Health Assessment: Chapter 14 Head, Face, Neck, and Regional Lymphatics

lumps or tenderness in the neck suggests ___

acute infection of suspicion of malignancy

when does lymphoid tissue atrophy occur?

after puberty

aggravating tiggers for CLUSTER headaches:

alcohol consumption, stress, or wind or heat exposure.

precipitating factors for migranes

alcohol, stress, menstruation, chocolate, cheese

submandibular lymph node located

along base of mandible

Cephalhematoma

collection of blood between periosteum and skull bone that it covers does not cross suture line results from trauma during birth

Narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia are characteristics of

congenital hypothyroidism.

Sutures of the skull

coronal, sagittal, lambdoid, squamous

crepitation

crackling sound

Bell's Palsy affects which cranial nerve?

cranial nerve #7

all head and neck lymph nodes eventually drain into the _____

deep cervical chain

cricoid cartilage

inferior to the thyroid cartilage

an infant with cephalhematoma is at greater risk for____

jaundice, because RBCs within the hematoma are broken down and reabsorbed

Supraclavicular lymph node

just above and behind the clavicle, at the sternomastoid muscle

blood vessels of the neck

left & right common carotid arteries (external & internal carotid arteries branch from common carotid arteries) left & right external jugular veins (primary drainage of head) vertebral artery

to ease a migraine headache, what do you advise the patient to do?

lie down

cachexia

a condition of physical wasting away due to the loss of weight and muscle mass that occurs in patients with diseases such as advanced cancer or AIDS

fetal alcohol syndrome (FAS)

a medical condition in which body deformation or facial development or mental ability of a fetus is impaired because the mother drank alcohol while pregnant

conduit

a pipe or channel through which something passes

prodrome

a symptom indicating an approaching disease

Onset of cluster headaches

abrupt

facial characteristics of down syndrome:

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

concussion

violent shaking up or jarring of the brain

rickets

vitamin D deficiency= osteomalacia in children; causes bone deformity

steps in palpating the lymph nodes of the face and neck

watch vid

symptoms of hypothyroidism

weigh gain, fatigue, slow heart rate and respiration rate, cold intolerance

Atelactis

collapsed lung

parotid gland enlargement

Rapid painful inflammation of the parotid occurs with mumps. Parotid swelling also occurs with blockage of a duct, abscess, or tumor. Note swelling anterior to lower ear lobe. Stensen duct obstruction can occur in aging adults dehydrated from diuretics or anticholinergics.

nystagmis

Rhythmic, constant, and rapid involuntary movement of the eyeball

what do normal lymph nodes feel like?

Soft, nontender, moveable and discrete

anxiety, stress, are associated with ____

tension headaches

If lymph nodes are enlarged or tender what should you check?

the area they drain at

Congenital Torticollis

the child prefers to hold the head to one side and is commonly due to malposition of the head in utero or birth trauma. May see a swelling where the affected SCD is.

what would be an important factor in evaluating a neurologic deficit?

the patients chaining level of consciousness

pregnant women and thyroid gland:

the thyroid gland enlarges slightly during pregnancy as a result of hyperplasia of the tissue and increased vascularity

internal carotid arteries supply _____

Brain

axis

C2 bone; allows one to pivot neck

nasolabial folds

"smile lines" or "laugh lines"

Presyncope

(dizziness) a light-headed, swimming sensation or feeling of fainting or falling caused by decreased blood flow to brain or heart irregularity causing decreased cardiac output

the carotid artery and internal jugular vein lie beneath what muscle?

Sternomastoid muscle

inspect the face:

-Facial expression -Symmetry of movement (cranial nerve VII) -Any involuntary movements, edema, lesions

inspect and palpate the skull:

-General size and contour -Note any deformities, lumps, tenderness -Palpate temporal artery, temporomandibular joint

How many facial bones are there?

14

infant can turn head side to side by_______ weeks, and shows what reflex?

2 weeks, tonic neck reflex

When does the tonic neck reflex disappear?

3-4 months

average size of newborn head

32-38cm

when does a Childs head size reach 90% size?

