4th lecture headneck and lympatics

8/10/2019 4th Lecture HeadNeck and Lympatics

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HEAD AND NECKREGIONAL LYMPHATICS

Prepared by: Jeffrey Esteron


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LEARNING OBJECTIVE ONEAnatomy and Physiology Review


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LEARNING OBJECTIVE ONE Head

Skull

Cranium and face

Cranial bones

Frontal

Parietal Temporal

Occipital


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** The Head:

Skull: a bony boxprotects the brain &

special senseorgans.

Cranial bones:frontal, parietal,

occipital, temporal


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Sutures: immovable joints;

coronal: crowns headfrom ear to ear at the

union of the frontal &parietal bones,sagittal: separate headlengthwise between twoparietal bones.

lambdoid sutureseparates parietalbones from occipitalbone.
http://images.google.jo/imgres?imgurl=http://www.neurosurgery.ufl.edu/Images/sutures_ped.jpg&imgrefurl=http://www.neurosurgery.ufl.edu/Patients/craniosynostosis.html&h=208&w=216&sz=11&hl=en&start=7&tbnid=L0nKHstpXu1z0M:&tbnh=97&tbnw=101&prev=/images%3Fq%3Dskull%2Bsutures%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8%26sa%3DN


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FONTANELS

(fontenelle= little fountain)At birth, membrane-covered soft spots

between cranial bones

These soft spots will eventually ossify-replaced by bone

Allow for growth of the brain during the firstyear

Posterior or occipital will ossify by 2 months

Anterior or frontal will ossify by 18-24 months


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LEARNING OBJECTIVE ONE Head

Facial bones

Facial muscles

Expression of emotion

Neck movement

Controlled by cranial nerves V and VII


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FACIAL BONES 14 Facial Bones articulate at sutures except for the

mandible

NASAL-forms part of bridge of nose PAIRED MAXILLAE-Unite to form upper jaw bone

ZYGOMATIC- Commonly called cheekbones

MANDIBLE- Lower jawbone; largest, strongest facialbone; only skull bone that moves

LACRIMAL- Smallest bones in face; lateral to nasalbones


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FACIAL MUSCLES Facial expressions are formed by the facial

muscles

Mediated by cranial nerve VII, the facialnerve

Facial muscle is symmetrical bilaterally,

except for an occasional quirk or wryexpression


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Figure 13-2 pg 273


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LEARNING OBJECTIVE Neck

Carotid and temporal arteries

Supported by vertebra and muscles

Neck muscles

Anterior and posterior triangles

Hyoid bone Thyroid gland


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**The Neck:

from base of the skull to manibrium, clavicle,1strib,1stthoracic vertebra below.

Structures are: vessels, muscles, nerves,lymphatics & viscera of the respiratory anddigestive system.

Carotid artery, jugular vein(internal &external).


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NECK VESSELS TEMPORALARTERY-Lies superior to the

temporalis muscle, and its pulsation is

palpable anterior to the ear CAROTIDARTERY-Right and left arise

from the aorta and are the principalblood supply to the head and neck; each

of these two arteries divide to form theexternal and internal carotid arteries


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NECK VESSELS

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NECK VESSELS

JUGULAR VEIN- External-Lies superficial to thesternocleidomastoid muscle as it passes down the neck to

join the subclavian vein; receives blood from the exteriorof the cranium and the deep parts of the face;INTERNAL-Directly continuous with the transverse sinus,

accompanying the internal carotid as it passes down theneck; Receives blood from the brain and superficial partsof the face and neck


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NECK MUSCLES STERNOMASTOID- Arises from the sternum

and the medial part of the clavicle and

extends diagonally across the neck to themastoid process behind the ear;

Accomplishes head rotation and flexion

TRAPEZIUS- Two muscles that form a

trapezoid shape on the upper back arisingfrom the occipital bone and extends fanningout to the clavicle and scapula; moves theshoulders and extends and turns the head


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Muscles : sternomastoid (

head rotation &

head flexion)&trapezius( movesshoulders &extend &turn head).


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20Figure 13-4. p 274.

MUSCLES OF THE NECKMuscles of the Neck


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LANDMARKSVertebra Prominens-C7 vertebra; has a

long spinous process that can be felt

when the neck is flexed Temporal Artery-Pulsation is palpable

anterior to ear


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Thyroid gland: in the middle of the

neck, has 2 lobes,

separated byisthmus, secreteT3&T4hormones(stimulate

metabolism)


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Cricoid cartilage:above thyroid isthmus,

thyroid cartilage

above that(adamsapple) in males,highest is hyoidbone.
http://images.google.jo/imgres?imgurl=http://www.jephc.com/ewebeditpro3/upload/Fig3CH.jpg&imgrefurl=http://www.jephc.com/full_article.cfm%3Fcontent_id%3D193&h=164&w=250&sz=7&hl=en&start=11&tbnid=IRowDRQnaK9unM:&tbnh=69&tbnw=106&prev=/images%3Fq%3Dcricoid%2Bcartilage%26svnum%3D10%26hl%3Den%26lr%3D%26ie%3DUTF-8


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* The Lymphatic's

1. preauricular: in front ofear

2. posterior auricular:

superficial to mastoidprocess

3. occipital: at the base ofthe skull

4.

submental: midline5. submandibular: halfway

between the angle & tipof the mandible.


