1 / 134

HEENT Assessment

HEENT Assessment

amccallgru
Télécharger la présentation

HEENT Assessment

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. HEENT Assessment Amber McCall PhD, FNP-BC, RN This is the camera box for live lecture picture

  2. Objectives • Obtain HEENT medical history • Perform HEENT physical assessment • Recognize normalHEENT findings • On an adult patient • On a pediatric patient • Identify abnormalHEENT findings • On an adult patient • On a pediatric patient Smile, you’re on camera!

  3. If you know what’s expected, you can determine what’s not. NURSE TIP: Know your “within normal limits”! Smile, you’re on camera!

  4. Spot the Differences Smile, you’re on camera!

  5. You’re Right! Smile, you’re on camera!

  6. You’re Right! Asymmetry may be a clueto abnormal physical assessments Smile, you’re on camera!

  7. Types of Data • Subjective • Objective • What patients say • What nurses Observe Hummm…My patient has ainflamed (red) outer ear with purulent (green-to-yellow) drainage. “My ear hurts!!!” Smile, you’re on camera!

  8. Subjective Data Past medical history may lead to new insights! Gather clues! A McCall story…

  9. Get Your Gear Head Eyes Ears Nurse’s eyes Head Nose Throat Smile, you’re on camera! Nurse’s hands

  10. Head & Neck Smile, you’re on camera!

  11. Subjective Data: Head • Headache, migraines • Head injuries • Dizziness, vertigo • Neck pain • Range of motion limitations • Lumps, swelling, tenderness • Problems swallowing (dysphagia) • Past head/neck surgeries • Self care (helmets) Smile, you’re on camera!

  12. Subjective Data: Head Neonatal Skull Infants & Children Aging Adult Dizziness & neck pain Activities of daily living (ADLs)? Driving? Safety? • Maternal drug use • Delivery • Vaginal or C-section • Forceps • Difficulties • Growth • Fontanel closure (“soft spot”) • Posterior (1-2 months) • Anterior (9 months -2 years) • Month of ability: head control Smile, you’re on camera!

  13. Objective Data: Head • Skull • Inspect size • Normocephalic • Palpate for shape • Symmetric & smooth • Non-tender • Temporal area • Palpate temporal artery • Palpate tempromandibular joint (TMJ) • Face • Inspect facial structures • Expression • Symmetry • Note abnormalities Smile, you’re on camera!

  14. Assessment Edition Smile, you’re on camera!

  15. Heads Up: Name that Abnormality Smile, you’re on camera!

  16. Heads Up: Name that Abnormality Hydrocephalus( cerebral spinal fluid, CSF) Smile, you’re on camera!

  17. Heads Up: Name that Abnormality Smile, you’re on camera!

  18. Heads Up: Name that Abnormality Acromegaly ( growth hormone, GH) Smile, you’re on camera!

  19. Heads Up: Name that Abnormality Acromegaly ( growth hormone, GH) Smile, you’re on camera! Anthony Robbins in the movie Shallow Hal

  20. Heads Up: Name that Abnormality Smile, you’re on camera!

  21. Heads Up: Name that Abnormality Smile, you’re on camera! Fetal Alcohol Syndrome (mother drinks alcohol, aka ETOH, while pregnant)

  22. Heads Up: Name that Abnormality Smile, you’re on camera!

  23. Heads Up: Name that Abnormality Down Syndrome (trisomy 21, low set ears, upslanting eyes, single palmar crease) Smile, you’re on camera!

  24. Heads Up: Name that Abnormality Smile, you’re on camera!

  25. Heads Up: Name that Abnormality Parkinson Syndrome (dopamine deficiency, basal ganglia degeneration, mask-like face, staring gaze) Smile, you’re on camera!

  26. Heads Up: Name that Abnormality Smile, you’re on camera!

  27. Heads Up: Name that Abnormality Cushing Syndrome ( adrenocorticotropin hormone, ACTH, moonface, red cheeks) Smile, you’re on camera!

  28. Heads Up: Name that Abnormality Unilateralcomplete facial paralysis Unilaterallower facial paralysis Smile, you’re on camera! If these two patients were asked to blink & smile, how do these two faces differ?

  29. Heads Up: Name that Abnormality Stroke(aka cerebrovascular accident, CVA, upper motor neuron lesion, paralysis of lower facial nerves only, upper half of face unaffected due to contralateral nerve involvement ) Unilateralcomplete facial paralysis Unilaterallower facial paralysis Smile, you’re on camera! Bell’s Palsy (lower motor neuron lesion, cranial nerve VII, facial nerve, paralysis, cause- may be herpes simplex virus)

  30. Heads Up: Name that Abnormality Unilateralcomplete facial paralysis What complication might these two individuals be at risk for??? Unilaterallower facial paralysis Smile, you’re on camera!

