Head, Face, Neck Regional Lymphatics

anencephaly

congenital deformity in which some or all of fetal brain is missing

Cluster

intermittent, excrutiating, unilateral, ALWAYS one sided, often behind or around the eye, temple, forehead and cheek, more prevalent in men, exacerbated by alcohol, stress, afternoon napping, severe stabbing pain, need to move and pace floor, nasal congestion

Hashimoto thyroiditis

is a condition with excess thyroid hormone production; symptoms include goiter, nervousness, fatigue, weight loss, muscle cramps, heat intolerance, tachycardia, shortness of breath, excessive sweating, fine muscle tremor, thin silky hair and skin, infrequent blinking, and a staring appearance.

Stroke

is you suspect a stroke, ask the person to smile, paralysis of LOWER facial muscles, person is still able to wrinkle the forehead and close the eyes (unlike Bells Palsy)

Sublingual glands

lie in the floor of the mouth

Characteristics of nodes

location, size, shape, mobility, tenderness, consistency

macrocephaly

abnormally large head

Downs Syndrome

upslanting eyes with inner epicanthal folds; flat nasal bridge; small, broad, flat nose; protruding thick tongue; and ear dysplasia.

Tracheal tug

Rhythmic downward pull that syncs up with systole in aortic arch aneurysm

Migraine

Run in family, vascular, more prevalent in women, headache plus aura, prodome, commonly one sided, pain often behind the eyes, the temples or forehead, hormonal fluctuations, chocolate, coffee, physical activity, need to lie down and darken room

Red flag for headaches

Severe headache in an adult or child who has never had one before

Disequilibrium

Shakiness or instability when walking related to muscularskeletal disorder or multisensory deficits

Virchow node

Single, enlarged no tender hard left supraclavicular node may indicate neoplasm in thorax or abdomen

Sample documentation

Solitary, hard, fixed node right occipital region

Nasolabial folds

the creases extending from the nose to each corner of the mouth

Palbebral fissures

the openings between the eyelids

The nurse examines the throat and asks the patient to say ahh, what are the expected findings

the soft palate rises symmetrically and uvula rise in the midline. This tests one function of CN X, the vagus nerve.

If the thyroid gland is enlarged,

Auscultation for prescience of a bruit, could mean hyperthyroidism

sentinel node

"Keeps watch"; serious if you lift your shoulder and feel node in clavicle, very bad. A sentinel lymph node is the first lymph node into which a tumor drains, and is the first place cancer cells are most likely to spread. In some cases, there can be more than one sentinel node. In breast cancer, for instance, the sentinel node is usually located in the axillary nodes (the lymph nodes under the arm). If you

Submental

Midline, behind the tip of the mandible; as you palpate with one hand, use the other hand to hold the person's head in place

Tracheal shift

-Pushed to the unaffected side or healthy side with aortic aneurysm, a tumor, thyroid love enlargement, or pneumothorax - trachea is pulled toward the affected side with atelactasis, pleural adhesions, or fibrosis

Health Promotion for Head Injuries

-loss of conciousness happens in 10 percent of the cases -signs and symptoms include changes in memory, sensitivity to light and sound, headache and pressure; very likely to get another concussion in the first 10 days afterwards

Aging Adults Issues

1. senile tremors are benign and include head nodding and tongue protrusion; 2. twisted prominent temporal arteries 3. increased cervical concavity to balance out kyphosis 4. sublingual gland prolapses; not a lymph node 5. tongue profusion 6. less apt to have palpable nodes; lymphs start to recede at puberty

microcephaly

Abnormally small head; infants with Zica virus

Senile tremors

Are benign and include head nodding and tongue protrusion,

Occipital

Base of the skull

Posterior Triangle

Behind the sternomastoid muscle with the trapezius muscle on the other side and its base along the clavicle below, when describing findings in the neck

Enlarged nodes

Check the area they drain for the source of the problem, explore the area proximal (upstream) to the enlarged node. All head and neck structures eventually drain into the deep cervical chain

Deep cervical

Deep under the sternomastoid muscle; tip the person's head to the side being examined to relax the muscle, then press fingers under the muscle

Cranial V

Facial sensations for pain and touch are mediated by the three sensory branches of cranial nerve 5,

Hyperthyroidism

Grave's disease; Hypersecretion of thyroxine from immune system attacking thyroid gland causing ANXIETY, irritability, insomnia, (LIKE MOTOR RUNNING) tachycardia, tremors, diaphoresis, sensitivity to heat, weight loss, exophthalmos and photosensitivity, diarrhea,

Submandibular

Halfway between the angle and the tip of the mandible

Normal Objective Findings

Head: normocephalic, no lumps, no lesions, no tenderness, no trauma Face: symmetric, no drooping, no weakness or involuntary movements Neck: supple with full ROM, no pain, symmetric, no cervical lymphenopathy or masses, trachea midline, thyroid not palpable

Preauricular

In front of the ear,

Posterior cervical

In the posterior Triangle along the edge of the trapezius muscle

Vertigo

Is when you are spinning, you feel like it is inside "I feel like I'm spinning."