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6. superficial cervical:overlying sternomastoid

muscle7. deep cervical: under

sternomastoid muscle

8. posterior cervical: at

the edge of the trapezius9. supraclavicular: above

clavicle, at sternomastoid

The Lymphatic's:


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THANK YOU

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LEARNING OBJECTIVE TWO Focused Interview

General questions


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*Subjective Data:

1. Headache:

onset- when did this kind of headache start?

Location- where do you feel it? Is pain localized on one side or all over?

Character: throbbing(shooting) or aching(dull)?

Is it mild, moderate, or sever?

Duration- what time of day do the headachesoccur: morning, evening?


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contHeadache:.1 How long do they last?

Precipitating factors- what brings it on?

Associated factors- as nausea orvomiting?

Do you have any other illness?

Do you take any medications?


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Types of headaches Headaches

Migraine

Cluster

Tension


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2 . Head injury:

onset-when? describe exactly whathappened?

Setting- any hazardous conditionsas(wearing helmet)?

Any hx of illness as DM?

Duration- how long were you unconscious? Associated symptoms- as vision change?


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3. Dizziness: onset- abrupt or gradual? Associated factors?

As nausea or vomiting or tinnitus

4. Neck Pain: onset- how did the pain start? injury

accidentetc

location- does the pain radiate? to shoulder,

arms? Associated symptoms- limitations to range of

motion

Precipitating factors-what movements cause

pain?


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Lumps or swelling:.6

how long have you had it? has it changed in

size?

Any difficulty swallowing? Do you smoke?

Ever had a thyroid problem?

7. history of head or neck surgery: for what condition? when did the surgery

occur?


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Specific Questions

Illness, infection, or injury

Symptoms Pain

Behaviors

Infants and children

Environment


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THANK YOU

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**Objective Data:

The Head:


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LEARNING OBJECTIVE THREE Assessment of the Head and Neck

Techniques

Inspection

Palpation

Auscultation


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LEARNING OBJECTIVE

THREE Areas of the Head

Palpation of the head and scalp

Observation of the skin and tissue integrity

Palpation of the temporal artery


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Areas of the Head

1. Inspection and palpate of thehead and scalp

2. Inspection and palpateof theface

3. Observation of movements of the

head, face, and eyes


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* INSPECT & PALPATE SKULL 1- size & shape: Normocephalic,

round symmetric skull, related to body

size. for shape palpate scalp, notenderness(symmetric & smooth).

2- temporal area: palpate temporal

artery, palpate joint tempomandibularjoint- as the person opens mouth, nolimitation or tenderness.


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Figure 12.10 Palpating the temporal artery.


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Abnormalities of the Skull and Face


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Hydrocephalus


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Acromegaly


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Down syndrome


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**INSPECT THE FACE:

facial structures: facial expressionappropriate to behavior CN VII , symmetric

same for eye brows, nasolabial folds &sides of the mouth. note any involuntarymovements.


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Abnormal Facial Features TICS- Abnormal facial movements

Exophthalmos- bulging eyeballs

Acromegaly- Gradual enlargement ofthe bones of the face and jaws

Abnormalities of the Skull and Face


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Abnormalities of the Skull and FaceParalysis following brain attack


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Abnormalities of the Face

Bells palsy


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The Neck:

** INSPECT & PALPATE THENECK:


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NECK:

Symmetry: head held erect & still

ROM: ask the person to touch the chin to chest,turn head to rt & lt, try to touch each ear to theshoulder- test muscle strength ( cranial nerveXI) by trying to resist the persons movementswith your hands as the person shrugs shoulders& turns the head to each side.- noteenlargement of salivary glands & lymph nodes-note pulsations(carotid artery)


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Trachea: midline, palpate for shift,place your index on trachea in the

sternal notch& slip it off to each side.Should be symmetric on both sides.

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Palpate Trachea


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Thyroid gland: inspect neck as person takes a sip & swallow

, thyroid moves up with a swallow

a. posterior approach: move behind theperson ask him to sit up straight & then tobend head slightly forward & to right, usefingers of your lt hand to push tracheaslightly to rt. Curve your rt fingers betweentrachea & sternomastoid , ask him to take asip of water ,thyroid moves up, reverse theprocedure for lt side, check for enlargement,symmetry.


