Chapter 9

What is torticollis?

Stiff neck with muscle spasm of sternocleidomastoid muscle one side of the body causing lateral flexion contracture of the cervical spine musculature.

What is a palpebral fissure?

The distance between the upper and lower eyelids. Should be the same on both eyes.

What is a nasolabial fold?

The distance from the corner of each nostril to the corner of the lip bilaterally. Should be equal on both sides.

____ is a blood test to evaluate the thyroid gland functioning.

Thyroid-stimulating hormone (TSH)

What is the purpose for inspecting and palpating the tongue?

To assess color, movement, and abnormalities.

What is the purpose of auscultating the thyroid?

To assess for an enlarged thyroid gland, to check for presence of bruit.

What is the purpose of inspecting and palpating the hard and soft palates?

To assess for color, tenderness, and abnormal deviations.

What is the purpose of inspecting and palpating the buccal mucosa?

To assess for inflammation, lesions, or abnormalities

What is the purpose of inspecting the pharynx and tonsils?

To assess for redness and inflammation.

The nurse is standing in front of the patient preparing to assess the maxillary and frontal sinuses. What is the purpose for this exam?

To assess for tenderness or pain.

What is the purpose for inspecting and palpating the trachea?

To assess for tracheal shift or deviation.

What is the purpose of inspecting the thyroid?

To assess size and mobility.

What is the purpose of inspecting the neck?

To assess symmetry, movement, and swelling.

What is the purpose of palpating the face?

To assess tenderness, swelling, and inflammation.

What is the purpose of palpating the thyroid?

To assess the thyroid for smoothness, enlargement, nodules, or tenderness.

When the nurse is assessing for history of seizures, she should ask about:

Types of seizures, symptoms, and medications taken for seizures

When the nurse is assessing history of headaches, she should ask about:

Unusually severe headaches, frequency, other associated symptoms, specific location of pain.

What is the nurse looking for when she assesses the mouth?

Redness, tenderness, lesions, abnormalities

What are some identifiers of mitral stenosis?

Rosy cheeks or slightly cyanotic cheeks, and dilated capillaries.

What are normal findings when assessing the face?

Round/oval/square shape, symmetrical facial structures, nasolabial folds and palpebral fissures are bilaterally equal, relaxed expression, good eye contact, no involuntary movement or pulsations, smooth and clean skin, no edema.

What are the major sutures of the cranial bones?

Sagittal, coronal, and lambdoidal

What is the neck composed of?

Seven cervical vertebrae, muscles, and ligaments.

What is the nurse looking for when she is inspecting the lips?

Shape and integrity, symmetry, color, moisture, lesions, swelling.

What are some identifiers of scleroderma?

Sharp nose and shiny, tightly drawn skin on face.

______ are hollow air-filled spaces that surround the nasal cavity and decrease the weight of the skull. They also give resonance to the voice during speech.

Sinuses

When the nurse in inspecting the head, what is she looking for?

Size, shape, configuration, movement, tenderness, masses, and depressions.

What is atrophic glossitis?

Smooth red or pink tongue, may indicate nutritional deficiencies

_____ made of muscle and connective tissue, responsible for closing off the nasal passages during swallowing.

Soft palate

Which health care specialist performs a swallowing evaluation?

Speech pathologist

How will the nurse palpate the thyroid?

Stand behind the patient and ask the patient to sit up straight with neck slightly flexed to the right. Place finger pads between sternomastoid muscle and trachea on each side of neck below cricoid cartilage. Have patient swallow and feel the rise of the thyroid. Assess the swallowing when thyroid is pushed to left then right.

How should the nurse position herself when assessing the sitting patient during an inspection of the face?

Stand in front of the patient

How will the nurse inspect the thyroid?

Stand in front of the patient. Inspect neck for swelling or enlargement of thyroid gland below cricoid cartilage. Have patient swallow and observe upward motion of thyroid.

