Weber Health Assessment in Nursing Chapter 15: Assessing Head and Neck

Structure and Function The Head Cranium Frontal; Parietal Temporal; Occipital Ethmoid; Sphenoid

Question Is the following statement true or false? The skull, which is the framework of a head, has two subsections – the cranium and cervical vertebrae.

Answer False. The skull has two subsections – the cranium and the face.

Structure and Function The Head Face Maxilla; Zygomatic Inferior conchae; Nasal Lacrimal; Palatine; Vomer Mandible

The Skull

Question Which bone belongs to the face? a. Parietal b. Temporal c. Palatine d. Mandible

Answer c. Palatine Rationale: Palatine is a facial bone that gives shape to the face. Parietal, temporal, and sphenoid are bones of the cranium.

Structure and Function The Neck Hyoid bone Several major blood vessels Larynx Trachea Thyroid gland

Structures of the Neck

Cervical Vertebrae

Question Tell whether the following statement is True or False. The axis is the first of the seven cervical vertebrae.

Answer False. The axis is the second of the seven cervical vertebrae.

Lymph Nodes

Traumatic Brain Injury Presence of transportation accidents involving automobiles, motorcycles, bicycles, and pedestrians Presence of violence, such as firearm assaults and child abuse or self-inflicted wounds Falling Excessive alcohol ingestion Infants and elderly being cared for by caregivers

Infant and Toddlers Risk Factors Environmental risks (for falls) Lack of parental knowledge of shaken baby syndrome Caregivers risk of shaken baby syndrome

Children and Teens Risk Factors Knowledge and use of protective equipment in sports and bicycle use Knowledge and use of safety practices when driving

Adults and Older Adults Risk Factors Knowledge and use of safety practices when driving Impairment of physical or mental stability Potential for maltreatment or domestic violence

Risk Reduction Buckling your child in the car using a child safety seat, booster seat, or seat belt (according to the child's height, weight, and age). Know the Stages Birth Through Age 2 Between Ages 2-4/Until 40 lbs Between Ages 4-8 or Until 4'9" Tall After Age 8 and/or 4'9" Tall Wearing a seat belt every time you drive or ride in a motor vehicle.

Risk Reduction (cont.) Never driving while under the influence of alcohol or drugs. Wearing a helmet and making sure your children wear helmets when: Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle; Playing a contact sport, such as football, ice hockey, or boxing; Using in-line skates or riding a skateboard; Batting and running bases in baseball or softball; Riding a horse; or skiing or snowboarding.

Risk Reduction (cont.) Making living areas safer for seniors, by: Removing tripping hazards such as throw rugs and clutter in walkways; Using nonslip mats in the bathtub and on shower floors; Installing grab bars next to the toilet and in the tub or shower; Installing handrails on both sides of stairways; and Improving lighting throughout the home.

Risk Reduction (cont.) Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance. Making living areas safer for children, by: Installing window guards to keep young children from falling out of open windows; and Using safety gates at the top and bottom of stairs when young children are around. Making sure the surface on your child's playground is made of shock absorbing material, such as hardwood mulch or sand.

Health Assessment: Subjective Data Interview Approach (COLDSPA) History of current health problem, past health, family Lifestyle and health practices

Headaches Character: Describe how the headache feels (sharp, throbbing, dull)? Onset: When did it first begin? Does it tend to occur with other factors (i.e., Menstrual cycle, emotional or physical stress, ingestion of alcohol or other certain foods like cheese or chocolate)? Locations: Where does your headache begin? (Ask client to point to area in head if possible). Does it radiate or spread to other areas?

Headaches (cont.) Duration: How long does it last? How often does it recur? Has there been any change in the duration of your headaches? Explain. Severity: How severe is the headache? Rate it on a scale of 1-10 (10 being most severe). Does the headache keep you from doing your usual activities of daily living? Explain. Pattern: What aggravates it? What makes the pain go away? What pain relievers work best for you? Associated Factors: Do you have other symptoms with the headache such as nausea, visual changes, dizziness, or sensitivity to noise or light?

Equipment Gloves Penlight or flashlight Small glass of water Stethoscope

Physical Assessment: Head Inspect the size, shape, configuration Consistency Involuntary movement Palpate the head

Physical Assessment: Face Inspect the face Symmetry Features Movement Expression Skin condition

Physical Assessment: Face Palpate Temporal artery: tenderness and elasticity Temporomandibular joint (TMJ): range of motion, swelling, tenderness, crepitation

Physical Assessment: Neck Inspect movement of neck structures Cervical vertebrae Neck range of motion (ROM)

Physical Assessment: Neck Palpate Trachea Thyroid gland Thyroid cartilage Cricoid cartilage Auscultate an enlarged thyroid gland

Physical Assessment: Neck Palpate lymph nodes of head and neck Preauricular Postauricular Occipital Tonsillar Submandibular

Physical Assessment: Neck Palpate lymph nodes of head and neck Submental Superficial cervical Posterior cervical Deep cervical Supraclavicular

Normal and Abnormal Findings Review and discuss findings of client’s head and neck with class peers

Altered Thyroid Function Increased sensitivity to cold Constipation Depression Fatigue Heavier menstrual periods Pale, dry skin, Thin, brittle hair or nails Weakness Unintentional weight gain.

Hyperthyroidism Increased appetite Sudden weight loss, without changes in appetite and diet Rapid heartbeat (tachycardia) greater than 100 beats a minute, irregular heartbeat (arrhythmia), or palpitations Nervousness, anxiety and irritability Tremor in the hands and fingers Sweating

Hyperthyroidism (cont.) Changes in menstrual patterns Increased sensitivity to heat Changes in bowel patterns, more frequent bowel movements Enlarged thyroid gland (goiter) Fatigue, insomnia Muscle weakness

Headaches Sinus Cluster Tension Migraine Tumor related

Abnormal Findings Acromegly Cushing’s Syndrome Scledodema Hypothryoidism Bell’s Palsy

Older Adults Older clients who have arthritis or osteoporosis may experience neck pain and a decreased range of motion In older clients, facial wrinkles are prominent because subcutaneous fat decreases with age. In addition, the lower face may shrink and the mouth may be drawn inward as a result of resorption of mandibular bone, also an age-related process. The strength of the pulsation of the temporal artery may be decreased in the older client.

Older Adults (cont.) In older clients, cervical curvature may increase because of kyphosis of the spine. Moreover, fat may accumulate around the cervical vertebrae (especially in women). This is sometimes called a “dowager’s hump.” Older clients usually have somewhat decreased flexion, extension, lateral bending, and rotation of the neck. This is usually due to arthritis. If palpable, the older client’s thyroid may feel more nodular or irregular because of fibrotic changes that occur with aging; the thyroid may also be felt lower in the neck because of age-related structural changes.

Validating and Documenting Findings Health promotion diagnoses Risk diagnoses Actual diagnoses Collaborative problems Medical problems