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What does assessment of the head and neck include?
  • Skull
  • Face
  • Eyes
  • Ears
  • Nose and Sinuses
  • Mouth and Pharynx
  • Trachea, Thyroid Gland
  • Lymph Nodes
What questions should be asked about onset when assessing headaches?
  • Any unusually frequent or unusually severe headaches?
  • When did this headache start?
  • Was onset gradual, over hours or days?
  • Was onset sudden over minutes or less than an hour?
  • Have you ever had this kind of headache before?
  • What time of the day do they happen?
  • Do they wake you up from sleeping?
  • Do they happen daily? In what time period?
What should be asked when Q/R/S?
  • Where do you feel the pain?
  • Is the pain localized on one side or all over?
  • What is the character of the pain? (throbbing, pounding, constant, shooting or arching, viselike, pressure or dull)
  • Is the pain mild, moderate, or severe?
  • What would you rate the pain at?
  • Are there any associated factors? (N/V, visual distrubances)
When assesing P what should you ask concerning headaches?
  • Are there any precipitating factors? Causes/triggers?
  • Does anything make it better or worse?
What are general health history questions to ask when assesing a headache?
  • Do you have any other illnesses?
  • what medications do you take?
  • Do you have a familial history of headaches?
  • What do you take for your pain?
What are some symptoms of migraine headaches?
  • often periorbital
  • 2x-3x a month lasting 2-3 days
  • light and sound sensitivity
What are some sypmtoms of tension/stress headaches?
  • constant band like pain from forehead to back of neck
  • can last from 30 minutes to several days
  • mild to moderate pain
What are some symptoms of cluster headaches?
  • can occur 2-3 times a day and last minutes to hours
  • onsets is sudden
  • most often they are unilateral
  • pain is extreme and described as piercing or boring
  • pain is often periorbital
Assesment after a head injury
  • When did it happen?
  • Where did it happen?
  • Where did you hit your head?
  • Did you blackout or seizure before the injury?
  • Did you lose conciousness before or after?
  • Any history of heary problems, DM, seizures?
  • Are there any associated symptoms? (N/V, bloody nose, leaking CSF)
  • Are there any changes in level of conciousness?
Assessment of dizziness
  • Determine what is meant by dizziness (light headed or falling feeling vs spinning)
  • Onset (when did it start)
  • Associated symptoms? (N/V, hearing loss, tinnitus)
What is the difference between objective and subjective dizziness?
  • Objective dizziness is when the pt feels the room is spinning
  • subjective dizziness is when the pt feels that they are spinning
Assesment of neck pain
  • Onset, how did it start? (MVA, after lifting, after a fall)
  • Location: does it radiate to shoulders or arms?
  • Associated symptoms: tingling in shoulders/arms, limited ROM
  • precipitating factors: what movement causes pain? lifting or bending?
Assesment of lumps or swelling in the neck
  • Any recent infections or tenderness?
  • How long has the lump been there?
  • Any difficulty swallowing?
  • Do you smoke or chew tobacco?
  • How much alcohol do you consume?
  • Have you ever had any thyroid problems?
  • persistent painless lumbs in people > 40 y/o are often malignent
Objective assesment of the head
  • inspect and paplate the skull
  • look at the shape and size
  • note lumps, depressions, deformities
  • inspect the face
  • look for symmetry of the eye brows, palpebral fissures, nasolabial folds, and sides of mouth
  • Note abnormal facial structure, skin pigmentation, exophthalmos, swelling under eyes, involuntray movements
Objective assesment of the neck
  • Inspect and palpate neck
  • check symmetry
  • check ROM
  • check lymphnodes
  • palapte border of the trachea
  • palpate the thyroid gland (not usually palpable in adults, isthmus may be papable if neck is long and thinn)
Assessment of lymphnodes
  • use the pads of the 2nd and 3rd fingers in a circular motion
  • palpate lymphnodes for enlargement, tenderness, and mobility
  • they are generally nonpalpable
  • document location, size, consistency, mobility and tenderness
What are abnormal findings for the skull?
  • Macro/microcephaly
  • hydrocephaly
  • lumps, depressions, abnormal protrusiuons
  • crepitation, tenderness
What are abnormal findings in the face?
  • allergic salute
  • parkinsons mask
  • asymmetry: bells palsy vs stroke (stroke can wrinkle forehead)
  • periorbital edema
  • tics
What are abnormal findings for the thyroid?
  • Lymphadenopathy: enlargement of nodes to > 1 cm
  • acute infection: bilateral, enlarged, warm, tender, firm, freely movable
  • chronic inflammation: nodes are clumped
  • HIV: nodes are enlarged firm, nontender, moble
  • Hodgkins lymphoma: painless, rubbery, discrete nodes that appear gradually
Eye assessment questions
  • Any difficulty seeing or blurriness?
  • onset slow or sudden?
  • in one or both eyes?
  • Any blindspots or night blindness?
  • cloudiness or floaters? (common after middle age, acute onset could be retinal detachment)
  • pain? burning or itching? stabbing/sharp?
  • strabismus? (cross eyes/lazy eyes)
  • diplopia (double vision)
  • redness or swelling?
  • watering or discharge?
  • do you wear glasses or contacts?
Eye assessment tests
  • snellen eye chart: 20 ft from chart, cover one eye and attempt to read
  • test visual fields: tests peripheral vision
  • cover uncover test: tests muscle strength
  • six cardinal fields: hold head steady and follow with eyes (each of six positions and back, clockwise)
What are you looking at while inspecting general ocular structures?
  • general shape
  • protrusion
  • eyebrows
  • eyelids/lashes
  • conjunctiva
  • sclera
Eye abnormalities
  • periorbital edema
  • cataracts (cloudiness) could mean a brain tumor in children
  • arcus senilis: white or grey ring in the corneal margin
  • ectropin: lower lid dropping
  • entropin: lower lid turning inward
  • ptosis: drooping upper lid
  • conjunctivitis: inflammatin of the conjuntiva
  • hordeolum: sty
Assessment of the ear
  • history of earaches?
  • infections?
  • discharge?
  • hearing loss? high or low pitch?
  • hearing loss noticed by others?
  • enviromental noise?
  • tinnitus?
  • vertigo (does the room spin)?
  • what kind of self-care behaviors do you have?
Assessing earaches
  • location of pain: close to surface or deep within ear?
  • does it hurt to push on your ear?
  • What does the pain feel like? (sharp, dull stabbing, throbbing)
  • any symptoms of an upper respiratory infection?
  • any discharge?
How should the ear be manipulated for assessment?
  • adults: the pinna should be pulled up and back
  • children: pinna pulled down
Outer ear abnormalities
swimmers ear/otitis externa
Inner ear abnormalities
  • otitis media
  • perforatedear drum
Subjective history of the nose
  • discharge?
  • frequent colds or URIs?
  • sinus pain?
  • trauma/hx of broken nose?
  • epistaxis?
  • allergies?
  • altered smell?
  • are you able to breathe through both nostrils?
  • turbinates normal size?
Subjective history of the mouth and throat
  • sores or lesions?
  • sore throats?
  • bleeding gums?
  • toothaches?
  • hoarseness?
  • dysphagia (trouble swallowing)
  • altered taste?
  • smoking or alcohol consumption?
Assessment of the nose, mouth, and throat
  • inspect and palpate the nose
  • look with a nasal speculum at the nasal cavity
  • palpate the sinus areas
  • transilluminate the sinuses
  • inspect the mouth and lips, look at the palate
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