Head, Neck and Lymphatics
Typically the examiner takes the following approach when assessing the lymphatic system
Region by region as each body system is assessed
Expected subjective and objective findings of a patient with Torticollis (Wry Neck) - excessive contraction of the sternocleidomastoid muscle
SUBJECTIVE DATA: Patient complains of stiff neck and difficulty moving neck OBJECTIVE DATA: - head tilted/twisted toward affected sternocleidomastoid muscle - chin elevated and turned toward the opposite side - hematoma palpated up to 2-3 weeks after birth - firm, fibrous mass palpated in the sternocleidomastoid
What can the nurse practitioner expect to find when palpating the patient's skull?
Scalp moves freely over the scull, no tenderness, swelling, or depressions
The nurse practitioner can expect what finding in a lymphatic examination of an older adult
Small and fatty lymph nodes
Shotty nodes
Small, nontender nodes that feel like BBs under the skin
What is the most appropriate question for the practitioner to elicit information about the lymphatic system?
"Are you aware of any lumps?"
The nurse practitioner sees a female patient with a suspected thyroid problem. What is an appropriate question to elicit further information?
"Have you noticed a change in your sleep pattern or energy level?"
Definition and Common causes of acute suppurative lymphadenitis
"Infection and inflammation of a lymph node and/or group of localized nodes" Streptococcus and Staphylococcus spp.
The characteristic facies of a patient with fetal alcohol syndrome include:
- small head - hirsute forehead - inner epicanthal folds - small eye openings - widespread eyes - flat midface - short nose - poorly formed/ smooth philtrum - thin upper lip - underdeveloped jaw
What finding is cause for concern in the lymphatic exam of an adult
A lymph node that is palpable and fixed in its setting
If a lymph node is cancerous, what would the nurse practitioner expect to find?
A matted, firm node that is affixed to underlying tissue
The nurse practitioner palpates a thyroid gland that is enlarged bilaterally. What is the next step?
Auscultate for a bruit over the thyroid lobes
Location of the supraclavicular node
Above and behind the clavicle
Location of preauricular lymph node
Above and behind the ear
Location of occipital node
Base of the skull
Location of the submental node
Behind the tip of the mandible
A patient's facial characteristics include left facial palsy (paralysis), asymmetry of one side of the face, droopy eyelid/not completely closing, drooping corner of the mouth, and loss of nasolabial fold. What is the disorder associated with these characterized facies?
Bell Palsy
Differentiate assessing lymphatic system of a child versus an adult versus an elderly adult
CHILD: - thymus is larger - lymph nodes are readily palpable (until puberty) ADULT: - thymus shrinks (to a point where it is not assessed) - lymph nodes decrease in size ELDERLY: - thymus shrinks (to a point where it is not assessed) - lymph nodes decrease in size and function - lymph nodes become fibrotic and fatty - lymph nodes become impaired in their ability to resist infection
Facial muscles are innervated by which cranial nerves?
CN V - Trigeminal CN VII - Facial
When inspecting the facial features for shape and symmetry during rest, movement and expression - which cranial nerves are partially assessed?
CN V - Trigeminal CN VII Facial
Location of the deep cervical node
Deep under the sternomastoid muscle
A patient's facial characteristics include epicanthal folds, Mongolian slant of eyes, flat nasal bridge, and low-set ears. What is the disorder associated with these characterized facies?
Down Syndrome (Trisomy 21)
What is a normal finding in the thyroid gland of an older patient
Fibrosis of the thyroid gland Nodular thyroid
How will the nurse practitioner assess CN IX (spinal accessory)
Flexion against resistance Extension against resistance Rotation left/right against resistance
How will the nurse practitioner assess ROM of the neck?
Flexion/Extension Lateral bending left/right Rotation left/right
Matted nodes
Group of nodes that feel connected and seem to move as a unit
Lymph nodes of the head and neck
HEAD: 1) Occipital 2) Posterior auricular 3) Preauricular 4) Parotid 5) Retropharyngeal (Tonsillar) 6) Submandibular 7) Submental NECK: 8) Anterior cervical 9) Posterior cervical and deep posterior cervical 10) Supraclavicular
Distinguish common characteristics of HYPERthyroidism versus HYPOthyroidism.
HYPERTHYROIDISM: Weight - decrease Emotional state - irritable, highly energetic Temperature preference - cool Hair - fine; hair loss Skin - warm; hyperpigmentation at pressure points Neck - goiter; pain over thyroid GI - increased frequency of bowel movements Eyes - Proptosis; lid retraction; double vision HYPOTHYROIDISM: Weight - Gain Emotional state - lethargic; disinterested Temperature preference - warm Hair - coarse; tendency to break Skin - coarse; scaling; dry Neck - no goiter GI - constipation Eyes - puffiness in periorbital region
Location of the submandibular node
Halfway between the angle and tip of the mandible
Identify regions the examiner may assess for lymph nodes:
Head Neck Axillae Inguinal Popliteal
Three physical signs indicating disorders of the lymph system
I. Lymphadenopathy (enlarged lymph nodes) II. Lymphagitis (red streaks on the overlying skin) III. Lymphedema (edematous swelling due to excessive accumulation of lymph fluid caused by inadequate lymph drainage)
Two major landmarks of the face
I. Palpebral Fissures II. Nasolabial fold
Enlargement of the inguinal nodes are an indication of
Infection OR metastatic carcinoma in the associated anatomic area
A gritty sensation when the thyroid gland is palpated indicates...
Inflammation of the thyroid gland
The nurse practitioner recognizes that the size of normal cervical lymph nodes are
Less than 1cm
Location of the superficial cervical node
Overlying the sternomastoid muscle
How will the nurse practitioner assess supraclavicular lymph nodes?
Palpate deeply behind the clavicles as the patient takes a deep breath
A patient has asymmetry of the mouth. The nurse practitioner suspects a problem with
Peripheral trigeminal nerve
Location of the posterior cervical node
Posterior triangle along the edge of the trapezius muscle
Location of postauricular lymph node
Superficial to the mastoid process
TRUE or FALSE. The nurse practitioner can expect to determine an enlarged thyroid gland in a pregnant woman a normal finding
TRUE
TRUE or FALSE. The nurse practitioner should recognize that enlarged tonsils in a young child may be a normal finding.
TRUE
TRUE or FALSE. While palpating the lymph nodes on an adult, the nurse practitioner should remember that in healthy adults, lymph nodes are NOT easily palpable.
TRUE
The examiner palpates enlarged inguinal nodes in a 2-month old infant. What is an appropriate explanation for this.
The infant has a severe diaper rash. NOTE: Enlargement of the inguinal nodes suggests infection
What is the importance of assessing the lymph system?
The lymph drainage pattern tracks the course of disease
The nurse practitioner will use which technique to differentiate an enlarged lymph node from a cyst...
Transillumination