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Science
Medicine
Health Assessment Exam 2 HEENT
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HEENT
Terms in this set (94)
What is HEENT exam?
head, eyes, ears, nose, throat
What increases risk for head and neck cancer?
smoking and alcohol abuse
What are you looking for while inspecting the head and neck ?
bumps/lumps
asymmetry
swelling
discoloration
bruising/trauma
abnormal hair growth
SYMMETRY
skull and scalp size, shape, symmetry, lesions
hair - distribution, texture, bugs
neck - symmetry, alignment of trachea, straight, midline, deviating, masses
What do you palpate on the head?
skull
scalp
temporal artery
(older adults, temporal arteritis can cause blindness)
What do you look for while inspecting the eyes?
eyebrows - symmetry, lesions
eyelids/lashes: entropion, extortion, ptosis(eyelid droop), lesions, xanthomas (plaque yellow lesions)
What does entropion look like?
what does ectropion look like?
What do you look for in an eye assessment?
- Conjunctiva/sclera- color, lesions, drainage
- Lacrimal apparatus (tear duct area)-swelling, drainage
- Cornea/lens-opacities, abrasions
- Iris/pupil- size, shape, symmetry
What is arcus senilis?
white ring around the outside of the iris (normal in older adults)
What does arcus senilis look like?
What is coloboma?
Cat-like iris slits as a result of failure in embryonic development of the iris
What does coloboma look like?
What is exopthalamus?
chronic bulging eyes (thyroid issue)
what does exopthalmos look like?
What is an ophthalmoscope?
instrument used to view the internal structures of the eye
How to use an ophthalmoscope
1. darken the room
2. turn the lens to the "0" diopter
3. your right side to their right side!!!
4. hold it at a 20 degree slant from the vertical to make sure you can see clearly through the lens
5. have the patient look slightly UP and OVER your shoulder
6. place yourself about 15 inches away from the pt and 15 DEGREES LATERAL TO THE PATIENTS LINE OF VISION
7. place your thumb on their eyebrow to steady
Where is the optic disc located?
Toward the nasal side of the retina
What does a normal ophthalmoscope exam look like?
What does a hypersensitive retinopathy look like?
abnormal retina
hemorrhage into the back of eye
flame hemorrhage - red spots
papolloedema - can't see optic disk
What does papilledema look like?
can't see optic disk
T/F you can't stick anything larger then your elbow in your ear
True
What is ototoxicity?
Damage to the hearing or balance functions of the ear by drugs or chemicals.
What drugs cause ototoxicity?
amino glycoside antibiotics
anticancer agents
loop diuretics
antimalarial drugs
aspirin
mercury, lead, arsenic
What are you looking for during an ear inspection?
ear size, shape and symmetry
skin condition
tenderness
piercings for inflammation and tearing
keloid (over formation of scar tissue)
What is otitis externa?
inflammation of external auditory canal aka "swimmer's ear"
(difficulty inserting Qtips)
use drops to get swelling down
What is auricular hematoma?
- "Cauliflower ear"
- Collection of blood in the helix of the ear
common in wrestlers
What does squamous cell cancer look like on the ear?
What does melanoma look like on the ear?
What does basal cell cancer look like on the ear?
How to palpate the ear
palpate auricle
push on tragus
What is an otoscope?
an instrument for visual examination of the eardrum and the passage of the outer ear
Import point while using otoscope
With the other free hand, gently pull up, out in age 3 and older and down and back in age < 3.
How to tell ear from cone of light?
Left ear - 7 o'clock
Right ear - 5 o'clock
What is acute otitis media?
Ear infection in the middle of the ear from a pathogenic organism (bacteria or virus)
presents with bulging tympanic membrane
What is otitis media with effusion?
inflammation of middle ear in which fluids collect
What is chronic otitis media?
recurrent acute middle ear infections and can damage the ear drum
eardrum is perforated and ear drains
What is cholesteatoma?
An epidemial cyst in the ear highly associated with otitis media.
What does a perforated ear drum look like?
T/F children are more at risk for ear infections because they have shorter, wider and more horizontal Eustachian tubes
True
What do you look for while inspecting the nose?
- External structure-symmetry, size, deviation
- Internal structures
- Tilt person's head backward
- Use a nasal speculum to examine the interior of the nares
- Examine for
- Flaring
- Color of mucosa-pink and moist
- Exudate
- Lesions
- Polyps
- Sites of recent bleeding
- Septal deviation
- In the absence of a nasal speculum, you will only be able to observe the lower turbinates
What is a nasal polyp?
Protrusion of edematous, inflamed nasal mucosa
Usually secondary to repeated bouts of rhinitis
Also occurs in cystic fibrosis and ASA-intolerant asthma (aspirin intolerant asthma)*** (HIGH YIELD)
What does septal deviation look like?
