Head, Face, and Neck, Including Regional Lymphatics Health Assessment Across the Lifespan NRS 102

Structure and Function Subjective Data—Health History Questions Objective Data—Physical Exam Abnormal Findings

Structure and Function Head Cranial bones Sutures Facial bones Facial muscles Salivary glands

Structure and Function (cont.) Neck Neck muscles Anterior and posterior triangles Thyroid gland

Structure and Function (cont.) Lymphatics Preauricular Posterior auricular (mastoid) Occipital Submental Submandibular

Structure and Function (cont.) Lymphatics (cont.) Jugulodigastric Superficial cervical Deep cervical Posterior cervical Supraclavicular

Structure and Function (cont.) Developmental care Infants and children Fontanels Head growth Lymphatic system Pregnant female Aging adult

Subjective Data— Health History Questions Headache Head injury Dizziness Neck pain or limitation of motion Lumps or swelling History of head or neck surgery Headache: Unusually frequent, severe? Onset? Had this type before? Location? Character? Mild, moderate, severe? Course and duration? Precipitating factors? Associated factors? Other illnesses? Taking meds? What makes it worse? Treatment? Coping strategies? Head injury: Onset? Setting? How were you just before injury? History of illness (heart trouble, diabetes, epilepsy)? Location? Duration? Associated symptoms? Pattern? Effort to treat? Dizziness: Determine what patient means by dizziness. Onset? Associated factors? Neck pain: Onset? Location? Associated symptoms? Precipitating factors? Related to stress? Coping strategies? Lumps or swelling: Recent infection, tenderness? Duration? Change in size? History of irradiation of head, neck, upper chest? Difficulty swallowing? Do you smoke? Do you drink alcohol? Thyroid problems? History of head or neck surgery: Ever had surgery of head or neck? Why? When? How do you feel about the results?

Subjective Data— Health History Questions (cont.) Additional history for infants and children Maternal alcohol or drug use Type of delivery Growth pattern Additional history for aging adult Dizziness Neck pain Infants and children: Maternal use of alcohol or drugs during pregnancy? Type of delivery? Was baby’s growth normal? Aging adult: Dizziness affect daily activities? Neck pain affect daily activities?

Objective Data— Physical Exam Head–Inspect and palpate the skull Size and shape Temporal area Head–Inspect the face Facial structures

Objective Data—Physical Exam (cont.) Neck–Inspect and palpate Symmetry Range of motion Lymph nodes

Objective Data—Physical Exam (cont.) Neck–Inspect and palpate (cont.) Trachea Thyroid gland Posterior approach Anterior approach Auscultate

Objective Data—Physical Exam (cont.) Developmental care Infants and children Skull Face Neck Special procedures Pregnant female Aging adult

Sample Charting

Sample Charting (cont.)

Sample Charting (cont.)

Abnormal Findings Abnormalities in Head Size and Contour Hydrocephalus Paget’s disease of bone (osteitis deformans) Acromegaly

Abnormal Findings (cont.) Swellings of the Head and Neck Torticollis (wryneck) Thyroid—multiple nodules Thyroid—single nodule Pilar cyst (wen) Parotid gland enlargement

Abnormal Findings (cont.) Pediatric Facial Abnormalities Fetal alcohol syndrome Congenital hypothyroidism Down syndrome Atopic (allergic) facies Allergic salute and crease © Pat Thomas, 2006.

Abnormal Findings (cont Abnormal Findings (cont.) Abnormal Facial Appearances With Chronic Illnesses Parkinson’s syndrome Cushing’s syndrome Graves’ disease Hyperthyroidism Myxedema (hypothyroidism) Bell’s palsy Brain attack or cerebrovascular accident Cachectic appearance Scleroderma