_____ are located in the upper buccal mucosa. Saliva flows from this rout into the mouth.

Stensen's ducts

What are the major muscles supporting the neck? These muscles also for the anterior and posterior triangles of the neck.

Sternocleidomastoid and trapezius

What is the nose made out of?

Bone and cartilage.

What is pharyngitis?

A sore throat caused by inflammation of the mucous membranes of the back of the throat. May be viral or bacterial.

____ is a blood test to differentiate causes of thyroid disfunction.

Free thyroxine (Free T4)

How is tonsil enlargement graded?

+1 tonsils are visible and slightly protruding. +2 tonsils are halfway between tonsil pillars and uvula. +3 tonsils are almost touching uvula. +4 tonsils are touching each other.

What is magnetic resonance imaging?

A noninvasive test that uses powerful magnetic field and radio frequency waves and a computer to produce images of inside the body.

What is a cluster headache?

A vascular headache, stabbing pain on one side of the face or behind one eye, or at the temple near the forehead. Constant pain in clusters or periods of time. Occurs between 12AM-3AM or early evening.

What is gingivitis?

Mild type of periodontal disease. Red, swollen, bleeding gums

What is tonsilitis?

A viral or bacterial infection of tonsils. Tonsils enlarge, are swollen, may have white or yellow drainage.

How many bones make up the adult skull?

22

What is a computed tomography scan?

A noninvasive test that combines xray equipment to produce images of inside the body. Can be done with or without contrast, such as iodine dye.

What is palatinus?

Abnormal growth that develops midline in the hard palate.

______ are clusters of lymphatic tissue behind the nose and are part of the immune system.

Adenoids

If the patient is experiencing hoarseness, what should the nurse assess?

Allergies, vocal cord straining, smoking, cancer, GI reflux, and neurological disorders

If the nurse notices nasal drainage, how should she document this finding?

Amount (scant, moderate, copious) color (clear, yellow, green, bloody), consistency (thin, thick), odor.

What is a goiter?

An enlargement of the thyroid gland

What is the nurse assessing when inspecting the face?

Appearance, shape (round, square, oval), symmetry, nasolabial folds, palpebral fissures, facial expression, involuntary movement, condition and texture of skin, and edema.

What should the nurse assess while inspecting the neck?

Ask the patient about neck injuries, stiffness, pain, swelling, lumps, or thyroid problems.

How will the nurse position the patient to assess the trachea?

Ask the patient to sit up straight and bed her head slightly forward to relax the sternomastoid muscles.

What are some identifiers of systemic lupus erythematosus (SLE)?

Butterfly rash on face

What is aphthous stomatitis?

Canker sore

_____ are located on each side of the neck and transport oxygenated blood.

Carotid arteries

What considerations should the nurse use before prepping a patient for a CT scan?

Check for allergies to iodine, shellfish, or contrast dyes. The nurse knows that CT scans expose the patient to more radiation than an Xray, which can lead to cancer.

____ (buccal mucosa) are the lateral walls of mouth.

Cheeks

What is gingival hyperplasia?

Chronic gum infection. Gums pull away from teeth and create open spaces that collect bacteria, which will destroy the teeth and surrounding tissues

What are some reasons a nasal passageway may be occluded?

Congestion, obstruction, rhinitis, or polyps

How are the bones of the head and face connected?

Connective tissue and immovable joints, called sutures.

_____ is the large part of the skull that protects the brain from injury and acts like a helmet to the brain.

Cranial vault

The head is divided into two parts, called:

Cranium and face

____ is a ring of cartilage around the trachea.

Cricoid cartilage

When the nurse is assessing the patient's nose, she should ask about:

Current problems with nose, breathing through nose, changes in ability to smell, nasal drainage, postnasal drip, sinus congestion, nosebleeds, and allergies.

With clean gloves, the nurse inspects the mouth for:

Dentures, caps, missing teeth, color, tooth decay.

