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.