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29 Cards in this Set
- Front
- Back
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Areas of the skull
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frontal, temporal, parietal, occipital
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sutures of the skull
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coronal, squamous, lambdoidal
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how many facial bones are there
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14
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History: head
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-Headache?
-Vertigo?: rotational spinning -Trauma?: head injury, amnesia, blackouts -Medications?: Rx, OTC, homeopathic -Systemic infections? |
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Headache subjective
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-Onset: when did this H/A start? Gradual suddenly
-Location: where do you feel it? Temporal, behind eyes, bandlike, in sinus area, occipital -character: throbbing -Course and duration -Pattern: family history, related to menses, getting worse, getting better? -Precipitating events? -what makes it worse? movement, coughing, straining, exercise -Coping strategies -Medications that produce H/As: OC's, bronchodilators, nitrates, carbon monoxide inhalation |
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tension headaches
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-location: bandlike
-bilateral -character: viselike -ass symptoms: anxiety/stress |
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cluster headaches
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-location: pain around eye, temple, forehead and cheek
-unilateral -character: severe throbbing -course/duration: 1-2 per day, each lasting ½ to 2 hours, for 1 or 2 months, then remission for months or years -precipitating events: alcohol and daytime napping -ass symptoms: Eyelid drooping, nasal congestion -Coping strategies: moving helps |
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migraines
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-Location: supraorbital, retroorbital, frontotemporal
-unilateral -character: severe throbbing -course/duration: 1 to 2 per month, each lasting 1 to 2 days -precipitating events: alcohol, let-down after stress, menses, eating chocolate or cheese -ass symptoms: nausea, vomiting and visual disturbances -Coping strategies: lying down helps |
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Head injury subjective
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-Onset?
-What happened? -Setting. Wearing a helmet? -Symptoms prior to injury. Dizzy, lightheaded, seizure, blackout? -Lose consciousness, then fall? -Hx of illness, heart trouble, diabetes, epilepsy -Location: where did you hit your head? -Duration: how lost unconsciousness? -Symptoms afterward: H/A/, N &V, sleepy? Worse since injury? Effort to treat? |
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neck pain subjective
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-Onset: injury, auto accident, after lifting, from a fall? Fever? (R/O meningeal inflammation) Gradual onset?
-Location: pain radiating to shoulders, arms? -Associated symptoms: limited ROM, numbness, or tingling in arms, shoulders or hands -Precipitating factors: lifting, stress, certain movements? |
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Lumps or swelling subjective
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-Any recent infection? Tenderness?
-Lump that persists? (over age 40 R/O malignancy) -Prior irradiation of head, neck, upper chest? (increased risk for salivary and thyroid tumors) Dysphagia? -Do you smoke? Chew tobacco? -Alcohol consumption? -Thyroid problem? -Surgery of head or neck? |
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Physical exam: head
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-Inspect: scalp contour-lesions, dryness, gross abnormalities
-Size and proportion to body -Hair color and distribution -Hair quality and texture -Skull-tenderness, masses, lesions, mastoid area tenderness -Mastoid process-tenderness -Temporal area: artery looks tortuous and feels hardened and tender with temporal arteritis -Caput Succedanem: crosses suture lines, edema and ecchymosis |
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infants head
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-anterior fontanels: diamond shaped: 9 months to 2 years
-posterior: triangle shaped: closed by 1-2 mos -head size > chest circumference |
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physical exam: face
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-Inspect: expression, symmetry, hair distribution, contour, involuntary movements, skin pigmentation, lesions, edema, masses, thickness, signs of trauma
-Palpate: use two hands: masses (size, contour, consistency, tenderness, mobility) -Areas of numbness, tenderness -Hair: quality, texture -Palpate: Maxillary sinuses for tenderness (tender with chronic inflammation) -Frontal sinuses for tenderness (ethnoid and sphenoid sinuses not accessible to examination) -Temporomandibular joint: check for tenderness (have client open and close mouth during examination-note decreased motion, tenderness, crepitus |
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History: nose and mouth
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-Injuries/trauma/sinus pain (trauma can cause deviated septum)
