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physical examination head and neck.pptx
- 1. HEAD AND NECK MUSTAFA ALISHLASH HEALTH ASSESSMENT
- 2. SESSION OBJECTIVES By the end of this presentation, learners will be able to: • Brainstorm the anatomy and physiology of the structures of the head, and neck. • Describe the components of health history that should be elicited during the assessment of head & neck. • Describe the specific assessment to be made during the physical examination of the Head & Neck. • Identify normal findings in physical assessment of the head, and neck. • Document the significant findings .
- 3. THE HEAD -- HEENT Techniques Inspection Palpation Auscultation Parts •Skull&Face •Eyes&Vision •EarsandHearing •NoseandSinuses •MouthandOropharynx
- 4. OVERVIEW OF HEENT ASSESSMENT • The assessment of the HEENT systems will include examinations of the; Head, Eyes, Ears, Nose, & Throat/neck Key parameters are; Symmetry, and color; Hair distribution to scalp, eyebrows, and eyelashes; Hydration status of the mucus membranes to the nose and mouth; The number and condition of teeth, palate structure and uvula placement and color of lips and buccal membrane. And the assessment of the XII cranial nerves.
- 5. STANDARD PROTOCOL FOR ASSESSMENT OF THE HEENT •Be organized and systematic in your assessment. •Use appropriate listening and questioning skills. •Listen and attend to patient cues. •Ensure patient’s privacy and dignity. •Apply principles of asepsis and safety. •Check vital signs.
- 6. STANDARD PROTOCOL FOR ASSESSMENT OF THE HEENT • Perform hand hygiene. • Check room for contact precautions. • Introduce yourself to the patient. • Confirm patient ID using two patient identifiers (e.g., name and date of birth or address). • Explain the process to the patient. • Assemble equipment prior to starting the exam.
- 7. Possible History you could gather- Focused. • Ask questions related to: • Pain to the head, eyes, ear, nose, throat and neck or drainage as applicable. • About changes to sight, smell, hearing, taste, chewing, swallowing and speech. • The need for glasses, hearing aids, dentures. • Acute or chronic disease of the HEENT and medication used to treat mentioned disease or abnormalities. • Risk factors noted to the HEENT systems.
- 8. THE HEAD pect hair for quantity, distribution, texture, pattern
- 9. Examination of the Head: SKULL & SCALP SCALP • Inspect for Scaliness & Lesions, infestations • Inspect for and Palpate Lumps and masses, edema SKULL Inspection • Size, Contour, Deformities, symmetry Palpation • Lumps • Tenderness
- 10. Examination of the Head: THE HAIR Inspection • Quantity, • Texture (Quality), • Cleanliness • Hair Loss • Hair Distribution • Inspect scalp for scales and lesions
- 11. Examination of the Head Inspection • Proportion/ Contour • Symmetry • Expression • Movement Palpation • Sensation • Lymph Nodes • Edema/ Lesions/ Masses THE FACE
- 12. SKULLANDFACE Characteristics Normal Deviationfrom normal Size,shapeand symmetry Rounded (normocephalic) Symmetrical Smooth skull contour. Lackofsymmetry Increasedskull size Nodules,masses anddepressions Smoothuniform consistency Absenceofnodulesor masses Sebaceouscysts Localdeformitiesfrom trauma Massesandnodules
- 13. SKULLANDFACE Characteristics Normal Deviationfrom normal Facialfeatures Symmetricorslightly asymmetricfacialfeatures; palpebralfissuresequalin size ;symmetricnasolabial folds. Increasedfacial hair Thinningofeyebrows Asymmetricfeatures; Exophthalmos; myxedemafacies ; moonface Eyesforedema andhollowness Noedema Periorbital edema Sunkeneyes
- 14. SKULL AND FACE Characteristics Normal Deviationfrom normal Symmetryof Symmetricfacial facialmovements movements Asymmetricfacial movements Droopingoflower eyelid andmouth Involuntaryfacial movements
- 18. Eyebrows • Hairdistributionandalignment • Symmetry • Skinquality • Movement Eyelashes • Evennessofdistribution • Directionofcurl Eyelids • Surfacecharacteristics • Positioninrelationtothecornea • Ability toblinkandfrequencyofblinking • Lesions/edema/stye/signsofinfection
- 19. Bulbarconjunctivaandpalpebralconjunctiva • Color • Texture • Presenceoflesions Lacrimalgland, lacrimalsacand nasolacrimalduct • Edema • TendernessandEvidenceoftearing Cornea • Clarityandtexture • Performcornealsensitivitytest
- 20. Anteriorchamber • Transparency • Depth Pupils • Color/shape/symmetryofsize • PERRLA(pupilsareroundand reacttolightandaccommodation)
- 21. pupils' reaction • Test pupils reaction to Light • Darkness– Pupils dilate • Light – Pupils Constrict • Record normal findings of the pupils as PERRLA DIRECT Vs CONSENSUAL
