Head and Neck

By Orest Kornetsky

Anatomy review

Anatomy

Anatomy – Salivary Glands

Anterior and Posterior Triangles

Anatomy

Lymphatics

Anatomy - Lymphatics

History Headaches?

“Any unusually frequent or unusually severe headaches?” A severe headache for a person who’s never had headaches

should warrant further attention When - onset, duration Where

Tension headaches – tend to be occipital or frontal Migraine headaches – supraorbital, retro orbital, or frontotemporal Cluster headaches – pain around the eye, temple, forehead, and cheek. Pain

unilateral. Character

Throbbing (pounding, shooting) – migraine Aching (constant pressure, dull) – tension headache

Intensity - mild, moderate, or severe Precipitating factors Associated factors

Vision changes, N&V, pain with bright light, neck stiffness, fever, Alleviating factors Other illnesses Medications

History Head injury?

When History of head injuries or other medical conditions? Location LOC – Loss of Consciousness?

Dizziness? Lightheadedness or spinning? Vertigo is true rotational spinning due to neurologic dysfunction (vestibular

apparatus) Objective – perception that room spins Subjective – perception that person is spinning

Neck pain? When, where, precipitating and alleviating factors

Acute onset of stiffness along with headache and fever occurs with meningeal inflammation

Limitations to ROM? Lumps or swelling?

Tenderness? Acute infection

Lumps If over 40, suspect malignancy until proven otherwise

Smoker? How long? Packs per day? Chew tobacco? Increased risk of tumors

Assessment - Head Size and shape

Normocephalic Hydrocephalus

enlargement of head, increased circumference

Paget’s disease Enlargement and softening of bone

Acromegaly abnormal enlargement of skull and

facial bones Temporal artery

Palpate above zygomatic bone, between eye and top of ear

Temporomandibular joint Anterior of ear, between mandible and

temporal bone Palpate joint as person opens mouth.

Normally smooth movement Abnormal – crepitations, limited ROM,

tenderness

acromegaly

TMJ

Assessment - Face

Symmetry of eyebrows, mouth

Changes in skin Tics or twitches Tightened facial

muscles - pain

Stroke vs Bell’s Palsy

Bell’s Palsy CN VII paralysis Unilateral Thought to happen due

to herpes simplex virus Person cannot wrinkle

forehead, raise eyebrow, close eye, or show teeth on affected side

Stroke

Acute neurological deficit due to obstruction of cerebral vessel, as in atherosclerosis, or rupture in a cerebral vessel

Paralysis of lower facial muscles, but upper half of face not affected.

Still able to wrinkle forehead and close eyes

Fetal Alcohol Syndrome

Down Syndrome

Trisomy 21 Characteristics

Upslanting eyes Flat nasal bridge and

nose Protruding tongue Short broad neck with

webbing Small hands

Assessment - Neck Symmetry – head and neck

muscles ROM

Ask person to touch chin to chest, turn head to right and left, try to touch each ear to shoulder, extend head backwards

Note limitation of movement

Muscle strength Test strength by resisting

movement CN XI – Accessory n. –

Trapezius m. Thyroid gland

Enlargement of lower neck may be bilateral or a unilateral lump

Diffuse enlargement or nodular lump

Palpating the Thyroid Gland Posterior approach Anterior approach

Place fingers inferior and lateral of thyroid cartilage and ask the person to swallow Usually, you cannot

palpate the normal adult thyroid

Enlarged lobes are also tender to palpation

Hypothyroidism Mild deficiency called

“hypothyroidism.” Severe deficiency called “myxedema.” In infancy called “cretinism.”

S/S: Face is pale, puffy, and

expressionless Skin is cold and dry Hair is brittle, hair loss Lowered heart rate and

temp Lethargy, fatigue,

intolerance to gold Impaired mentality Goiter!

Cause Hashimoto’s disease

Autoimmune disease where antithyroid antibodies block thyroid hormone production

Iodine deficiency in diet Surgical removal of

thyroid

Hyperthyroidism

Grave’s disease Most common. More common in women. S/S

Rapid heartbeat, dysrhythmias, angina Rapid thought flow and rapid speech,

nervousness, and insomnia Increased BMR, appetite Goiter + Exophthalmos

Cause Thyroid Stimulating Immunoglobulins (TSIs) mimic

the effects of TSH on thyroid function Toxic nodular goiter (Plummer’s disease)

Result of thyroid adenoma Exophthalmos is missing

Exophthalmos

Lymph Nodes

Lymph nodes Beginning with the preauricular lymph nodes, palpate

the 10 groups of lymph nodes in a routine order Lymphadenopathy - enlargement of lymph nodes due to

infection, allergy, or neoplasm

Trachea Normally, the trachea is

midline Palpate for any tracheal

shift by placing index finger in the sternal notch Trachea pushed to unaffected side in aortic aneurism, a tumor, pneumothorax

Trachea pushed to affected side with large atelectasis, pleural adhesions, fibrosis

Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysms

Developmental Considerations - Infants

Skull Should be round and

symmetrical Caput succedaneum –

elongation of skull at birth – resolves

Cephalohematoma – hemorrhage due to trauma at birth – resolves in few weeks (Fig 13-17)

Fontanels – anterior and posterior. Normally close by 2 years

Depressed – dehydration Bulging – increased ICP

Transillumination done if abnormal head size or intracranial lesion is suspected

Hydranencephaly – thinning or absence or cerebral cortex

cephalohematoma

transillumination

Question 1

A magnetic resonance imaging (MRI) is prescribed for a client with Bell’s palsy. Which nursing action is included in the client’s plan of care to prepare for this test?1. Keep the client NPO for 6 hours before the

test2. Remove all metal-containing objects from the

client3. Shave the groin for insertion of a femoral

catheter4. Instruct the client in inhalation techniques for

the administration of gas

Question 2

A nurse has an order to obtain a sputum culture from a client admitted to the hospital with a diagnosis of pneumonia. The nurse avoids which action when obtaining the specimen?1. Placing the lid of the culture container face

down on the bedside table2. Obtaining the specimen early in the morning3. Having the client brush teeth before

expectoration4. Instructing the client to take deep breaths

before coughing

Question 3

A nurse employed in a long-term care facility is planning the client assignments for the shift. Which of the following clients would the nurse most appropriately assign to the nursing assistant (NA)?1. A client requiring BID dressing changes2. A client requiring frequent ambulation3. A client on a bowel management program

requiring rectal suppositories and a daily enema

4. A client with diabetes mellitus requiring daily insulin and reinforcement of dietary measures

Question 4

A client with a subarachnoid hemorrhage has been placed on subarachnoid (aneurysm) precautions. The nurse ensures that the client is provided with which of the following?1. Daily stool softeners2. Bright lights3. Television and radio4. Enemas as needed

Question 5

Which assessment is most important for the nurse to make before advancing a client from liquid to solid food?

1. Food preferences2. Appetite3. Presence of bowel sounds4. Chewing ability

Question 6

A nurse prepares a nursing care plan for a client with Graves’ disease who is to receive radioactive iodine therapy. Which of the following statements would be most appropriate for the nurse to include in the teaching plan for this client?1. The radioactive iodine is designed to destroy the

entire thyroid gland with just one dose2. It takes 6 to 8 weeks after treatment to experience

relief from the symptoms of the disease3. The high levels of the radioactivity prohibit contact

with family for 4 weeks after initial treatment4. Following the initial dose, subsequent treatments

must continue lifelong