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Thursday, December 13, 2007

Examination of Head and Neck For Nurse Practitioner Students

Examination of Head and Neck
History for Head: frequent HA, trauma, dizziness, syncope, loss of consciousness
· Inspect and Palpate the Head - size, shape, position of eyes, ears, nose and mouth. Note any swelling or asymmetry.
· Acromegaly (excess growth hormone) - produces enlargement of both bone and soft tissue. Elongation of head with bony prominence of forehead, nose and jaw. Soft tissue of nose, lips and ears enlarge.
· Hydrocephaly - increased fluid within the ventricles of the brain.
· Hypothyroidism (myxedema) - dull, puffy face with periorbital edema. Skin is dry, hair course, eyebrows thin on outside.
· Cushing's Syndrome (excess adrenal hormone production) - moon face, red cheeks, possible mustache. Iatrogenic in patients taking long term, large doses of Prednisone.
· Parkinson's - decreased facial mobility giving "mask face" appearance with decreased blinking, stare with head flexed forward.
· Bell's Palsy - results from a paralysis of CN VII. The eye on the affected side cannot close completely, lower eyelid droops, corner of the mouth droops.
· Temporal Arteries - palpate and auscultate the temporal arteries for tenderness and bruits. Temporal arteritis can cause blindness and immediate referral is necessary.
· Temperomandibular Joint - palpate the TMJ for tenderness, crepitus, strength (CN V)
History for Nose: olfaction, nose bleeds, allergies, post nasal drip (PND), frequent colds or sinusitis.
Inspect the Nose: Upper 1/3 is bone, the remainder is cartilage
· Nasal mucosa - note color (normally dark pink), swelling, exudate, bleeding
· Turbinates - winding cavities from outside to pharynx, purpose is to increase surface area of nose for filtration. Inspect for deformity, asymmetry, inflammation. Use otoscope with wide nasal speculum. Can visualize middle and inferior turbinates but not superior.
· Septum - note any bleeding, perforation, deviation. Septal deviation is not significant if there is no airway obstruction
o acute rhinitis (cold) - thick yellow or green nasal discharge, often fever, mucosa red and swollen.
o allergic rhinitis - clear, watery nasal discharge, no fever, mucosa pale and boggy.
Palpate the Sinuses - tender in acute sinusitis. May complain of teeth hurting. Purulent discharge, nasal stuffiness, fever, malaise.
· Maxillary - under cheeks
· Frontal - over eyes
*Can't directly palpate ethnoid and sphenoid sinuses
Special Maneuvers: Transillumination of the sinuses is accomplishes in a slightly darkened room. A bright focused light is placed directly on the cheek over the maxillary sinuses. The patients mouth is open and the examiner looks for a light glow on the roof of the mouth. Diminished light may indicate full sinus cavities. Unequal light may indicate unilateral sinus fullness. For the frontal sinuses, the light is placed in the upper nasal orbit while the examiner looks for the glow in the frontal sinuses.