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Head and Neck

By O.Krekhovska-Lepyavko, MD,

Institute of Nursing, TSMU

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Anatomy review

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Anatomy

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AnatomySalivary Glands

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Anterior and Posterior Triangles

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Anatomy

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Lymphatics

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Anatomy - Lymphatics

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History Headaches?

Any unusually frequent or unusually severe headaches? A severe headache for a person whos never had headaches

should warrant further attention When - onset, duration Where

Tension headaches tend to be occipital or frontal Migraine headaches supraorbital, retro orbital, or frontotemporal Cluster headaches pain around the eye, temple, forehead, and cheek.

Pain unilateral.

Character Throbbing (pounding, shooting) migraine Aching (constant pressure, dull) tension headache

Intensity - mild, moderate, or severe Precipitating factors Associated factors

Vision changes, N&V, pain with bright light, neck stiffness, fever,

Alleviating factors Other illnesses Medications

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History Head injury?

When History of head injuries or other medical conditions? Location LOC Loss of Consciousness?

Dizziness? Lightheadedness or spinning? Vertigo is true rotational spinning due to neurologic dysfunction (vestibular

apparatus) Objective perception that room spins

Subjective perception that person is spinning

Neck pain? When, where, precipitating and alleviating factors

Acute onset of stiffness along with headache and fever occurs with meningealinflammation

Limitations to ROM?

Lumps or swelling? Tenderness?

Acute infection

Lumps If over 40, suspect malignancy until proven otherwise

Smoker? How long? Packs per day? Chew tobacco? Increased risk of tumors

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Assessment - Head

Size and shape Normocephalic Hydrocephalus

enlargement of head, increasedcircumference

Pagets disease

Enlargement and softening of bone Acromegaly

abnormal enlargement of skull andfacial bones

Temporal artery Palpate above zygomatic bone,

between eye and top of ear

Temporomandibular joint Anterior of ear, between mandible and

temporal bone Palpate joint as person opens mouth.

Normally smooth movement Abnormal crepitations, limited

ROM, tenderness

acromegaly

TMJ

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Assessment - Face

Symmetry ofeyebrows, mouth

Changes in skin

Tics or twitches

Tightened facialmuscles - pain

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Stroke vs Bells Palsy

Bells Palsy

CN VII paralysis

Unilateral

Thought to happen dueto herpes simplex virus

Person cannot wrinkleforehead, raiseeyebrow, close eye, or

show teeth on affectedside

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Stroke

Acute neurological deficit due to obstruction ofcerebral vessel, as in atherosclerosis, or rupturein a cerebral vessel

Paralysis of lower facial muscles, but upper half of

face not affected. Still able to wrinkle forehead and close eyes

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Fetal Alcohol Syndrome

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Down Syndrome

Trisomy 21

Characteristics

Upslanting eyes

Flat nasal bridge andnose

Protruding tongue

Short broad neck with

webbing Small hands

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Assessment - Neck

Symmetry head andneck muscles

ROM Ask person to touch chin to

chest, turn head to rightand left, try to touch each

ear to shoulder, extendhead backwards Note limitation of

movement

Muscle strength Test strength by resisting

movement CN XI Accessory n.

Trapezius m.

Thyroid gland Enlargement of lower neck

may be bilateral or aunilateral lump

Diffuse enlargement ornodular lump

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Palpating the Thyroid Gland

Posterior approach

Anterior approach

Place fingers inferiorand lateral of thyroidcartilage and ask theperson to swallow Usually, you cannot

palpate the normaladult thyroid

Enlarged lobes are alsotender to palpation

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Hypothyroidism Mild deficiency called

hypothyroidism. Severedeficiency calledmyxedema. In infancycalled cretinism.

S/S: Face is pale, puffy, and

expressionless

Skin is cold and dry

Hair is brittle, hair loss

Lowered heart rate andtemp

Lethargy, fatigue,intolerance to gold

Impaired mentality

Goiter!

Cause Hashimotos disease

Autoimmune diseasewhere antithyroidantibodies block thyroidhormone production

Iodine deficiency in diet Surgical removal of

thyroid

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Hyperthyroidism

Graves disease Most common. More common in women.

S/S

Rapid heartbeat, dysrhythmias, angina

Rapid thought flow and rapid speech,nervousness, and insomnia

Increased BMR, appetite

Goiter + Exophthalmos

Cause

Thyroid Stimulating Immunoglobulins (TSIs)mimic the effects of TSH on thyroid function

Toxic nodular goiter (Plummers disease) Result of thyroid adenoma

Exophthalmos is missing

Exophthalmos

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Lymph

Nodes

Lymph nodes Beginning with the preauricular lymph nodes, palpate

the 10 groups of lymph nodes in a routine order

Lymphadenopathy - enlargement of lymph nodes due to

infection, allergy, or neoplasm

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Trachea Normally, the trachea is

midline

Palpate for any trachealshift by placing indexfinger in the sternal notch

Trachea pushed tounaffectedside in aorticaneurism, a tumor,pneumothorax

Trachea pushed toaffectedside with large

atelectasis, pleuraladhesions, fibrosis

Tracheal tug is a rhythmicdownward pull that issynchronous with systoleand that occurs with

aortic arch aneurysms

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Developmental Considerations -

Infants Skull

Should be round andsymmetrical

Caput succedaneum elongation of skull at birth resolves

Cephalohematoma hemorrhage due to trauma atbirth resolves in few weeks(Fig 13-17)

Fontanels anterior andposterior. Normally close by 2years Depressed dehydration Bulging increased ICP

Transillumination done ifabnormal head size orintracranial lesion is suspected Hydranencephaly thinning

or absence or cerebral cortex

cephalohematoma

transillumination