6 years old

the head and neck have_____ lymph nodes

60-70

WITH LARGE RIGHT-SIDED ATELECTASIS, THE TRACHEA IS DEVIATED TO THE ________

AFFECTED SIDE (RIGHT)

inspect and palpate the neck:

Active ROM, potential enlargement and position of trachea

posterior cervical lymph node

Along the edge of the Trapezius Muscle

fontanel

Anatomical feature of an infant's skull, the "soft-spot" during 1st year

infants must sleep on their ___

BACK

atlas

C1 bone; allows one to nod

Vertigo

Condition of dizziness, "room spinning" -often from a labyrinth-vestibular disorder

Facial muscles are innervated by

Cranial Nerve VII (facial nerve)

Multinodular goiter

Enlarged thyroid gland with multiple nodules

Simple Diffuse Goiter (SDG)

Goiter, a chronic enlargement of the thyroid gland, is common in wide regions of the world (especially mountainous regions) where the soil is low in iodine. Iodine is an essential element in the formation of thyroid hormones.

what does bruit in the thyroid indicate?

Hyperthyroidism

facial characteristics of hypothyroidism:

Puffy face around the eyes dry skin dry course hair dry facial hair

palpating the trachea

Normally, the trachea is midline; palpate for any tracheal shift. Place your index finger on the trachea in the sternal notch, and slip it off to each side (Fig. 13-13). The space should be symmetric on both sides. Note any deviation from the midline.

subjective vertigo

Person feels like he or she spins

stroke

Sudden loss of consciousness, sensation, and voluntary motion caused by rupture or obstruction (as by a clot) of a blood vessel of the brain.

Hypothalamus secretes

TRH

symptoms of hyperthyroidism

Tachycardia; heat intolerance; fatigue; restlessness; tremor; emotional instability; insomnia; warm, moist skin; increased appetite, weight loss; frequent stools; decreased serum lipids; decreased libido; erectile dysfunction

vertebra prominens (C7)

Transitions to thoracic vertebrae Has a long spinous process with a broad tubercle Has large transverse processes

facial sensations of pain or touch are mediated by the 3 sensory branches of the cranial nerve ____

V (5)

two triangles of the sternomastoid muscle

anterior triangle and posterior triangle

Plagiocephaly

asymmetry of the skull

occipital lymph node located

base of skull

what can parotid gland enlargement be caused by?

blockage of duct, abscess, tumor mumps, or AIDS

bruit

blowing, swooshing sound heard through a stethoscope when an artery is partially occluded

tonic neck reflex beyond 5 months may indicate ____

brain damage

loss of consciousness before a fall may have a _____cause

cardiac

myxedema

caused by extreme deficiency of thyroid secretion; also known as adult hypothyroidism

Cushing's syndrome

caused by prolonged exposure to high levels of cortisol, rounded features

drainage patterns of lymph nodes:

check the area proximal (upstream) to the enlarged lymph node

atopic facies

children with chronic allergies get an exhausted face, blue shadows below eyes, facial pallor, open mouth breathing

deep cervical chain lymph nodes

deep under the sternomastoid muscle

deep cervical lymph node

deep under the sternomastoid muscle

what are causes of depressed of sunken fontanels in infants?

dehydration or malnutrition

the trachea is________ with a right pneumothorax

deviated to the unaffected side (left)

dysphagia

difficulty swallowing

Hodgkin's lymphoma

distinguished from other lymphomas by the presence of large, cancerous lymphocytes known as Reed-Sternberg cells -painless, rubbery, in neck region

caput succedaneum

edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma

lymphdenopathy

enlarged (diseased) lymph nodes

lymph nodes: HIV

enlarged, firm, non-tender, and mobile, occipital node enlargement is common with HIV infection

acromegaly

enlargement of the extremities, excessive pituitary gland secretion

the external carotid arteries supply____

face, salivary glands, temporal area

onset of tension headache

gradual

head size is _____ than chest circumference at birth

greater

lymph nodes: cancerous

hard, unilateral, non tender, fixed to adjacent structures

four areas where lymph nodes can be examined:

head & neck, arms, axillae, and groin area (inguinal)

Role of sternocleidomastoid neck muscle

head rotation and flexion

leading cause of acute pain and lost productivity

headaches

aggravating tiggers for MIGRANES;

hormonal fluctuations, certain foods, letdown after stress, changes in sleep pattern, sensory stimuli, and changes in weather or physical activity.

