N209 - Head, Face, and Neck

term that denotes a round, symmetrical skull that is appropriately related to body size

Which of the following would require you to further evaluate the pt. head, neck or face?

a. “any time I cough or sneeze, I get a headache.”

b. “I can’t turn my neck to the left side.”

c. “I don’t ever experience dizziness.”

d. “I had a concussion about a month ago.”

Which of the following findings on the skull are abnormal and which are normal?

• round, symmetric skull

• large, fixed masses

• inflammation of hair follicles (folliculitis)

• appropriate size in relation to the body

• sebaceous cysts

• pain, ulcers, indentations, old scars

abnormally small head

abnormally large head

= large, elongated bones, jaw, forehead, nose, & lips

• possibly caused by a pituitary tumor bc of excessive secretion of GH

= cerebrospinal fluid accumulation around the brain, causing the head to enlarge in babies

• Causes downcast or “sunsetting” eyes

• use shunts to drain fluid down brain to abdomen

What is being palpated in the image? What is a normal finding? What is abnormal?

Is this face a normal finding? why or why not?

fixed, nonmobile expression, shows no emotion

shifts rapidly b/t moods and facial expressions.

withdrawn, turned down mouth, no eye contact

Where should you expect symmetry in the face?

= deficiency of the neurotransmitter dopamine and degeneration of the substantia nigra

• Immobility of features produces a face that is flat and expressionless

• Fixed/staring gaze, elevated eyebrows

= a wasting syndrome associated with complex disease processes such as cancer, heart failure, AIDS, and COPD

Signs:

• Severe weight loss

• Loss of muscle

• sunken eyes

• Hollow cheeks

• Fatigue

• Muscle weakness

• anorexia

Caused by excessive secretions of ACTH and chronic steroid use.

Signs:

• a rounded, “moonlike” face

• prominent jowls (lower portion of cheek)

• red cheeks

• hirsutism of upper lip

• lower cheeks & chin

• acneiform rash on chest

= a lower motor neuron lesion, producing rapid onset of cranial nerve VII paralysis of facial muscles

• almost always unilateral

• Most common cause of facial paralysis

Risk factors include:

• Being exposed to herpes simplex virus type 1

• Having diabetes

• Being pregnant

• Having had a previous episode of Bell's palsy

= an upper motor neuron lesion; caused by a blood clot of a cerebral vessel

• lower face paralysis (can still move forehead and close eyes)

alcohol = a teratogenic to the developing fetus

• can cause intellectual disabilities, birth defects, & changes in face and brain structures

Signs:

• small, wide-set eyes

• wide flat area between eyes

• thin upper lip

• upturned nose

= a deficiency of thyroid hormone, meaning metabolic rate is reduced

• caused by hypothyroidism

Signs:

• dull skin

• round, swollen face and eyes

Which triangle of the neck is this?

Which triangle of the neck is this?

A nurse is palpating the neck on both sides at the same time. Why is this incorrect?

= a condition causing asymmetrical head or neck position (stiff neck, lateral flexion contracture)

Caused by:

• neck injury

• inflamed lymph glands

• sinus, ear, and throat infections

• tumors

• drug abuse (i.e., acetaminophens & cocaine)

supplies the sternocleidomastoid and trapezius muscles

How would you test muscle strength and the status of cranial nerve XI?

size, shape, borders, tenderness/pain, consistency should all be noted when palpating _________ _______.

Which Size/shape indicates a normal lymph node?

a. large, irregular

b. <1 cm or nonpalpable, round

Which delineation indicates an abnormal lymph node?

a. confluent

b. discrete

Which mobility indicates a normal lymph node?

a. mobile

b. fixed

Which consistency indicates a normal lymph node?

a. hard

b. soft

Would a tender node be a normal finding?

#1?

#2?

#3?

#4?

#5?

#6?

#7?

#8?

#9?

#10?

= enlargement of the lymph nodes (>1cm) from infection, allergy or neoplasm

Lymph nodes are bilateral, enlarged, warm, tender, and firm, but are still freely moveable. What can this mean?

what does it mean if the lymph nodes are clumped together? What illness can cause this?

If the lymph nodes are hard (like rocks), >3 cm, unilateral, nontender, and fixed, what can this indicate?

What does a single, non-tender, hard, left supraclavicular node indicate?

What do painless, rubbery, discrete nodes in the cervical region indicate?

What might the pt. have if their lymph nodes are enlarged, firm, non-tender, and mobile?

Which nodes are common with HIV when abnormal?

When might the trachea be pushed to the unaffected/normal side?

When might the trachea be pulled to the abnormal side?

Is the trachea being pushed or pulled in the image?

Is the trachea being pushed or pulled in the image?

What might unilateral bulging of the thyroid gland indicate?

= an autoimmune disease with increased production of TH and increased metabolic rate

manifested by:

• goiter

• bulging eyes

• eyelid retraction

What does this photo depict?

What would you normally hear when listening to the thyroid gland? What part of the stethoscope is used?

Soft, pulsatile, whooshing, blowing sound heard when there is accelerated or turbulent blood flow to the thyroid.

• unstable neck

• discrete, palpable nodes in children

• misshapen skulls from birth trauma

• measuring head circumference

swelling & ecchymosis from the presenting part of the head (resolves w/o treatment)

subperiosteal (beneath periosteum) hemorrhage (resolves w/o treatment)

premature closure of cranial sutures

• Results in malformed head & cosmetic deformity

• From genetic mutations

• Temporal artery may look prominent & twisted

• Isolated head tremors are benign (includes head nodding and tongue protrusion)

• Slower ROM head/neck

  • May experience dizziness

• Kyphosis (“hump back”)

• Thyroid often nodular and may be lower in the neck

  • Nearly impossible to palpate

= light-headed, swimming sensation from decreased blood flow to brain or decrease cardiac output

= room is spinning

= shakiness or instability when walking (r/t musculoskeletal disorder or multisensory deficits)

palpation that can cause the heart rate to drop =

usually nonpalpable, right side is 25% larger than left, sometimes felt in thin necks, and always felt in pregnancy.

• character: throbbing, pulsation

• severity: moderate-to-severe

• duration: rapid onset, peaks 1-2 hours, last 4-72 hours

• location: behind the eyes, temples, or forehead

• sensitive to light

• character: continuous, sharp, burning, piercing, excruciating

• duration: abrupt onset, peaks in minutes, lasts 15-180 min

• location: always one-sided, behind or around the eye, temple

• severity: can occur multiple times a day, very severe pain

• character: tightness, nonthrobbing, nonpulsatile

• duration: gradual onset, lasts 30 minutes-7 days

• location: frontal, temporal, occipital

• severity: mild-to-moderate pain