What are some risk factors of nasopharyngeal cancers?

Diets high in salt-cured fish and meat, Epstein-Barr virus, smoking. 2x more common in men than women. Most common in Chinese, Asian, Black, Hispanic than Whites.

What are some identifiers of trauma and basal skull fracture with bleeding into the middle fossa, also called battle sign?

Discoloration behind the ear, and mastoid ecchymosis

What are some identifiers of severe myxedema?

Dull, puffy face, thickening of the tongue, dry, rough skin, pallor and lip pallor, edema particularly pronounced around the eyes and does not pit with pressure

When the nurse is palpating the patient's face, what will the nurse palpate?

Earlobes, corner of eyes, and temporal arteries simultaneously.

What is angioedema?

Edema of the lips related to allergic reaction. Pallor may indicate decreased perfusion related to respiratory cardiovascular problems.

____ is the flap that separates trachea from esophagus. Prevents aspiration of food and fluids.

Epiglottis

What are some identifiers of Cushing's syndrome?

Face is round and puffy (Moon face), red cheeks, excessive hair growth on face, and acne

What are some risk factors for thyroid cancer?

Family history of thyroid cancer, diet low in iodine, exposure to radiation. 3x more often in women than men.

____ requires endoscope to pass through nose into the pharynx to view structures of the through and assess swallowing.

Fiber optic endoscopic evaluation of swallowing

While the nurse is assessing the patient, she uses her ______ to palpate the face.

Finger pads

The nurse will use her ______ to palpate the patient's zygomatic arch.

Fingertips

What are the four pairs of sinuses and their locations?

Frontal: above the eyes in the center of the forehead. Ethmoid: between the eyes and deeper in the skull. Sphenoid behind the nasal cavity, deep in the skull. Maxillary in the cheekbones below the eyes.

What is thrush?

Fungal infection that creates thick, white to yellow patches on tongue or cheeks. Occurs with weakened immune system and antibiotic therapy

______ are covered by mucous membranes, mucosa, and is the surface area of the tooth root and the alveolar bone.

Gingiva (gums)

What equipment will the nurse need to use for the inspection of the tongue?

Gloves, penlight, tongue blade, sterile gauze.

____ is a thin horizontal plate of the skull, located in roof of mouth, covered with stratified squamous epithelium.

Hard palate

What is a geographical tongue?

Harmless condition. Tongue is covered with tiny, pinkish-white bumps, patches on tongue are missing papillae. Tongue appears smooth, red. Island has raised borders.

What is a hairy tongue?

Has white or dark overgrowth, has a hairy surface that may indicate immune suppression or too much bacteria

How does the nurse inspect and palpate the tongue?

Have patient stick out tongue and inspect color, look for lesions, or coating. Look at lateral edges, voluntary movement, tremors, position of the tongue. Have patient touch roof of mouth with tongue.

How will the nurse inspect the pharynx and tonsils?

Have the patient open wide, tilt the head back, and say "ahh." Use a penlight to inspect the palates and uvula. With a moistened tongue blade, depress patient's tongue and have them say "ahh" to look at throat and tonsils. Touch back of pharynx with tongue depressor to make gag reflex.

The nurse is assessing a patient's nasal passageway for signs of occlusion. What should she have the patient do?

Have the patient press on the right naris to occlude the passageway and inhale through the left naris with the mouth closed. Repeat the step with the left naris.

How should the nurse treat a patient with a nosebleed?

Have the patient sit and lean forward to keep the blood from dripping into the posterior pharynx. Have the patient continuously pinch the nostrils tightly for 10-15 minutes.

What are some identifiers of severe aortic insufficiency?

Head bobbing or hard nodding with each heartbeat.

When the nurse is assessing the head, she should ask about:

Head injuries, dizziness or vertigo, fainting spells, loss of consciousness, seizures, headaches.

Which senses are contained in the head?

