Term
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Definition
| adjustment of the eye to variations in distance;an adjustment of the eyes for near vision, consisting of pupillary constriction, convergence of the eyes, and increased convexity of the lens. |
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Term
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Definition
| excessive secretion of growth hormone from the pituitary gland after puberty , it creates an enlarged skull and thickened cranial bones;characterized by gradual, marked soft tissue enlargement and widening and thickening of skeletal bones in the face, jaw, hands, and feet |
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Term
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Definition
| when a person has pupils of two differnt sizes, an inequality of the diameter of the pupils of the two eyes |
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Term
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Definition
| an opaque ring, gray to white in color, that surrounds the periphery of the cornea. It is caused by deposits of cholesterol in the cornea or hyaline degeneration and occurs primarily in older persons. |
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Term
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Definition
| an abnormal condition of the eye in which the light rays cannot be focused clearly in a point on the retina because the spheric curve of the cornea or lens is not equal in all meridians |
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Term
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Definition
| an abnormal progressive condition of the lens of the eye, characterized by loss of transparency |
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Term
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Definition
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Term
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Definition
a beady nodule protruding on the lid; an infection or retention cyst of meibomian gland
-a stye |
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Term
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Definition
| infection of the conjunctiva- pink eye |
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Term
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Definition
| shine the light toward the eyes; the light should be reflected at exactly the same spot in the two corneas |
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Term
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Definition
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Term
|
Definition
| an expression or appearance of the head and neck that, when taken together, are characteristic of a clinical condition or syndrome |
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Term
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Definition
| increased intraocular pressure |
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Term
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Definition
| a chronic enlargment of the thyroid gland that occurs in some regions of the world where the soil is low in iodine |
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Term
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Definition
| a pathologic condition characterized by an abnormal accumulation of cerebrospinal fluid, usually under increased pressure, within the cranial vault and subsequent dilation of the ventricles. |
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Term
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Definition
inflammation of the mucous membrane lining the larynx, accompanied by edema of the vocal cords with hoarseness or loss of voice
-occurring as an acute disorder caused by a cold, irritating fumes, or sudden temperature changes
-or as a chronic condition resulting from excessive use of the voice, heavy smoking, or exposure to irritating fumes |
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Term
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Definition
| upper eyelid continues to overlap the superior part of the iris, even during downward movement. |
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Term
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Definition
| one of the many small oval structures that filter the lymph and fight infection and in which lymphocytes, monocytes, and plasma cells are formed. |
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Term
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Definition
| abnormal largeness of the head and brain in relation to the rest of the body |
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Term
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Definition
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Term
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Definition
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Term
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Definition
| contraction of the sphincter muscles of the iris , causing the pupil to dialte, CONSTRICTION OF THE PUPILS |
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Term
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Definition
dilated and fixed pupils
-enlarged pupils occurs with stimulation of the sympathetic nervous system |
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Term
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Definition
| a round symmetric skull that is appropriately realted to the body size |
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Term
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Definition
| involuntary, rhythmic movements of the eyes |
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
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Term
|
Definition
| an infection of the outer ear - swimmners ear |
