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