Copyright 2002, Delmar, A division of Thomson Learning Chapter 11 Head, Neck, and Regional Lymphatics

Copyright 2002, Delmar, A division of Thomson Learning Competencies Identify the anatomic structures of the head and neck. Identify the lymph nodes of the head and neck. Describe the system-specific health history for the head and neck. (continues)

Copyright 2002, Delmar, A division of Thomson Learning Competencies Demonstrate the physical assessment of the head and neck. Describe normal findings in the physical assessment of the head and neck. List common abnormalities found in physical assessment of the head and neck. Explain pathophysiology of common abnormalities found in physical assessment of the head and neck.

Copyright 2002, Delmar, A division of Thomson Learning Anatomy and Physiology Skull Face Neck Thyroid Lymphatics Blood supply

Copyright 2002, Delmar, A division of Thomson Learning Health History Determine presence/absence of age- and gender-specific diseases of the head and neck Common chief complaints  Neck pain or stiff neck  Hoarseness  Neck mass  Headache  Head injury

Copyright 2002, Delmar, A division of Thomson Learning Evaluating Chief Complaint Determine the following characteristics  Quality  Associated manifestations  Aggravating factors  Alleviating factors  Setting  Timing

Copyright 2002, Delmar, A division of Thomson Learning Past Health History Medical conditions Surgeries Medications Communicable diseases Injuries or accidents Special needs

Copyright 2002, Delmar, A division of Thomson Learning Family Health History Determine if family history of  Thyroid disease  Headache

Copyright 2002, Delmar, A division of Thomson Learning Social History Alcohol use Work environment Home environment Stress

Copyright 2002, Delmar, A division of Thomson Learning Health Maintenance Activities Sleep Diet Use of safety devices

Copyright 2002, Delmar, A division of Thomson Learning General Approach to Head and Neck Assessment Greet patient, explain assessment techniques Environment  Quiet  Warm  Private  Adequate lighting  Upright sitting position Compare right and left sides Systematic approach

Copyright 2002, Delmar, A division of Thomson Learning Assessment of the Head Inspection  Shape  Symmetry Palpation  Contour  Masses  Depression  Tenderness

Copyright 2002, Delmar, A division of Thomson Learning Inspection and Palpation of the Scalp Inspect  Lesions or masses Normal findings  Scalp is shiny, intact, without lesions or masses Abnormal findings  Bleeding, lesions, masses, hematomas

Copyright 2002, Delmar, A division of Thomson Learning Assessment of the Face Inspection  Shape  Symmetry (continues)

Copyright 2002, Delmar, A division of Thomson Learning Assessment of the Face Normal findings  Symmetrical features  Palpebral fissures equal  Nasolabial folds present bilaterally  Shape can be oval, round, or slightly square (continues)

Copyright 2002, Delmar, A division of Thomson Learning Assessment of the Face Abnormal findings  Deformed or absent structures  Asymmetry  More or less pronounced facial features  Diseases which may alter facial features: Bell’s palsy, Down syndrome, Graves’ disease, Myxedema, Cachexia, Cushing’s syndrome

Copyright 2002, Delmar, A division of Thomson Learning Mandible Palpate and auscultate the temporo- mandibular joint when the client opens and closes the mouth Normal findings  No discomfort, joint articulates smoothly without clicking or crepitus Abnormal findings  Pain, tenderness, crepitus, clicking, or snapping sound

Copyright 2002, Delmar, A division of Thomson Learning Neck Inspection Palpation Normal findings  Full ROM, pain free, symmetrical muscles, no masses Abnormal findings  Limited ROM, pain, asymmetrical muscles, masses

Copyright 2002, Delmar, A division of Thomson Learning Thyroid Gland Inspection Palpation Auscultation (continues)

Copyright 2002, Delmar, A division of Thomson Learning Thyroid Gland Normal findings  Symmetrical movement with swallowing  Adam’s apple more pronounced in males  No masses, tenderness, or enlargement  Absent bruit (continues)

Copyright 2002, Delmar, A division of Thomson Learning Thyroid Gland Abnormal findings  Mass  Enlarged gland  Goiter  Asymmetrical enlargement  Presence of a nodule or bruit

Copyright 2002, Delmar, A division of Thomson Learning Lymph Nodes Inspection Palpation (continues)

Copyright 2002, Delmar, A division of Thomson Learning Lymph Nodes Location  Preauricular  Postauricular  Occipital  Submental  Submandibular  Anterior and posterior cervical chains  Tonsilar  Supraclavicular (continues)

Copyright 2002, Delmar, A division of Thomson Learning Lymph Nodes Normal findings  Unable to palpate or see nodes Abnormal findings  Enlarged nodes  Able to palpate or see nodes  Tenderness  Firm, hard nodes

Copyright 2002, Delmar, A division of Thomson Learning Gerontological Variations Appearance and function of head and neck may be altered Buffalo hump Kyphotic posture Limited ROM Dizziness