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Physical Assessment Exam 3 - Coggle Diagram
Physical Assessment Exam 3
CH 13- Head, Face, Neck, and Regional Lymphatics
A&P Review
Head
Bones
Frontal
Parietal
Occipital
Temporal
Cranial Nerves
VII, the facial nerve - facial expressions
Salivary Glands
parotid
submandibular
sublingual
Neck - the great conduit
Arteries
internal carotid - supplies brain
external carotid - supplies face
Veins
internal jugular - under sternomastoid
external jugular - across sternomastoid
Cranial Nerve + Muscles
XI, the accessory nerve - innervates sternomastoid and trapezius
Sternomastoid = rotation and flexion
Trapezius = extension and turn head
Thyroid
hugs traches in middle of neck
Makes T3 and T4
Trachea - palpate for deviations and shifts
cricoid cartilage - sits above thyroid isthmus, makes Adam's apple
Lymphatics
All lymph nodes drain towards deep cervical chain
play a role in the immune system
Lymph Nodes by Group
2
submental
submandibular
jugulodigastric
3
superficial cervical
posterior cervical
deep cervical
Supraclavicular
1
preauricular
posterior auricular
occipital
Palpate gently with more than one finger pad. They shouldn't be that easy to palpate unless there's a problem
Major Lymphatic Regions
head/neck
axillae
arms
inguinal
Aging
temporal arteries twist and pop out
mild tremor of head is normal
kyphosis
missing teeth
ROM is slowed and they might get dizzy
submandibular glad prolapse
Objective
Head
normocephalic - some protrusions are normal
check tenderness
temporal artery
temporomandibular joint - opens and closes mouth
sinuses
frontal
ethmoid
maxillary
sphenoid
Face
facial expression = behavior = mood
look for symmetry
watch for tics
Neck
symmetry
ROM
limitations
strength of CN XI by resistance test
lymph nodes
trachea + thyroid
Pulsations outside of the carotid artery
Abnormal Findings
hydrocephalus - excessive accumulation of cerebrospinal fluid on brain
Paget disease - soften, thickens, and deforms bones
acromegaly - enlarged skull and thick cranial bones, makes heavy facial features
Torticollis - hematoma on one sternomastoid muscle causes head tilt and limited ROM
Pilar cyst
Parotid gland enlargement
caused by
mumps
Stensen duct obstruction
abscess
tumor
Pediatrics
congenital hypothyroidism
fetal alcohol syndrome
down syndrome
atopic (allergic) face + allergic salute crease
Chronic illness
Parkinson's
Cushing Syndrome
Thyroid Issues
Graves' Disease
Hypothyroidism
Hyperthyroidism
Bell's Palsy (CN VII)
Stroke
Cachexia
Scleroderma
Hemiplasia - one side of the head is working
Causes of Tracheal Deviations
pneumothorax
hemothorax
trauma
masses
Cranial Nerves
VII - the facial nerve, facial expressions
XI - the accessory nerve, trapezius + sternomastoid
V - the trigeminal nerve, touch and pain
CH 14- Eyes
A&P Review
Structures
Eye covers
cornea - covers only the iris and pupil, focuses light
conjunctiva - lubricates eye
lids
Fissures
limbus - the line between the cornea and the sclera
palpebral fissures - the line where the scleral and the eyelid meet
lateral and medial canthus - clean medial to lateral
Internal
iris
sclera
pupil
lacrimal gland
Eyebrows
Muscles
4 Rectus
superior (CN III)
inferior (CN III)
medial (CN III)
lateral (CN VI)
2 Oblique
superior (CN IV)
inferior (CN III)
Subjective
visual difficulty
pain
strabismus (cross-eyed)
redness or swelling or discharge
history
diplopia (double vision)
glasses/contacts
Objective
Reflexes
Pupillary light reflex - pupils constrict with light, CN III
consensual light reflex
Fixation - follow the attention grabber
Accommodation
Corneal Light - parallel alignment of eyes, spot of light should be symmetrical
Normal findings
PERRLA - Pupils are Equal, Round, Reactive to Light, and Accommodate
inner lids should be moist, and glossy
blood vessels on sclera are okay
normal reflexes
smooth and clear eyes when light is shown across it
do from front and side
Arcus senilis
Pseudoptosis
Snellen Eye Test
place 20 feet away from patient
shield one eye and use the other
leave the glasses on
Jaeger's chart - near vision test
Tests
Cover test - looks for lazy eye
Confrontation test - peripheral vision, CN II test
Corneal Light
Diagnostic Positions - tests fixation and movement
Accommodation
Pupillary Light
Diagnostic Positions Test - CN's III, IV, and VI
Cranial Nerves
III - oculomotor nerve, superior/inferior/medial rectus + inferior oblique, pupillary light reflex
IV - trochlear nerve, superior oblique
VI - abducens, lateral rectus, motor ONLY
II - optic nerve, vision
Abnormal Findings