- 22. Visualfields • Detects decreases in peripheral vision or central vision that are usually not noticeable by the patient • Inspection: Test the peripheral visual fields using the Confrontational technique
- 23. Visualfields Normal • Whenlookingstraight ahead,clientcanseeobjects intheperiphery Deviationfromnormal • Visual field smaller than the normal(possibleglaucoma) • One half vision in one or both eyes (possible nerve damage)
- 24. Extraocularmuscletests CN III. OCULOMOTOR CN IV: TROCHLEAR CN VI: ABDUCENS
- 25. Extraocularmuscletests THE 6 CADINAL FIELDS OF GAZE
- 26. • Botheyes coordinated ,moveinunison,with parallel alignment • Eyemovementsnot coordinatedorparellel. • Strabismus(crosseye): abnormalalignmentofthe eyes; theconditionofhaving asquint. • Nystagmus: rapid involuntarymovementsofthe eyes. Extraocularmuscletests Normal Deviationfromnormal
- 27. Visualacuity Snellen’schart • A test is used to determine the smallest letters you can read on a standardized chart (Snellen Chart) • Assesses Cranial nerve II- Optic Nerve
- 28. Visualacuity Normal • NEARVISION:-Abletoread newsprintoramagazine • DISTANTVISIO:-(Snellen’s chart)20/20visiononSnellen’s- typechart Deviationfromnormal • Difficultyreadingnewsprint unlessduetoagingprocess. • Denominatorof40ormore onSnellen-typechartwith correctivelenses. Iftheclientisunabletoseeeventhetoplineofthesnellentypechart performfunctionalvisiontests lightperception Handmovements(H/F) Countingfingers(C/F)
- 29. Myopia • Nearsightedness Hyperopia • Farsightedness Presbyopia • Loss of elasticity of the lens and thus loss of ability to see close objects Astigmatism • An uneven curvature of the cornea that prevents horizontal and vertical rays from focusing on the retina Refractive errors
- 30. Inflammation Conjunctivitis • Inflammationofthebulbarandpalpebralconjunctiva Dacryocystitis • InflammationoftheLacrimalsac Hordeolum(sty) • Rednessswellingandtendernessofthehairfollicle andglandthatemptyattheedgeoftheeyelids Iritis • Iflammation oftheiris
- 31. Contusionsorhematomas • “Blackeyes”resultingfrominjury Cataracts • Opacityoflensanditscapsule Glaucoma • Adisturbanceinthecirculationofaqueousfluid whichcausesanincreaseinintraocularpressure.
- 34. color Normal • Sameasfacial skin Deviation • Cyanosis • Pallor • Excessiveredness symmetryof size Normal • symmetrical Deviation • Asymmetry Position Normal • Auriclealigned withouter canthusofeye about10degree fromvertical Deviation • Lowsetears (downsyndrome) Auricle(Inspection)
- 35. Auricle(Palpation) • Textureelasticityandareasoftenderness Normal • Mobilefirm andnon tender • Pinnarecoils after it is folded Deviation • Lesions • Flaky ,scaly skin • Tenderness
- 37. EXTERNALEARANDTYMPANICMEMBRANE Characteristics Normal Deviationfromnormal Externalearcanal Distalthirdcontainshair Rednessanddischarge follicles andglands Scaling Cerumen Drycerumen,grayish tancolor;stickywet cerumenin various shadesofbrown Excessivecerumen obstructingcanal Tympanicmembrane (color,andgloss) Pearly gray color, semitransparent Pinktored,some opacity ,yellow amber, White Blue ordeepred Dullsurface
- 38. Grosshearingacuitytests • Assessclients responsetonormalvoice tones • Watchtick test • Tuningforktests – WhisperTest. – Weber’stest – Rinnetest
- 39. Normal • Soundis heardin bothears oris localizedatthe centreofthehead (Weber negative) Deviation • Boneconductive hearingloss • Sensoryneural disturbances (Weberpositive) Weber’stest Normal • AC>BC • Positive Rinne Deviation • BC>AC • BC=AC • Negative Rinne Rinnetest
- 41. NOSE • Inspectfornoseforanydeviationsin Shape,size, colorandflaring ordischargefromthenares. • Lightly palpatetheexternal nosefor Tenderness,massesanddisplacementofboneandcartilage. • Determinepatencyofbothnasal cavities • Inspectthenasal cavities usingnasal speculum Observemucosaforredness, swelling, growths,and discharges. • Inspectthenasal septumbetweenthenasal champers
- 42. SINUSES • Palpate themaxillary andfrontalsinusesfortenderness
- 44. Lipsandbuccalmucosa • Inspectouterlipsfor – Symmetry,contour,colorandtexture,abilitytopurselips Normal • Uniformpinkcolor&soft,moistandsmoothtexture • Symmetry ofcontour • Abletopurselips Deviationfromnormal • Pallor ,cyanosis • Blisters, swelling, scaling • Inability topurselips
- 45. Lipsandbuccalmucosa • Inspectandpalpate innerlipsandbuccalmucosafor – Color, moisture,textureandpresenceoflesions Normal • Uniformpinkcolor&soft,moist,smooth, glisteningandelastic texture. Deviationfromnormal • Pallor; leukoplakia(white patches), red,bleeding • Excessive dryness • Mucosalcysts ;irritation fromdentures , abrasions, ulceraions ;nodules.