  31. Heads Up: Name that Abnormality Unilateralcomplete facial paralysis What complication might these two individuals be at risk for??? Unilaterallower facial paralysis Smile, you’re on camera! Dysphagia (difficulty swallowing)

  32. Recognize this Bell’s Palsy? Smile, you’re on camera! 1976

  33. Does it Ring a Bell? Smile, you’re on camera! 1976

  34. It’s George Clooney! 90s Now Smile, you’re on camera! ‘76

  35. Objective Data: Neck Palpate Trachea • Inspect • Symmetry • Neck & trachea (midline) • Range of motion (ROM) • Palpate • Lymph nodes (covered in another lecture) • Thyroid gland • Approach • Posterior • Anterior • Auscultate thyroid if enlarged • Bruits? • Bruit = “whoosh” sound • + bruit =  blood flow Thyroid Anterior Approach Thyroid Posterior Approach Smile, you’re on camera!

  36. Necks Heads Up: Name that Abnormality Smile, you’re on camera!

  37. Necks Heads Up: Name that Abnormality Goiter (enlargement of thyroid gland, due to lack of iodine, thyroid disorder) Smile, you’re on camera! Torticollis (aka wryneck, possibly due to hematoma on sternomastoid muscle)

  38. Cranial Nerves Cranial nerves will be covered later on, but here’s a sneak peak! Sensation Smile, you’re on camera! Expression

  39. Quiz It! The nurse is assessing a patient’s face & neck bilaterally for nerve damage. The patient is unable to feel any of the sensations. The nurse suspects damage to which nerve? • Cranial nerve IV: trochlear nerve • Cranial nerve V: trigeminal nerve • Cranial nerve VII: facial nerve • Cranial nerve XI: spinal accessory nerve Smile, you’re on camera! 1

  40. Quiz It! The nurse is assessing a patient’s face & neck bilaterally for nerve damage. The patient is unable to feel any of the sensations. The nurse suspects damage to which nerve? • Cranial nerve IV: trochlear nerve • Cranial nerve V: trigeminal nerve • Cranial nerve VII: facial nerve • Cranial nerve XI: spinal accessory nerve Smile, you’re on camera! 1

  41. Developmental Care: Head Cephalahematoma • Infants • Skull • Measure head circumference birth-2 years old • Palpate for symmetry • Caputsuccedaeum – crosses suture lines • Cephalahematoma – one hemisphere only • Molding- overriding of the cranial bones (allows ease of coming through birth canal) Smile, you’re on camera!

  42. Which Am I? -Caput Succadeum -Cephalahematoma Smile, you’re on camera!

  43. -Caput Succadeum -Cephalahematoma Crosses suture lines Smile, you’re on camera!

  44. Developmental Care: Head Tonic neck reflex -When head is turned to a certain side, same arm & leg is extended -Opposite arm & leg is flexed • Infants • Palpate fontanels • Inspect posture, head control • Tonic neck reflex How cute! Smile, you’re on camera!

  45. Developmental Care: Head • Infants • Face • Inspect facial features • Symmetry, appearance, swelling • Neck • Appears short • Muscle development, passive ROM • Pregnant women • 2nd Trimester • Chloasma, “mask of pregnancy” • Blotchy, hyperpigmented skin • Aging adult • Temporal arteries appear twisted • Senile tremors (trembling) Smile, you’re on camera!

  46. Eyes Smile, you’re on camera!

  47. Notes on the Eyes Cranial Nerves • Visual reflexes • Pupillary light reflex (constriction) • Direct light- eye 1 constriction • Consensual- eye 2 simultaneous constriction • Fixation • Reflex, eye moves toward attention-grabbing object • Accommodation • From far to near vision We have 2 eyes to see with (optic) 3 4 6 Vision (Sight) Movement Smile, you’re on camera!

  48. Subjective Data: Eyes • Vision problems • Pain • Strabismus- both eyes don’t focus together (“crossed eyes”) • Diplopia-double vision • Diplopia-doublevision  • Redness, swelling • Watering, discharge • History of eye problems • Glaucoma ( pressure) • Glasses, contact lens use • Personal care (sunglasses) Smile, you’re on camera!

  49. Subjective Data: Eyes Infants & Children • Delivery • Vaginal infections at that time? • Developmental milestones • Vision • Vision testing at school • Results • Safety • Eye wear • Toys Smile, you’re on camera!

  50. Subjective Data: Eyes Aging Adult • In transit • Climbing stairs • Driving • Night vision • Presbyopia • Loss of near vision, aka “farsightedness” • Macular degeneration (breakdown of retinal cells, loss of central vision) • “I can’t see my grandkids faces when I look at them” • Glaucoma ( pressure) • Cataracts (opacity) • Peripheral vision • Dry eyes • Burning eyes • Decreased activity • Sewing • Reading Smile, you’re on camera!

More Related