copyright 2002, delmar, a division of thomson learning chapter 11 head, neck, and regional...
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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.
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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.
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Anatomy and Physiology Skull Face Neck Thyroid Lymphatics Blood supply
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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
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Evaluating Chief Complaint Determine the following
characteristics Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing
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Past Health History Medical conditions Surgeries Medications Communicable diseases Injuries or accidents Special needs
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Family Health History Determine if family history of
Thyroid disease Headache
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Social History Alcohol use Work environment Home environment Stress
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Health Maintenance Activities Sleep Diet Use of safety devices
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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
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Assessment of the Head Inspection
Shape Symmetry
Palpation Contour Masses Depression Tenderness
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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
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Assessment of the Face Inspection
Shape Symmetry
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Assessment of the Face Normal findings
Symmetrical features Palpebral fissures equal Nasolabial folds present bilaterally Shape can be oval, round, or slightly
square
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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
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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
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Neck Inspection Palpation Normal findings
Full ROM, pain free, symmetrical muscles, no masses
Abnormal findings Limited ROM, pain, asymmetrical
muscles, masses
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Thyroid Gland Inspection Palpation Auscultation
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Thyroid Gland Normal findings
Symmetrical movement with swallowing
Adam’s apple more pronounced in males
No masses, tenderness, or enlargement Absent bruit
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Thyroid Gland Abnormal findings
Mass Enlarged gland Goiter Asymmetrical enlargement Presence of a nodule or bruit
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Lymph Nodes Inspection Palpation
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Lymph Nodes Location
Preauricular Postauricular Occipital Submental Submandibular Anterior and posterior cervical chains Tonsilar Supraclavicular
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Lymph Nodes Normal findings
Unable to palpate or see nodes Abnormal findings
Enlarged nodes Able to palpate or see nodes Tenderness Firm, hard nodes
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Gerontological Variations Appearance and function of head
and neck may be altered Buffalo hump Kyphotic posture Limited ROM Dizziness