- 46. Teethandgums Normal • 32adult teeth • Smooth,white, shiny toothenamel • Pinkgums • Moistfirmtexture togums • Noretraction ofgums Deviationfromnormal • Missingteeth ;ill fitting dentures • Brownorblackdiscoloration oftheenamel(dental caries) • Excessively redgums • Spongytexture ; bleeding; tenderness • Receding; atrophiedgums; swelling thatpartially coverstheteeth
- 47. Tongue/floorofthemouth Inspectthesurfaceofthetonguefor • Position,color,andtexture. Normal • Central position • Pinkcolor • Smooth,lateral margins ; ornolesions • Raisedpapillae ( taste buds) Deviationfromnormal • Deviated fromcentre • Smoothredtongue • Dry,furry tongue(fluiddeficit), whitecoating(yeast infection) • Nodules, ulcerations, discolorations andareas oftenderness
- 48. Tongue/floorofthemouth • Inspectthetonguemovement • Insectthebaseofthetonguethemouthfloorandfrenulum • Palpatethetongueandfloorofthemouth Normal • Movesfreelynotenderness • Smoothtonguewithprominentveins • Smooth, nopalpablenodules Deviationfromnormal • Swelling andulceration • Nodules
- 49. Salivaryglands • Inspectsalivary ductopeningsfor – swellingorredness Normal • Sameas colorofbuccal mucosaandfloorofthemouth Deviationfromnormal • Inflammation (rednessandswelling)
- 50. • Inspectthehardandsoftpalateforthe – Color, shape,textureandpresenceofbonyprominences • Inspecttheuvulafor – Positionandmobility Palatesanduvula
- 52. • InspecttheOropharynxforthe – Colorandtexture Normal:Pinkandsmoothposteriorwall. Deviationfromnormal: Reddenedoredematous,presenceof lesions. • Inspectthetonsils – Color,discharge,andsize Normal:Pinkcolorandsmoothtexture, nodischarge,normalsize. Deviationfromnormal:Inflamed, presenceofdischarge, swollen. • Elicit thegagreflex Oropharynxandtonsils
- 55. Neckmuscles • Inspecttheneckmuscles • Observeheadmovements – Movechintothechest(sternocleidomastoid) – Movetheheadsothattheearis movedtowardtheshoulderon eachside (sternocleidomastoid) – Turntheheadtotheright andtotheleft (sternocleidomastoid) – Moveheadbacksothatthechinpointsupward(Trapezius) • Assessthemusclestrength
- 56. Lymphnodes • Palpatetheentire lymphnodeforenlargement Normal lymph nodes are Non-palpable
- 57. Trachea
- 58. Trachea Palpatethetracheafor lateral deviation •Normal: Centralplacementin midline ofneck •Deviationfrom normal: Deviationtooneside (neck tumor, thyroid or lymph node enlargement)
- 59. Thyroidgland Inspectthethyroidgland Normal: Not visible oninspection Deviationfromnormal: Localenlargement
- 60. Thyroidgland Palpatethethyroidglandfor smoothnessnoteanyareas of enlargement, masses and nodules. Posteriorapproach Anteriorapproach Normal: Lobesmaynotbepalpated Deviationfromnormal: Solitary nodules
- 61. Thyroidgland If enlargement of the gland is suspected , auscultate over the thyroid area for bruit (a soft rushing sound created by turbulent blood flow)
- 63. “Lets have a brake” THANK YOU