Graves disease

hyperthyroidism caused by an autoimmune response; may cause exophthalmos

preauricular lymph node located

in front of the ear

facial characteristics of 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.

vertigo together with unilateral hearing loss may suggest ____

meniere disease

Types of headaches

migraine, cluster, tension

nausea, vomiting, and visual disturbances are associated with ____

migraines

role of the two trapezius muscles

move the shoulders and extend and turn the head

facial characteristics of FAS

narrow palpebral fissures, epicanthal folds, and midfacial hypoplasia

lymph nodes: acute infection

nodes are bilateral, enlarged, warm, tender, and firm but freely movable

lymph nodes in chronic inflammation

nodes are clumped

Symptoms of Myedema (hypothyroidism)

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.

When does the tonic neck reflex appear?

occurs in an infant when supine and head turned to one side

palpebral fissure

opening between eyelids

Palpate the TMJ as the patient:

opens mouth

superficial cervical lymph node

overlying the sternomastoid muscle

parotid glands

pair of salivary glands in the cheeks in front of the ears

objective vertigo

person feels like the room is spinning

during infancy, trunk growth ____

predominates, so head size changes in proportion to to body height

Crainosynostosis

premature closure of sutures in infants

Craniosynostosis

premature closure of sutures of the skull in an infant

What does Tummy Time do?

prevents the development of flat spots on the back and head. Helps strengthen the muscles of the head, neck, back

thyroid gland

produces hormones that regulate metabolism, body heat, and bone growth

the trachea is _______ with a aortic arch aneurysm

pulled downward with each systole

normocephalic

refers to round symmetric skull that is appropriately related to body size

during what trimester can chloasma show up?

second trimester

Disequilibrium

shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits

pilar cyst

smooth, firm, fluctuant swelling on the scalp that contains sebum and keratin

major neck muscles

sternomastoid and the trapezius; innervated by cranial nerve XI

The major neck muscles are

sternomastoid and trapezius

aggravating symptoms or triggers for tension headaches:

stress, anxiety, depression, and poor posture

onset of migraine headache

sudden

posterior auricular lymph node

superficial to the mastoid process (behind the ear)

what lymph nodes enlarge in Hodgkins lymphoma?

supraclavicular nodes

what happens to facial bones in the aging adult?

they may look more prominent due to loss of skin elasticity and sub q fat

where is the thyroid gland located

throat

thyroid hormone

thyroxin, influences metabolism

how to inspect thyroid

tilt patient's head back and have them drink a glass of water to watch the thyroid tissue move up with a swallow and fall to a resting position

when palpating the deep cervical chain of lymph nodes, have the patient

tip their head towards the side being examined

how do you test a patient's neck strength & status of cranial nerve XI?

trying to resist the patient's movements with your hands as the person shrugs the shoulders and toes the head side to side

jugulodigastric (tonsillar) lymph node located

under the mandible

Palpate lymph nodes

with finger pads in a slow waling, gentle circular motion with BOTH hands

chronic migraines are more common in who?

women, whites & hispanics

does hypertension, fever, and hypothyroidism produce headaches?

yes

oral contraceptives cause headaches?

yes

Is lymphoid tissue well developed at birth?

yes, grows to adult size at 6 yrs old

are bruits common in the skull of younger children?

yes, heard in the temporal area

Are migraines genetic?

yes, they can play a role

tracheal shift

• The trachea is pushed to the unaffected (or healthy) side with an aortic aneurysm, a tumor, unilateral thyroid lobe enlargement, and pneumothorax. • The trachea is pulled toward the affected (diseased) side with large atelectasis, pleural adhesions, or fibrosis. • Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysm.