1. Mosby items and derived items © 2005, 2001 by Mosby, Inc. HEAD ASSESSMENT

2. Mosby items and derived items © 2005, 2001 by Mosby, Inc. HEAD The skull is composed of seven bones that, in adulthood are fused (compound ) along structure lines. These bones include:- Two frontalTwo frontal Two parietalTwo parietal Two temporalTwo temporal One occipitalOne occipital The movable (nonfused) lower jaw bone, or mandible and the fused bones of face include:- FrontalFrontal NasalNasal ZygomaticZygomatic LacrimalLacrimal SphenoidSphenoid maxillamaxilla

3. Mosby items and derived items © 2005, 2001 by Mosby, Inc. FACE Eyes, noise, and mouth are generally symmetric as are the ears. Sensation is mediated by the trigeminal nerve, cranial nerve which has three sensory branches (1) ophthalmic (2) maxillary and (3) mandibular. The muscle of facial expression enervated the facial nerve The major artery accessible on the face is the temporal artery

4. Mosby items and derived items © 2005, 2001 by Mosby, Inc. I.Olfactory nerve II.Optic nerve III.Oculomotor nerve IV.Trochlear nerve V.Trigeminal nerve VI.Abducens nerve VII.Facial nerve VIII.Vestibulocochlear nerve IX.Glossopharyngeal nerve X.Vagus nerve XI.Accessory nerve XII.Hypoglossal nerve The Cranial Nerves

5. Mosby items and derived items © 2005, 2001 by Mosby, Inc. NECK Muscles (sternoclodeiomastoid and trapezes)Muscles (sternoclodeiomastoid and trapezes) Thyroid glandThyroid gland Carotid artery and jugular veinCarotid artery and jugular vein TracheaTrachea cervical lymph nodscervical lymph nods Cervical vertebraCervical vertebra Carotid arteries and jugular vein.Carotid arteries and jugular vein.

6. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Thyroid Gland Thyroid gland is butterfly shaped, with two lateral lobes lying on either said of trachea.Thyroid gland is butterfly shaped, with two lateral lobes lying on either said of trachea. It is the largest endocrine gland in the body and only one accessible to direct physical examination.It is the largest endocrine gland in the body and only one accessible to direct physical examination. Adult normal weight of thyroid gland is 15-20 gram male 20-25 gram femaleAdult normal weight of thyroid gland is 15-20 gram male 20-25 gram female The lobes are irregular and cone shaped each about 5cm long 3cm in diameter and 2cm thickThe lobes are irregular and cone shaped each about 5cm long 3cm in diameter and 2cm thick

7. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Thyroid Gland Inspection, palpation, percussion, and auscultation of the: Posterior thoraxPosterior thorax Lateral thoraxLateral thorax Anterior thoraxAnterior thorax

8. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Lymphatic System

9. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Superficial Lymph Nodes by Region HeadHead NeckNeck Upper extremityUpper extremity AxillaAxilla BreastBreast Lower extremityLower extremity

10. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Upper extremity The epitrochlear node is palpated above and post to the medical condoyle of the humorous. Axilla Palpation of lymph nodes here done by gently rolling the soft tissue against the chest wall and muscles. Lower extremity Palpation of inguinal and popliteal nodes while client is lying down with knee slightly flexed. Breast will be discussed later.

11. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the Eye

12. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Globe ScleraSclera Visible white layer of the eye Visible white layer of the eye PupilPupil Dark, central aperture Separates anterior from posterior chamber Separates anterior from posterior chamber IrisIris Pigmented contractile tissue controlling pupil size Pigmented contractile tissue controlling pupil size ConjunctivaConjunctiva Mucous membrane lining globe, eyelids and socket Mucous membrane lining globe, eyelids and socket CorneaCornea Transparent anterior covering of eye Transparent anterior covering of eye Focuses light as it enters eye Focuses light as it enters eye LensLens Focuses light onto retina at back of eye Focuses light onto retina at back of eye Suspended by ligaments from ciliary body Suspended by ligaments from ciliary body RetinaRetina Rods/cones are photoreceptors Rods/cones are photoreceptors Optic nerve transmits impulses to brain Optic nerve transmits impulses to brain

13. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Equipment needed Eye chart (Snellen chart) Eye chart (Snellen chart) Near vision chart or newsprint. Near vision chart or newsprint. Cover card. Cover card. Penlight, ophthalmoscope & ruler. Penlight, ophthalmoscope & ruler.

14. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Subjective Data Client should be seated comfortably in a well Lighted room that can be darkened for ophthalmic exam. History of prior eye surgery, trauma, use of corrective glasses or contact lenses, blurred vision, Diplopia, strabismus.History of prior eye surgery, trauma, use of corrective glasses or contact lenses, blurred vision, Diplopia, strabismus. Recent changes in vision. Date of previous vision test. Recent changes in vision. Date of previous vision test. Allergies, eye redness, frequent watering discharge.Allergies, eye redness, frequent watering discharge.

15. Mosby items and derived items © 2005, 2001 by Mosby, Inc. General Eye Evaluation HistoryHistory InspectionInspection – Periorbital region – Eyebrows – Eyelids – Globe orientation Orbital concerns Orbital concerns PalpationPalpation – Supraorbital ridges – Nasal, frontal, zygomatic bone/arch

16. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Eye Pathologies Orbital HematomaOrbital Hematoma Orbital fractures (Blowout fracture)Orbital fractures (Blowout fracture) Ruptured GlobeRuptured Globe Corneal AbrasionCorneal Abrasion Corneal LacerationCorneal Laceration HyphemaHyphema IriticIritic Detached RetinaDetached Retina ConjunctivitisConjunctivitis HordeolumHordeolum Periorbital LacerationsPeriorbital Lacerations Foreign BodiesForeign Bodies Contact Lens RemovalContact Lens Removal

17. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the Ear

18. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Hearing Center

19. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Deeper structure and middle ear can be observed only by Otoscope. Assessment of hearing acuity done simply by identification of voice tones, with the client repeating testing words spoken by the nurse.

20. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Subjective Data Ask about the following History of prior ear surgery.History of prior ear surgery. Trauma.Trauma. Frequent infection.Frequent infection. Ear pain.Ear pain. Drainage.Drainage. Hearing loss.Hearing loss. Tinnitus.Tinnitus. Vertigo.Vertigo. Ototoxic medications.Ototoxic medications. Last hearing examination.Last hearing examination.

21. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Inspect and Palpate The External Ear 1).Size and shape :bilaterally equal size, no swelling, thickening 1).Size and shape :bilaterally equal size, no swelling, thickening 2).Skin condition :intact, no lump or lesion 2).Skin condition :intact, no lump or lesion 3).Tenderness : move the pinna and push the tragus 3).Tenderness : move the pinna and push the tragus 4).The external auditory meatus : size / swelling / redness / discharge 4).The external auditory meatus : size / swelling / redness / discharge

22. Mosby items and derived items © 2005, 2001 by Mosby, Inc. USING AN OTOSCOPE Adult : pull upwardAdult : pull upward Child: pull downward.Child: pull downward. Hearing loss is usually documented under neuro as it generally results from nerve damage.Hearing loss is usually documented under neuro as it generally results from nerve damage. Tuning fork: evaluates bone conduction sound.Tuning fork: evaluates bone conduction sound.

23. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Hearing Acuity Voice Test. test one ear at a time. test one ear at a time. 30 ~ 60 cm ; whisper slowly. 30 ~ 60 cm ; whisper slowly unable to hear whisper  high tone lossunable to hear whisper  high tone loss

24. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Tuning Fork Test Weber test :.place a vibrating tuning fork in the midline skull.place a vibrating tuning fork in the midline skull.the same sound in both ears.the same sound in both ears Rinne test :.compares air conduction ( AC ) and bone conduction( BC ).compares air conduction ( AC ) and bone conduction( BC ).mastoid  near ear canal.mastoid  near ear canal.AC : BC 2 : 1 or, AC > BC.AC : BC 2 : 1 or, AC > BC

25. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Hearing loss Conductive loss Sensorineural loss Webber test Rinne test

26. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the Nose

27. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Functions of Nose Identify odors (upper 1/3 of septum) CN IIdentify odors (upper 1/3 of septum) CN I Air passageway (obligate in newborns)Air passageway (obligate in newborns) “Air conditioning”“Air conditioning” – Humidify – Warms/cools air – Cleans and filters air of dust and most bacteria – Voice resonance

28. Mosby items and derived items © 2005, 2001 by Mosby, Inc. N.B For client with NGT nurse routinely checks for local breakdown of skin “Excoriation” of the naris characterized by redness and sloughing of the skin.

29. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the sinuses

30. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Frontal and maxillary sinuses are examined for pain and edema.Frontal and maxillary sinuses are examined for pain and edema. palpate sinuses (both frontal and maxillary for tenderness, which verbalized by client during exam.palpate sinuses (both frontal and maxillary for tenderness, which verbalized by client during exam. Percuss sinuses for resonance which is normally hollow tone, and noting abnormality e.g. flat, dull tone elicited or expresses pain on percussionPercuss sinuses for resonance which is normally hollow tone, and noting abnormality e.g. flat, dull tone elicited or expresses pain on percussion. Assessment of the Sinuses

31. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of Mouth

32. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the Mouth Inspection (use good light source) Lips (color, moisture, cracking, lesions) – smile for symmetry (CNVII)Lips (color, moisture, cracking, lesions) – smile for symmetry (CNVII) Tongue (color, surface fissures, moisture) – stick out for deviation (CN VII)Tongue (color, surface fissures, moisture) – stick out for deviation (CN VII) Gums, buccal mucosa (check for pink color, bleeding, swelling)Gums, buccal mucosa (check for pink color, bleeding, swelling) Teeth (#, molars, color, cavities, dental repair) 32 adult – 20 children (3rd molars may be missing – wisdom teeth)Teeth (#, molars, color, cavities, dental repair) 32 adult – 20 children (3rd molars may be missing – wisdom teeth)

33. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Mouth Assessment Inspection Hard palate & soft palateHard palate & soft palate Floor of mouth (Wharton’s duct/Submandibular gland, Sublingual gland)Floor of mouth (Wharton’s duct/Submandibular gland, Sublingual gland) Parotid gland (in cheek in front of ear) and Stensen’s duct (opposite 2nd molar)Parotid gland (in cheek in front of ear) and Stensen’s duct (opposite 2nd molar) Tongue (Lingual frenulum, lingual veins)Tongue (Lingual frenulum, lingual veins)

34. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Mouth Assessment Palpate Roof of mouth in infantsRoof of mouth in infants Lips, cheek, tongue, floor of mouthLips, cheek, tongue, floor of mouth Use gauze to hold tongueUse gauze to hold tongue Find Stensen’s duct (parotid salivary gland) opposite upper second molarFind Stensen’s duct (parotid salivary gland) opposite upper second molar Check temporomandibular joint (TMJ) – depression in front of tragus felt with fingers (slight pop can be normal; crepitus and masses are abnormal)Check temporomandibular joint (TMJ) – depression in front of tragus felt with fingers (slight pop can be normal; crepitus and masses are abnormal)

35. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the Mouth Normal findings Pink, moist lipsPink, moist lips Tongue midline, adequate movementTongue midline, adequate movement No lesionsNo lesions Tongue, gums, buccal mucosa are pink, moist, smoothTongue, gums, buccal mucosa are pink, moist, smooth No bleedingNo bleeding Smooth, white teeth, no dental cariesSmooth, white teeth, no dental caries

36. Mosby items and derived items © 2005, 2001 by Mosby, Inc. Assessment of the Mouth Abnormal findings Lesions, growthsLesions, growths Dry, cracked lipsDry, cracked lips Vesicles or blistersVesicles or blisters Red, tender, inflamed tongue, gums, buccal mucosaRed, tender, inflamed tongue, gums, buccal mucosa ThrushThrush Coating on tongueCoating on tongue Bleeding gumsBleeding gums

37. Mosby items and derived items © 2005, 2001 by Mosby, Inc. THANK YOU FOR LISTENING