Supraclavicular

Just above and behind the clavicle, at the sternomastoid muscle; have the person hunch the shoulders and elbows forward; this relaxes the skin; make sure to not mistake the omohyoid muscle for a lymph node

Health promotion for headaches

Keep neck supple

Anterior Triangle

Lies in front between the sternomastoid and the midline of the body with its base up along the border of the mandible and its apex down at the Suprasternal notch

Presyncope

Light headed swimming sensation or feeling of fainting

Head injuries

Lose consciousness before the fall then it may have a cardiac cause (heart block), a change in level of consciousness is most important in evaluating a neurological deficit

Thyroid enlargement

May be a unilateral lump or it may diffuse and look like a donut lying across the lower neck

Carotid arteries

More anterior than the jugular, on each side; listen for bruits with the bell of stethoscope in three places

Jugular Arteries

More posterior on each side

Cranial nerve XI

Movement of trapezius and sternomastoid muscles; test it by trying to resist the person's movements with your hands as the person shrugs the shoulders and turns the head to the side

Hypothyroidism

Myxoedema, resulting in puffy face, eyelids, narrow palebral fissures, dry skin, sparse and brittle hair, loss of hair in the eyebrow; cant lose weight A disorder caused by a thyroid gland that is slower and less productive than normal; DEPRESSION

Subjective questions for headaches

Not a good question to ask, "do you have ever have headaches," because most people have had at least one headache. Make sure to get a detailed history of headaches regardless,

Superficial cervical

Overlying the sternomastoid muscle

matted

Packed into a thick mass; anywhere there is an infection,

Hodgkins

Painless, rubbery discrete nodes that gradually appear occur with Hodgkin lymphoma, commonly in cervical region

Palpating the thyroid

Posterior approach: move behind the person; curve your right fingers between the trachea and the sternomastoid, retracting slightly and have them take a sip of water; only enlarged thyroid are palpable

Posterior auricular (mastoid)

Superficial to mastoid process

Trachea

The trachea is normally midline; enlarged thyroid could push trachea to one side -with a right pneumothorax, the trachea is deviated to the unaffected side (left) -The trachea is pulled downward with systole of an aortic arch aneurysm. -With a large right-sided pleural adhesion, the trachea is deviated to the affected side (right). -With a large right-sided atelectasis, the trachea is deviated to the affected side (right).

Dizziness

The world is spinning;

Jugoludigastric

Tonsillar, under the angle of the mandible

Inspecting the thyroid

Use tangential light to assess; have pt relax their muscles, expect to see symmetry; have them drink water three times, look for big lump rising when swallowing

Headaches

Women are apt to migraines, cluster headaches are men, migraines are vascular

hydrocephaly

__________ is the excess of cerebrospinal fluid in the head due to a blockage.

Submandibular gland

beneath the mandible at the angle of the jaw;

Pregnancy in thyroid

can make the thyroid bigger

Body systems affected by the thyroid

cardiovasular, neurological, reproductive, digestive, integumentary

Myxedema

deficiency of thyroid hormone. If severe, the symptoms include nonpitting edema or myxedema; a puffy edematous face, especially around the eyes (periorbital edema); coarse facial features; dry skin; and dry coarse hair and eyebrows.

lymphadenopathy

enlarged nodes associated with infection

Goiter

enlargement of the thyroid gland; as a result of hypothyroidism; thyroid cant make enough so keeps making more thyroxin, need iodine salt

Parkinson Syndrome

face that is flat and masklike, elevated eyebrows, staring gaze, oily skin and drooling

Normal Findings for nodes

feel moveable, discrete, soft, and nontender

Alteration

hard, fixed can mean cancer; tender, matted means infection

Auscultating the Thyroid

if it is enlarged, use the bell of stethoscope and listen for a bruit or occlusion in blood flow; increased vascularity is secondary to Grave's Disease

Assess motion of temporomandibular joint

in front of ears, moving jaw up and down, bit of clicking is ok, headache from tmj problem

Congenital hypothyroidism

low hairline, hirsute forehead, swollen eyelids, narrow palpebral fissures, widely spaced eyes, depressed nasal bridge, puffy face, thick tongue protruding through an open mouth, and a dull expression.

Thyroid gland

low in the neck, lobes lie beneath sternomastoid muscle. Isthmus of thyroid connects two lobes and lies below cricoid cartlage

Bells Palsy

lower motor neuron lesion producing rapid onset of cranial nerve VII paralysis of facial muscles, usually unilaterally, wide palpebral fissure,

Tension headache

musculoskeletal origin; less painful than migraines, usually bilaterally over forehead, sides and back of head, in response to overwork; leaning over books or computer, rest, massaging muscles, NSAID

Technique of Palpation

organized and efficient, pads of fingers, rotary or circular movement, lightly, avoid pressure on the carotoid, note: location, size, shape, mobility, tenderness, consistency

Parotid gland

salivary gland within the cheek just anterior to the the ear; largest but NOT palpable

Thyroidectomy

surgical removal of the thyroid gland; or biopsyis node is greater than 1cm to rule out thyroid cancer, not common

Fetal Alcohol Syndrome

short palpebral fissures, flat midface, short nose, indistrinct philtrum, low nasal bridge

shotty

small nodes that fell like BBs or buckshot under the skin; full all the time, never goes away; always palpable

Expected Findings

soft firm, mobile, non-tender, discrete, shotty

Trachea

the trachea is midline, palpate for any tracheal shift, place index finger in the sternal notch and slip it off to one side. the space should be symmetric on both sides. Note any deviation from midline; usually enlarged thyroid

Cranial nerve VII

the trigeminal nerve; what controls facial muscles. Facial muscle function is bilaterally symmetrical except for the occasional wry expression