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Term
|
Definition
middle ear infection
-occurs because of obstruction of the eustachian tube or passage of nasopharyngeal secretions into the middle ear
-children commonly get this |
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Term
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Definition
| the elliptical open space between the eyelids |
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Term
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Definition
| swelling of the optic disc, visible on ophthalmoscopic examination of the fundus of the eye, caused by increase in intracranial pressure. |
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Term
|
Definition
| any one of the air cavities in various bones around the nose, such as the frontal sinus in the frontal bone lying deep to the medial part of the superciliary ridge and the maxillary sinus within the maxilla between the orbit, the nasal cavity, and the upper teeth. |
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Term
|
Definition
| swollen, puffy lids, lid tissues are lossely connected so excess fluid is easily apparent. |
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Term
|
Definition
| inflammation of infection of the pharynx - usually causes a sore throat |
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Term
|
Definition
| abnormal sensitivity to light, especially of the eyes |
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Term
|
Definition
| a refractive condition in which the accommodative ability of the eye cannot meet the accommodative demand for near work. It results from a loss of elasticity of the lens of the eye. The condition commonly develops with advancing age, with the first symptoms appearing about age 40. |
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Term
|
Definition
| drooping upper eye lid; gives a sleepy appearence |
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Term
|
Definition
| inflammation of the mucous membranes of the nose |
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Term
|
Definition
| tuning fork on the mastoid process |
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Term
|
Definition
| a defect of vision in a defined area of the visual field in one or both eyes. A common prodromal symptom is a shimmering film appearing as an island in the visual field. |
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Term
|
Definition
| an abnormal ocular condition in which the visual axes of the eyes are not directed at the same point |
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Term
|
Definition
| a subjective noise sensation, often described as ringing, heard in one or both ears. |
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Term
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Definition
| a small tongue-like projection of the auricular cartilage of the ear, anterior to the external meatus |
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Term
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Definition
| three parellel bony projections in the lateral walls of each nasal cavity |
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Term
|
Definition
| a sensation of instabiliy, giddiness, loss of equilibrium, or rotation of the brainstem |
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Term
|
Definition
| tuning fork on the top of the head |
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Term
|
Definition
| speaking softly to test hearing one ear at a time |
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Term
| Review of related history dealing with the eyes, ears, sinuses, and neck |
|
Definition
* Head trauma and sequelae( consqequences, after effects)
* Brain tumor and Sequelae
* headaches ( full symptom analysis)
* Stiff neck ( injury, strain, swelling, fever, or bacteria illness)
* Dizziness ( sensation or faintness)
* Verigo ( sensation of spinning: self =internal, or external=room or objects)
* weakness
* falls
* Epistaxis- nosebleeds
* Nasal Discharge
* Frequent URI's ( colds)
* Seasonal allergies
* nasal discharge ( color and amount)
* Facial Pain
* Sinusitis
* Painful Ulcers or sores ( mouth, lip, nose)
* bleeding gums
* sore throat
* strep throat
* Abnormal taste ( hypogeusia; geusia meaning taste; decreased sensitivity to taste) ( Dysgeusia = unpleasent taste)
* Horseness
* Dysphagia
* changes in vision ( diplopia= double vision, blurred vision, halos)
* excessive tearing
* Burning of the eyes
* eye pain
* use of assistive devices
* changes in hearing
* ear pain
* use of assistive devices
* thyroid problems
- swelling in the neck
- changes in temperature preferences; texture of the hair, skin, nails, menstraul pattern, energy levels
- tachycardia , palpitations ( beating of the heart vigorously that the person is awar of it)
* |
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Term
| what equipment will we need? |
|
Definition
* light source
* tongue blade
* cotton ball
* tape measure
* stethoscope
* otoscope
* snellen eye chart or pocket vision card
* ophthalmoscope |
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Term
| what techniques will we be using |
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Definition
|
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Term
|
Definition
the head and the neck exam is not a single fixed sequence
* different portions are included depending on the examiner and the situation
* it is usually most efficient to examine the ears, nose, and throat in one smooth process |
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Term
| the charcteristics of the most common cheif complaints of visual impairment |
|
Definition
floaters are common with myopia or after middle age due to condensed vitreous fibers. usually not significant, but acute onset of floaters. ("shade" or "cobwebs") occurs with renal detachment.
Halos around light occurs with acute narrow angle glaucoma.