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Thyroid gland Posterior approach


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Palpate Thyroid; Posteriorappraoch


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Thyroid gland:

b.anterior approach:stand facing person.ask him to tip head forward & to rt, use your

rt thumb to displace trachea slightly to thepersons right. Hook your lt thumb & fingers

around the sternomastoid. Feel for lobeenlargement as he swallows.

c. auscultate thyroid: if it enlarged auscultatefor bruit( a soft pulsatile blowing sound heardwith bell).


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Thyroid gland

Anterior approach


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Palpate Thyroid: Anteriorappraoch


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NECK: cont

Lymph nodes: using gentle circular motion ofyour finger pads, palpate lymph nodes, palpate10 groups in a routine order in both hands. if

any nodes are palpable note location, size,shape, mobility, tenderness, cervical nodespalpable in health persons decreased with age,normal nodes feel movable, soft & no tender.


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Palpating Lymph Nodes

USE A FIRM DELIBERATE YET GENTLE TOUCH INFECTION-May be indicated when nodes are

palpable bilaterally, feel large, warm, tender, firm

but freely movable MALIGNANCY- May be indicated when nodes are

unilateral, hard, discrete, asymmetric, fixed, andno tender

Abnormal Nodes- Explore the area proximal(upstream) to the location of the abnormal node


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Palpate Deep Cervical Chain


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Palpate supraclavicular node


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Palpate cervical nodes


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THANK YOU

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Clinical Case Study 1

Focused Assessment


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Mr. Omar A. is a 57-years old ,insuranceexecutive who is in his fourth

postoperative day after a transurethralresection of the prostate gland. He alsohas chronic hypertension, managed by

oral hydrochlorothiazide, exercise, anda low-salt diet.


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Subjective data:

Complaining of dizziness, a lightheaded

feeling that occurred on standing and clearedon sitting. No previous episodes of dizziness.Denies palpitations, nausea, or vomiting.States urine pink tinged as it was yesterday

with no red blood. No pain medication today.On second day of same antihypertensivemedication he took before surgery.


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Objective data:

BP 142/88 RA sitting, 94/58 RA standing. Pulse 94sitting and standing, regular rhythm, no skippedbeats. Temp 37o C.

Color tannish-pink, no pallor, skin warm and dry. Neuro: Alert and oriented to person, place, and time.

Speech clear and fluent. Moving all extremities, noweakness. No nystagmus, no ataxia, past pointingnormal. Rombergs sign negative (normal).

Intake/output in balance. Urine faint pink tinged, noclots.

Lab: Hct 45, serum chemistries normal.


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Assessment

Orthostatic hypotension

Risk for injury R/T orthostatichypotension


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Clinical Case Study 2

Focused Assessment:

Mara is a 19-year-old single white

female college student with a history ofgood health and no chronic illnesses;she enters the outpatient clinic today

stating. I think Ive had a stroke.


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Subjective data:

One day PTA: first noticed at dinner atcollege cafeteria when joking with friends,started to stick out tongue and roll tongueand could not do it, right side of tongue wasnot working. Mara left room to look in mirrorand became scared; when smiled, noticed

right side was not working. Tried to puckerlips, could not. Could not whistle, could notraise eyebrow


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I looked like a Vulcan. No other movementdisorder below neck. Mild pain behind rightear with buzzing in ear. Able to sleep last

night, but roommate said Maras right eyeliddid not close completely during sleep. Today: still no movement on complete right

side of face. Feeding self-conscious in classand during conversations with friends. Nowhas taste aversion, fluids with high watercontent taste especially bitter. No hearingloss.


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Objective data:

T 37o C, P 64, R 14, B/P 108/78

Forehead appears smooth and immobile on

right, unable to wrinkle right side. Unable toclose right eye, Bells phenomenon presentwhen attempts to close (right eyeball rollsupward), right plapebral fissure appears

wider. No corneal reflex on right. Unable towhistle or puff right cheek. Absent nasolabialfold on right. Mouth sroops on right, sags


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Objective data

on right when tries to smile. Slight drooling.Left side of face responds appropriately to allthese movements. Superficial sensationintact.

Rest of musculoskeletal system intact; able tohold balance while standing, able to walk

heel-to-toe, do knee bend on each knee. Armstrength and range of motion intact.


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Assessment

Right-sided facial paralysis, consistent withBells palsy

Disturbed body image R/T effects of loss offacial function

Risk for deficient fluid volume R/T tasteaversion and dietary alteration

Risk for sensory deficit, visual Impairment,R/T effects of neurological impairment


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4th lecture headneck and lympatics

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