Hearing, seeing, smelling, and tasting

Which bone is a horse-shaped bone between the chin and the thyroid? It's the only bone in the body not connected to any other bone.

Hyoid bone

How will the nurse inspect the buccal mucosa?

If patient wears dentures, remove them. Use a tongue blade to depress the tongue. Wearing gloves, palpate the buccal mucosa and gums.

When should a patient seek emergency medical attention regarding a nosebleed?

If the nosebleed lasts longer than 30 minutes, interfering with breathing, or if the nosebleed follows an injury.

How will the patient be positioned during the assessment of the thyroid?

Seat the patient with her head in a neutral or slightly extended position.

When assessing a patient's head, nose, and throat, how should the nurse position the patient?

In a sitting position

What can a CT scan of the sinuses help diagnose?

Infection, nasal polyps, birth defects, or abnormalities of the sinuses.

What is angular cheilitis?

Inflammation of the corners of the mouth, sore, cracked corners of the lips. Caused by yeast infections, dry mouth, or vitamin deficiency.

When reviewing past medical history of the patient and family, what is the nurse looking for?

Injuries, hospitalizations, surgeries, use of tobacco, and psychological history.

How will the nurse assess the neck?

Inspect the neck for symmetry and swelling. Have patient turn her head to assess ROM. Turn side to side, forward and backward, shoulder to shoulder.

How will the nurse inspect and palpate the trachea?

Inspect trachea below thyroid isthmus. Place right index finger in the sternal notch. Slip finger off to each side noting distance from sternomastoid muscle. Assess symmetrical spacing on each side.

What is the purpose of the neck?

It supports the weight of the head, and protect the nerves that carry sensory and motor impulses from the brain to the body.

____ is the largest and strongest bone of the face.

Jaw bone (mandible)

____ are located on each side of the neck, empty deoxygenated blood into superior vena cava.

Jugular veins

___ is located between the trachea and tongue; organ of voice.

Larynx

What are normal findings of the palpation of the trachea?

Lateral lobes may or may not be palpable. Lobes are smooth, firm, and nontender.

What are some identifiers of myasthenia gravis?

Lid lag (upper eyelid doesn't keep pace with the eyeball as it follows a moving object down from above), flushing of skin, exophthalmos (protruding eyes), nervousness

____ mark the transition of mucous membrane of mouth to skin.

Lips

_____ are part of the lymphatic system, made up of reticular connective tissue filled with lymphocytes. Found all over the body.

Lymph nodes

What considerations should the nurse use before prepping a patient for an MRI?

Make sure all jewelry is removed and notify the physician of any metallic implants or pacemakers.

What are some identifiers of Parkinson's disease?

Mask-like features, lack of facial expression, slowness to smile, decreased blinking, and characteristic stare

If a patient is experiencing xerostomia, what else should the nurse assess?

Medications the patient is taking, if the patient is experiencing a systemic disease, radiation therapy, anxiety, or depression, eating and/or talking difficulties.

______ is a radiologic procedure which uses a fluoroscope to view images of liquid passing from the mouth to the stomach.

Modified barium swallow study

______ is midline, made of cartilage and many blood vessels, divides the nose into two equal parts. Receptors for CN 1 (Olfactory) are located in upper part of septum and nasal cavity.

Nasal septum

The anterior part of the neck in front of the vertebrae makes up the ____ and ____ and consists of the pharynx, larynx, trachea, and esophagus.

Nasopharynx and oropharynx

What are normal findings of an inspection of the thyroid?

Neck area at the site of thyroid should have smooth, straight appearance. Thyroid gland and cricoid and thyroid cartilage should move up when swallowing.

What are normal findings of a neck assessment?

Neck is symmetrical, no swelling, no pain with ROM, full ROM.

What is a normal finding when auscultating the thyroid?

No sounds are heard.

What are normal findings of an assessment of the maxillary and frontal sinuses?

No tenderness or pain

What are normal findings when assessing a patient's face?