Common Problems
cataracts
glaucoma
age-related macular degeneration
diabetic retinopathy
opacities anywhere
Strabismus
esotropia - inward lazy eye, cross-eyed
exotropia - outward lazy eye
hypertropia - upward lazy eye
paralysis
periorbital edema
Eye position in skull
exophthalmos
enophthalmos
ptosis - drooping lid
Pupil size
miosis - too constricted
mydriasis - too dilated
conjunctivitis = pink eye
subconjunctival hemorrhage
iritis
acute glaucoma
pterygium - fleshy triangular growth on eye's surface cause by trauma, AKA: Surfer's eye
corneal abrasion
hyphema - collection of blood in eye's anterior chamber, collects around pupil
xeropthalmus - bulging eyes
xeropthalmia - dry eyes
Developmental Considerations
Infants have poor muscle coordination
Elderly
fat and muscle atrophy
decreased tears -> dry eyes
decreased pupil size -> decreased adaptation to darkness
presbyopia - decreased accommodation with age
floaters
CH 15 - Ears
A&P Review
External Ear = Auricle + Pinna
secretes cerumen
funnels sound
tympanic membrane - border between external and middle ear
Middle Ear
conducts sound
moderates sound
pressure equalizer
Inner Ear
equilibrium
hearing
Pathways
Normal = air conduction
Rinne hearing test
Alternate = bone conduction
Weber hearing test
Bones conduct vibrations straight to inner ear and CN VIII (acoustic nerve)
Subjective
otalgia - ear pain
infection
otorrhea
hearing loss
tinnitus
vertigo
self-care habits
Objective
Developmental Considerations
Infants
flat tube to brain connection
at risk for acute otitis media
pinna gets pulled down
Adulthood
otosclerosis - bone formation -> hearing loss
Elderly
cilia become stiff and coarse -> cerumen accumulation
presbycusis - present in 60% of the elderly, inability to hear high pitched sounds
dry cerumen
Inspect
skin condition
size/shape
External auditory meatus - opening to the ear canal
tympanic membrane should be clear and pearly-grey
cerumen
Palpate
tenderness
Hearing Tests
Whispered voice test
Weber - bone conduction, tuning fork
Rinne - air conduction
Abnormal Findings
Hearing Loss
Types
Cerebral cortex damage
CN VII damage, sensorneural
conductive - loss of function of external/middle ear
Causes
presbycusis
ototoxic drugs
Furuncle - boil on the ear
Otitises
externa
media
interna
Vertigo
Cranial Nerves
VIII - acoustic nerve or vestivulocochlear, hearing and balance
CH 16 - Nose, Mouth, and Throat
A&P Review
Nose
warms, moistens, and filters air
filter = hair + mucous
Smell = CN I, Olfactory Nerve
receptors lie in hairs in nasal cavity roof and upper third of septum
septum divides nasal cavity
nares - openings at base
Sinuses - lighten skull, resonates sound, provides mucous
frontal
maxillary
ethmoid
sphenoid
Mouth
digestive and respiratory system
oral cavity
lips
palate = hard + soft + uvula
cheeks
tongue
teeth (32)
gums
tongue
salivary glands
parotid
submandibular
Throat (Pharynx)
gag reflex = CN IX + CN X
Pharynxes
Oropharynx
Nasopharynx - pharyngeal (adenoid) tonsils + eustachian tubes
lots of lymphatic activity
Tonsils
Immune protectors
Subjective
Nose
discharge
frequent colds
sinus pain
trauma
epistaxis (nosebleeds)
Hold nose and lean FORWARD
allergies
changes in smell
Mouth and Throat
sores/lesions
sore throat
bleeding gums
toothache
hoarseness
dysphagia
changes in taste
smoking/alcohol
hygiene
Objective
Nose
symmetry
nasal patency
Sinus palpation
transillumination - not commonly used anymore
septum deviation
Inspect Mouth
Mouth
Lips
Tongue - movement tests CN XII, light tight dynamite
Teeth
Buccal Mucosa - especially for cancer
Uvula - use "ahhh" test
Throat
Tonsil Grading
1+ = visible, normal
2+ halfway between tonsillar pillars and uvula, normal
3+ = touches uvula
4+ = touching each other
Cranial Nerves
I - the olfactory nerve, smell
IX - glossopharyngeal, swallowing, taste, gag reflex
X - vagus nerve, gag reflex, uvula movement
XII - hypoglossal, tongue movement
Developmental Considerations
Infants/Children
only have maxillary and ethmoid sinuses
Elderly
Taste decreases by 80%
Cranial Nerves
I - the olfactory nerve, smell
II - the optic nerve, vision
III - oculomotor, eye movement
IV - trochlear nerve, down and inward movement
V - trigeminal nerve, facial sensation, chewing
VI - abducens, outward eye movement, motor ONLY
VII - the facial nerve, facial expressions
VIII - vestibulocochlear, hearing and balance
IX - glossopharyngeal, swallowing, taste, gag reflex
X - vagus nerve, digestion, HR, speech, breathing, gag reflex
XI - the accessory nerve, trapezius + sternomastoid
XII - hypoglossal, tongue movement