-Surgical procedures -Tooth extraction -Last dental check-up: findings -Dentures -Medication history: iron, flouride (brown with excessive use), tetracycline -Exposure to toxin-lead, bismuth -Systemic disease: infection/deficiencies -Allergies: pollen, dust pet dander: how was this determined? -Asthma -Frequent colds -Nasal discharge: rhinorrhea -Sore throat/hoarseness:untreated strep throat can lead to rheumatic fever -Bleeding gums -Dysphagia -Epistaxis: trauma, vigorous nose blowing, pregnancy (main reasons for nosebleeds) -Smoking (associated with tooth loss, gum disease, mouth and throat cancers)/alcohol consumption -Altered smell or taste ( can be due to aging) -Pain/soreness -Bleeding (comes from anterior septum) -Foul taste/breath odor -Masses/lesions/fissures (any lesions persisting more than 2 weeks should be investigated) -Difficulty opening mouth -Hoarseness/ptalism/nasal discharge -Coughing/sneezing |
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Physical exam: nose
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-Place client in a comfortable sitting position for viewing of the nose, mouth and throat
-Inspect for deformity, asymmetry, inflammation, skin lesion -Gently palpate for pain -Test patency of nostrils -Test sense of smell (Cranial nerve I) -Nasal cavity: insert lighted speculum avoiding upward pressure -Inspect middle and inferior turbinates (superior not in view) -Note polyps, swelling, discharge, bleeding or foreign bodies (insects, peanuts, etc.) |
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Physical exam: lips
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-Inspect color (pallor with shock and anemia, cyanosis with hypoxemia, cherry red lips with CO poisoning), fissures, nodules, masses, swelling, dryness, ulcers
-Check for congenital or acquired defects (e.g. cleft lip) -Inspect inner lip by retracting with tongue blade while lips are closed-pursed lips |
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physical exam: teeth:
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-Check number of teeth (adults have 32-16 in each arch; children have 20 deciduous teeth erupting between 6 months and 24 months of age)
-Tap each tooth for tenderness Presence of wisdom teeth -Check for alignment -Malocclusion: arches out of alignment -Infants have Epstein's pearls (small retention cysts-normal finding) |
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physical exam: gums
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-Check for gum retraction
-Check for bleeding -Check for abscess or swelling -if client has false teeth, remove dentures prior to examination -Breath: what did you eat last? |
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physical exam: tongue
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-Inspect coating, color, adhesiveness, thickness, texture, fissures, size, geographic tongue (normal variation)
-Check deviation from midline when protruded (Cr Nerve XII) -Check for restricted protrusion -Raise tongue to roof of mouth -check for length of frenulum: check for lesions (most mouth cancers develop here) -Check for salivary excretion-submaxillary -Duct at root of frenulum |
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Stenson's ducts
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next to second molar
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Wharton's ducts
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floor of mouth
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Bucchal mucosa
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-inspect for lesions, color, bleeding,
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inspection of mouth and throat
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--use tongue blade to inspect throat: Say "ah", depress middle of the tongue
-anterior and posterior pillars -Tonsils if present: grade 1-4+ scale -tonsillar buds -Check for crypts, any material -Color of uvula and symmetry to rise of uvula when client says "Ah" -Check pharynx for color, swelling, exudate, lesions -Check hard and soft palates for color, perforation, lesions/masses, symmetry |
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gag reflex is what nerves
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cranial nerves IX & X
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Neck info
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-C1- the Atlas
-C2- the axis down to C7 -Major muscles: sternomastoid, trapezius (very tight with stress) -Innervated by cranial nerve XI-shrug against resistance -Trachea: normally midline; palpate for shift |
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Neck history
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-Neck pain? Onset? Injury?
-Gradual onset? Does it radiate? -Limitations to ROM? -Coping strategies: meds, treatments -Checking lymph nodes: gentle circular motion -Always use same sequence: know the lymph nodes |
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Neck exam
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-Check ROM: note any pain, limitation of movement
-Chin to chest, turn head to right and left -Ear to shoulder -Head extended backward ( be careful with this) -Normal finding: motion smooth and controlled without limitation -Check thyroid: note enlargement, tenderness, nodules. May find lump or diffuse enlargement -May use anterior or posterior method to evaluate thyroid |
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Cranial nerve XI Spinal Accessory
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resists shoulder shrug and head turned to side
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