No tenderness, no signs of TMJ clicking or limited ROM.

_____ are lined with mucus membranes.

Nostrils (nares)

What is the OPQRST method?

Onset, Provokes or Palliates, Quality of the pain, Region and Radiation, Severity, and Timing

_____ is mucous membrane epithelium lining inside the mouth.

Oral mucosa.

_____ are the largest salivary glands for the mouth, located in the front, back, and each side of the mouth.

Parotid glands.

If the trachea deviates to the affected side of the disease, what could this indicate?

Pulmonary fibrosis, pleural adhesion, or large pulmonary atelectasis.

_______ secrete saliva to start the process of digestion and moisten the mucosa. They produce 0.5 to 1.5 listers per day.

Parotid, submandibular, and sublingual salivary glands

What are normal findings of an inspection and palpation of the tongue?

Pink skin color, saliva, papillae on dorsal tongue surface, midline position, ventral surface of tongue is smooth, pink, and moist, no lumps or nodules, ducts are visible.

What are normal findings of a buccal mucosa inspection?

Pink, smooth, moist, no lesions, no swelling, no bleeding, tight margin around each tooth, no tenderness

What is squamous cell carcinoma?

Presents as a thickened white or red patch or plaque. May develop nodularity or ulceration. Usually laterally on the tongue.

What is a tension or stress headache?

Pressure in front or both sides of head or neck, related to muscle contraction. Feels like a band is tightening around the head.

What are some identifiers of congenital aortic stenosis, also called elfin face?

Prominent forehead, short upturned nose, widely spaced eyes, full cheeks, and deep husky voice.

What are some identifiers of aortic regurgitation of heart failure, also called corvisart facies?

Puffy cyanotic face, swollen eyelids, and shiny eyes.

_______ is located in the lower mandible and drains saliva through the Wharton's ducts into the lower oral cavity.

Submandibular gland

When the patient is touching the roof of his mouth with his tongue, what is the nurse looking for?

Surface of the floor of the mouth, the frenulum, ventral surfaces of the tongue, Wharton's ducts.

______ will help diagnose difficulty swallowing, also known as dysphagia.

Swallowing evaluation

What should the nurse assess while inspecting the throat?

Swallowing, sore throat, pain, or hoarseness.

What are the normal findings of a head assessment?

Symmetric, midline, round, normocephalic, head is erect and still with no involuntary movements, no pain, tenderness, masses, or depressions.

When the nurse is standing in front of the patient and looking at the nose, she is looking for what?

Symmetry, alignment of the septum, color, swelling, and drainage.

What are normal findings while assessing a patient's nose?

Symmetry, straight and center septum, skin color is same as face color, no lesions, swelling, or deformity, no drainage.

What are some normal findings during a lip inspection?

Symmetry, the upper lip is everted, skin is pink, moist, no lesions, no swelling, intact skin

_____ are rooted in the gums and used for chewing and breaking down food.

Teeth

_____ is a major artery of the head which branches from the external carotid artery and is palpable in front of each ear.

Temporal artery.

______ is a hinge joint connecting the upper temporal bone and the mandible and can move front, back, and side to side.

Temporomandibular joint

How will the nurse assess the maxillary and frontal sinuses? looking for when she assesses the mouth?

The nurse will place her thumbs below the eyebrows and press up and under the brows. She will then place her thumbs below the cheek bones and palpate that area.

How will the patient be positioned for an inspection of the neck?

The patient will sit up straight with neck in the normal position and slightly hyperextended.

The cranium (or skull) is supported on what?

The top of the vertebral column by the atlas, also known as the first cervical vertebrae.

How many bones are in the adult face, and what are they?

There are 14 bones in the adult face: zygomatic (2), vomer (1), palatine (2), nasal (2), maxillae (2), mandible (1), lacrimal (2), and inferior nasal conchae (2).

How many cranial bones are there, and what are their names?

