavities.
      - Classic Migraine: Severe, throbbing pain with possible nausea/vomiting, and light sensitivity.
      - Cluster headache: Stabbing pain usually localized around one eye or forehead, occurring 1-2 times a day.
      - Tension headache: Dull, tight pain in the occipital or frontal regions, often associated with stress.
      - Tumor-related headaches: Persistent aching pain accompanied by neurological symptoms.

Cranial Nerves

  • Mnemonic for Cranial Nerves:
      - Oolfactory (I) - Smell
      - Optic (II) - Vision
      - Oculomotor (III) - Eye movement
      - Trochlear (IV) - Eye movement
      - Trigeminal (V) - Both sensory and motor functions including facial sensation
      - Abducens (VI) - Eye movement
      - Facial (VII) - Both, includes facial expressions
      - Vestibulocochlear (VIII) - Hearing and balance (sensation)
      - Glossopharyngeal (IX) - Both; taste and swallowing
      - Vagus (X) - Both; heart rate and digestion
      - Accessory (XI) - Motor; neck and shoulder movement
      - Hypoglossal (XII) - Motor; tongue movement

Subjective Data Collection

  • Components of the nursing interview:
      - Current symptoms
      - Past medical history
      - Family history
      - Lifestyle and health practices

  • COLDSPA Framework:
      - Used for assessing any head/neck pain, headaches, or difficulty in moving head/neck.

Headache Impact Test

  • Assessing headaches impact on daily activities and severity using specific questions related to functional limitations, fatigue, and mood.

Objective Data Collection

  • Equipment for head and neck examination:
      - Gloves
      - Penlight or flashlight
      - Stethoscope
      - Small glass of water

Physical Assessment of the Head

  • Assessing characteristics of the head:
      - Size, shape, and configuration (e.g., normocephalic).
      - Symmetry of features
      - Involuntary movements
      - Hair/scalp condition

  • Palpation of bones, TMJ, and temporal artery: Should be nontender and elastic.

Physical Assessment: Neck

  • Check for movement of neck structures:
      - Inspect cervical vertebrae and perform ROM assessments.

  • Palpate:
      - Trachea (should be midline)
      - Thyroid gland (should be non-palpable and nontender), auscultate if enlarged.

Abnormal Findings in Thyroid Assessment

  • Hydrocephalus: Abnormal buildup of cerebrospinal fluid in the brain ventricles.

  • Down Syndrome: Characterized by unique facial features including slanted eyes and a protruding tongue.

  • Acromegaly: Excessive growth hormone from the pituitary gland.

Conditions Causing Decreased Facial Mobility

  • Parkinson’s Disease

  • Scleroderma

  • Facial paralysis (Bell’s Palsy)

Assessment of Lymph Nodes

  • Physical Examination:
      - Assess size, shape, mobility, consistency, and tenderness of lymph nodes.
      - Compare bilaterally for proper assessment.

  • Characteristics:
      - Normal nodes should be non-palpable, small, round, discrete, mobile, and non-tender.
      - Lymphadenopathy: Node size >1cm.

Abnormal Findings in Lymph Nodes

  • Normal: Non-palpable or small, round, discrete and mobile nodes.

  • Inflammation: Enlarged and tender, but remain mobile.

  • Malignancy: Nodes may be hard, fixed, or matted together and usually non-tender.

Special Considerations for Lymph Nodes

  • Clue Nodes:
      - A single enlarged, nontender hard left supraclavicular node may suggest a neoplasm.
      - Hard, fixed nodes could indicate cancer; painless, discrete nodes may suggest lymphoma.

Stroke Assessment (CVA)

  • Recognizing Stroke Symptoms with F.A.S.T:
      - Face drooping
      - Arm weakness
      - Speech difficulties
      - Time to call emergency services

Traumatic Brain Injury (TBI)

  • Common causes include:
      - Auto accidents
      - Violence
      - Falls
      - Excessive alcohol consumption

Safe Living Practices for TBI Reduction

  • For all ages:
      - Prevent falls with safety procedures (railings, mats, etc.)
      - Ensure appropriate safety gear when participating in sports or riding vehicles.

Assessing Mouth, Throat, Nose, and Sinuses

  • Anatomy of the Mouth:
      - Parts include superior lip, hard palate, soft palate, uvula, and anatomical structures relevant to salivary glands.
      - Total of 32 permanent teeth categorized into incisors, canines, premolars, and molars.

Assessment of Salivary Glands and Tongue

  • Procedure: Inspect for inflammation, note color and consistency, assess cranial nerve function.

  • Inspection of teeth for alignment, discoloration, and presence of cavities.

Assessment of Pharynx & Tonsils

  • Criteria for assessing tonsils: Grading from 0 (absent) to 4 (extending to midline). Abnormal findings indicate potential infection.

Assessment of Nose and Sinuses

  • Procedure for inspection: Check for color, tenderness, airflow resistance, and history of allergies.
      - Sinus Palpation & Transillumination: To detect tenderness and fluid presence.

Age-related Changes in the Oral Cavity

  • Older Adults: Changes in gums, tooth surfaces, decreased smell/taste, and fragility of oral mucosa.

Risk Factors for Oral Cavity Cancer

  • Include tobacco use, heavy alcohol consumption, HPV infection, poor nutrition, and poor oral hygiene.