What does septal perforation look like?
how to examine sinuses
- Inspect the area over the frontal and maxillary sinuses
- Palpate over the frontal and maxillary sinuses
- Percuss over the frontal and maxillary sinuses
Assessment of oropharynx
- Inspect: lips, buccal mucosa, hard and soft palate, tongue, gums and teeth. Note lesions, inflammation, leukoplakia, ulceration, masses, exudate, petechia, missing or decayed teeth, bleeding gums.
- Note foul breath (acetone, ammonia (liver failure))
- Have a good light source.
- Ask patient to remove dental appliances.
- Palpate mouth for lesions, obstruction of ducts
- Inspect throat: using tongue depressor assess pharynx, tonsils, soft palate.
What do you look for when examining the lips?
- Color
- Moisture
- Ulcers
- Lesions
- Cracking
- Edema
What is leukoplakia of the lip?
whitish color lesion - pre cancers
people who use chewing tobacco at risk
if not picked up early can turn into squamous cell cancer
What does squamous cell cancer of the lip look like?
T/F you don't need to wear gloves whole palpating the lips
False, always wear gloves
T/F gauze is used to hold the tongue while inspecting
True
What is the buccal mucosa?
inside of cheeks
What are you looking for when inspecting the buccal mucosa?
- Color
- Ulcers
- White patches
- Plaques
- Nodules
What do you look for while inspecting the gums?
color
edema
bleeding
What does gingival hyperplasia look like?
overgrowth of the gums
What is torus of the hard palate?
What are you looking for when inspecting the tonsils?
- Presence
- Symmetry
- Size Grading 0-4
- Color
- Swelling
- Exudate
What is the tonsil grading scale?
1+ visible
2+ halfway between tonsillar pillars and uvula
3+ touching the uvula
4+ touching each other
What do 3+ tonsils look like?
What do 4+ tonsils look like?
lots of exudate
hot potato voice - can't talk and drooling - airway impairment
What is leukoplakia in the mouth?
white lesions on the side of the mouth. shows mouth cancer
What does candidiasis look like in the mouth?
yeast infection, thrush. White patches on tongue, palate, inner aspect of cheeks and can be painful to baby.
What does petechiae look like in the mouth?
pin point red hemorrhages
strep
What is atrophic glossitis?
smooth, glossy tongue
no papilla or buds
vitamin B12 deficiency
What is geographic tongue?
benign but permanent condition in which a portion of the tongue has a rough, unusual appearance
What does tracheal deviation look like?
- Deviated towards affected lung: Atelectasis, Pneumonectomy, Pleural fibrosis
- Deviated away from affected lung: Pneumothorax, Pleural effusion, Large mass
How to palpate lymph nodes in the head and neck?
- Palpate using pads of fingertips-both sides simultaneously.
- Normally, may not be palpable, or feel like very small beads.
- 3 middle fingers use circular soft motion
Where are lymph nodes located in head and neck?
What are all the lymph nodes in head and neck?
- Preauricular - right in front of ear
- Postauricular
- Occipital
- Tonsillar - beginning of jaw line
- Submandibular - middle of jaw line
- Submental - right under chin
- Anterior Cervical Chain - mid neck toward front on side
- Posterior Cervical Chain - lower almost back of neck
- Supraclavicular - concerning (cancers of thorax) at collar bone
What is lymphadenopathy?
enlarged lymph nodes
What are signs of infected lymph nodes?
- Nodes become overwhelmed with microorganisms and become swollen and painful
- May be diffusely enlarged in response to generalized infection or systemic inflammatory process
- TB, HIV, Mono
What is malignancy in lymph nodes?
slowly progressive, firm, multiple nodes involved, may be attached to underlying structures, usually not painful
T/F normal lymph nodes are round and moveable
True
Where is the thyroid located?
neck
how to palpate the thyroid
- Locate thyroid cartilage: walk fingers down to 1sttracheal ring.
- Ask patient to swallow as you
palpate right side of the gland,
then repeat on left.
- If the thyroid is enlarged, check
for bruit with the bell of
the stethoscope.
T/F pregnant women have enlarged thyroids and bruit
True
What are some HEENT developmental variations in pregnancy?
- Thyroid often enlarges
- May hear a thyroid bruit
- Chloasma (melasma) (mask of pregnancy - pigment changes in face)
- Changes in hormones and increased circulation
- Epistaxis
- Nasal "stuffiness"
- Hypertrophy of the gums
- May bleed with brushing
What are some HEENT developmental variations in neonates?
- fontanels
- nose breathers
- flaring of nares may indicate respiratory distress
What are fontanels?
soft spots in the skull
What are some HEENT developmental variations in children?
- assess for allergic salute
- foreign bodies in nose
- do not use nasal speculum
what is allergic salute?
Transverse crease across the nose from repeatedly rubbing nose to release itch
What are some HEENT developmental variations in older adults?
- hearing loss
- increased ear wax production
- presbycusis - sensory hearing loss
- decreased tear production
- glaucoma
- cataracts
- decreased night vision
- decreased vision in general
- loss of peripheral vision
- Thyroid may feel more nodular or irregular on palpation (increased incidence hypothyroidism)
- Be careful with range of motion
- Skin changes on the face and neck
- May be edentulous
- Decreased salivation
What are cultural considerations for HEENT?