There are 8 cranial bones: frontal (1), parietal (2), temporal (2), occipital (1), ethmoid (1), and sphenoid (1)

What is a normal finding for nasal patency?

There should be no occlusion of the nose.

_____ is commonly done to identify organisms causing infection. Completed by swabbing the back of the throat and incubating on a medium.

Throat culture

What is a sinus headache?

Throbbing pain in the front of the face, accompanied by upper respiratory symptoms.

____ is a butterfly shaped organ, largest endocrine gland and has a major role in metabolism.

Thyroid

_____ is the largest cartilage of the larynx, which protects the vocal folds. Can be prominent and known as the Adam's Apple.

Thyroid cartilage

____ is a nuclear medicine test to assess functioning of thyroid gland, masses, of inflammation. Radioactive iodine detected in thyroid corresponds with amount of hormone being produced in the thyroid.

Thyroid scan

What is the purpose of inspecting teeth?

To determine the position, number, and integrity of teeth. Adults will have between 28 and 32 teeth.

What is the purpose of assessing the patient's nose?

To look for tenderness, inflammation, or deviation.

What is the purpose of the nose?

To warm, moisten, and filter the air. Used for inhaling and exhaling air, and for smelling.

What are some risk factors of oral cavity and oropharyngeal cancers?

Tobacco use, alcohol consumption, sun exposure, weakened immune system, and HPV. These are twice as common in men than women.

____ is a muscle in the mouth used for taste.

Tongue

_____ are soft masses of lymphoid tissue in the back of the pharynx, make up part of the immune system.

Tonsils

____ is a cylindrical tube made of cartilage and membranes, measures 4.5" in length, 3/4" in diameter.

Trachea (wind pipe)

What are normal findings when inspecting and palpating the trachea?

Trachea is midline and symmetric on each side.

What are normal findings of a hard and soft palate inspection?

Transverse rugae, irregular ridges are firm, pink to light red in color, moist, ducts are draining, no tenderness, soft palate is pink, moist, no lesions. Skin is intact. Bony ridge of posterior hard palate is present.

_____ is a blood test to help identify an overactive thyroid gland.

Triiodothyronine (T3)

If the trachea deviates to the unaffected side of the disease, what could this indicate?

Tumor or aneurysm, thyroid lobe enlargement, or pneumothorax.

_____ are boney lobes on lateral walls of nasal cavity and increase surface area. Contain airflow pressure and temperature-sensing nerve receptors.

Turbinates

How will the nurse assess the hard and soft palates?

Using a pen light, inspect the palates and the ducts. With index finger, palpate hard and soft palate.

What are normal findings of an inspection of the pharynx and tonsils?

Uvula rises midline and symmetrically, throat is pink, tonsils are pink, may protrude partially or be absent. Positive gag reflex.

What is a migraine headache?

Vascular headaches, with unilateral, pulsating, intense pain lasting 4 hours to 3 days. Nausea, vomiting, sensitivity to light and noise and smells.

_____ are located on each side of the oral cavity and drain saliva from the submandibular and sublingual glands.

Wharton's ducts

How will the nurse assess for TMJ disorder?

While palpating the zygomatic arch with the fingertips, the nurse will have the patient open and close her mouth. The nurse will listen for any clicks and assess for decreased ROM.

What is leukoplakia?

White or grey patches on the tongue. Precancerous.

What are normal findings of teeth inspection?

White to ivory color, should be clean and free of debris, smooth edges, 32 or 28 teeth present

How will the nurse auscultate the thyroid?

With the patient sitting up straight with her neck slightly flexed, the nurse will her the bell of the stethoscope to auscultate both lobes of the thyroid to listen for a whooshing or abnormal sound.

What does the nurse look for while assessing a patient's mouth?

Xerostomia, bad breath, excessive saliva, mouth pain, jaw pain, tooth pain, bleeding gums, access to dental insurance, status and amount of teeth.