- Retina can vary from red/orange whites to darker orange in persons with darker skin
- Sclera color may vary from white, brownish hue to bluish hue.
- Caucasians -↑ risk of age related macular degeneraton and myopia
- African Americans-↑incidence glaucoma
- Cerumen: "wetter" in Caucasians and AA, "dryer" in Asians and Native Americans.
- Increased incidence of otitis media in Native Americans, Alaskans, Canadian Eskimos.
What is health promotion for HEENT?
- Head Injury prevention
- Stop smoking/chewing tobacco
- ETOH abuse
- Sunscreen face, neck, ears
- Protective Eyewear
- Regular eye exams
- Regular Dental Care: use of dental floss
- Controlling noise exposure
- Ear cleaning
- Review ototoxic meds (aminoglycosides, NSAIDS, ASA)
What are head and neck red flags?
- Headache: "worst ever", "new" HA after age 50, vomiting, neurochanges, loss of coordination, stiff neck, systemic illness, numbness.
- Neck pain
- Neck lump > 3 weeks
- Enlarged, non-tender, fixed, irregular shaped lymph node.
- Chronic hoarseness (> 6 weeks), dysphagia, dystonia
- Neurologic deficits (ptosis, drooping eye, drooping mouth)
- Unexplained swelling
- Severe snoring/Sleep apnea
- Oral lesions: white or red lesions > 6 weeks
A 26-year-old female with a history of asthma presents with a whitish coating on her tongue and lips. When you attempt to rub the plaque with a tongue depressor, a small amount of bleeding is noted from the oral mucosa. The nurse suspects this condition is:
A. Candidiasis
B. Leukoplakia
C. Cancer
D. Due to poor oral hygiene
A. candidiasis
A 63-year-old male presents with an asymptomatic, white lesion in his mouth that was discovered by his dentist at a check-up. He states he uses chewing tobacco. The nurse suspects this condition is:
A. Candidiasis
B. Leukoplakia
C. Cancer
D. Due to poor oral hygiene
B. Leukoplakia *
A 45-year-old male presents with purulent discharge from his right ear for three weeks. During the interview, he states he went swimming in a pond a few days before the symptoms began. On examination, the nurse notes the ear is painful when the tragus is pushed and the ear canal is almost swollen shut. The nurse tells the client this is most likely:
A. Otitis externa *
B. Otitis media
C. Meniere's disease
D. Labyrinthitis
A. otitis externa
A 64-year-old male was found to have an opacity on his lens and decreased visual acuity. Which of the following is the most likely diagnosis?
A. Glaucoma
B. Cataract
C. Astigmatism
D. Conjunctivitis
B. Cataract
The nurse is caring for an older client who presents with dizziness and difficulty hearing. The nurse performs an otoscopic exam on the client? Which findings would the nurse report to the provider as an abnormality. (Select all that apply.)
A. Tympanic membrane is retracted, with multiple air bubbles.
B. There is cerumen lining the ear canals.
C. Tympanic membrane is shiny and translucent, with light reflex noted.
D. The client reports pain when the ear is lifted up and back.
A. Tympanic membrane is retracted, with multiple air bubbles.
D. The client reports pain when the ear is lifted up and back.
The nurse is examining a client's nasal cavities and notes a smooth, pale, nontender growth in the right nare. The client has a history of seasonal allergies and states the lesion "has been there for a year or so." The nurse documents this finding as a:
A. Tumor
B. Stensen duct
C. Polyp
D. Deviated septum
C. Polyp
The nurse is palpating the sinus areas. If the findings are normal, then the patient should report which sensation?
A. No sensation
B. Firm pressure.
C. Pain during palpation
D. Pain sensation behind eyes
B. Firm pressure.
A 10 year old is at the clinic for a sore throat that has lasted 6 days. Which of these findings would be consistent with an acute infection?
A. Tonsils 1+ and pink; the same color as the oral mucosa.
B. Tonsils 2+ and pink with small plugs of white debris.
C. Tonsils 3+ and red with large white patches.
D. Tonsils 3+ with pale coloring.
C. Tonsils 3+ and red with large white patches.
A patient comes into the clinic complaining of facial pain, fever, and malaise. On examination, the nurse notes swollen turbinates and purulent discharge from the nose. The patient also complains of a dull, throbbing pain in his cheeks and teeth on the right side and pain when the nurse palpates the areas. The nurse recognizes that this patient has:
A. Posterior epistaxis.
B. Frontal sinusitis.
C. Maxillary sinusitis.
D. Rhinitis.
C. Maxillary sinusitis. *
The nurse is assessing the ear of an adult client. How should the nurse perform the examination?
A. Pull the pinna down and insert scope.
B. Insert the scope straight into the ear.
C. Pull the pinna up and back and insert the scope.
D. Tilt the scope to the angle of the ear.
C. Pull the pinna up and back and insert the scope.
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