Scotoma, a bling spot surrounded by an area of normal or decreased vision, occurs with glaucoma. objects appear out of focus , or clouding over objects? grayness of vision. Spots moving in front of their eyes, rings around light, halos/ rainbows around objects, night blindness |
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Term
| Chief complaints of eye infections |
|
Definition
| redness, swelling, burning, itching, |
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Term
| chirf complaints of ear infections |
|
Definition
odor, pus, discharge ( otorrhea)
ear pain, otitis externa, otitis media, cholesteatoma- dirt, yellow, gray discharge, smells |
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Term
| chief complaints of sinus infections |
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Definition
| pain in the sinus regions, stuffy, congested |
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Term
| chief compaint of rhinitis |
|
Definition
| stuffy nose, runny nose, post nasal drip |
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Term
| focused health history on a person with rhinitis |
|
Definition
| any nasal discharge or runny nose? Continuous? Is the discharge watery, purulent, mucoid, or bloody? |
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Term
| focused health history on a person with sinus pain |
|
Definition
| any sinus pain? or sinustitis? how is this treated? do you have chronis post nasal drip? |
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Term
| focused health history on a person with ear infections |
|
Definition
at what age was the child's first episode? how many ear infections in the past 6 months? how many total? hwo were they treated?
* any surgery, such as insertion of ear tubes or removal of tonsils?
* are infections increasing in frequency, in severity, or staying the same?
* does anyone smoke cigarrettes in the home?
* does the child receive childcare outside your home? day care or someone elses home? how many children in the group care/ |
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Term
| focused health history on someone with vision impairment |
|
Definition
any difficulty seeing? any blurring? any blind spots? does it some on suddenly or progressively slowly? in one eye or both eyes?
* constant or does it come and go?
* so objects appear out of focus? or does it feel like a clouding over objects? doe it feel like " grayness of vision"? do spots move in front of your eyes? one or many? In one or both eyes? any halos, rainbows around the objects? or rings around lights? any blind spot? does it move as you shift your gaze? any loss of peripheral vision? |
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Term
| focused health histoy on someone with eye infections |
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Definition
| any redness or swelling in the eyes? any infections? now or in the past? when do these occur? in a particular time of year? |
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Term
|
Definition
|
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Term
|
Definition
| behind the ear, superficial to the mastoid process |
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Term
|
Definition
|
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Term
|
Definition
| halfway between the angle and the tip of the mandible |
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Term
|
Definition
| under the angle of the mandible , right below the ear |
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Term
|
Definition
| midline, behind the tip of the mandible |
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Term
|
Definition
| overlying the sternomastoid muscle |
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Term
|
Definition
| in the posterior triangle along the edge of the trapezius muscle |
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Term
|
Definition
| just above and behind the the clavical at the sternomastoid process |
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Term
| What techniques will we using |
|
Definition
|
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Term
|
Definition
* the head and neck exam is not a single fixed sequence
* different portions are included depending on the examiner and the situation
* it is usually most efficient to examine the ears, nose, and throat in one smooth sequence |
|
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Term
| what are the areas of the lymph nodes on the head and neck |
|
Definition
Preauricular
Postauricular
Occipital
Tonsillar
Submandibular
Submental
Anterior Cervical Chain
Posterior Cervical Chain
Supraclavicular |
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Term
| what is the first thing you do when inspecting the head |
|
Definition
observe head position and movement
* Normal = upright, midline and still
- jerking may indicate tremors
-nodding may indicate aortic stenosis |
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Term
| What is the second thing you do when inspecting the head |
|
Definition
* inspect the skull and scalp
-size
-shape
-symmetry
-lesions |
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Term
| What is the third thing you do when inspecting the head |
|
Definition
inspect facial features
-shape and symmetry
*cranial nerve 5 (trigeminal):
-motor =jaw opening, clenching, mastication ( chewing)
- sensory= sensation over the face
*Cranial Nerve VII (Facial)
Motor
Raise eyebrows
Smile, frown, and show teeth
Puff out cheeks
Close eyes tightly
Sensory
Taste: anterior 2/3 of tongue
ALSO INSPECT FOR
unusual features
* edema: tissue swelling
* Prominant eyes: hyperthyroidism
* sunken eyes: dehydration, malnutrition
*Hirsutism: excessive hair growth
*Alopecia: hair loss
*Tics: Spasmodic muscular contractions
*Facies: an expression or appearance of the head and neck that, when taken together, are characteric or a clinical condition or syndrome |
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Term
| what does cranial nerve 5 do |
|
Definition
(Trigeminal)
Motor
Jaw opening and clenching
Mastication (chewing)
Sensory
Sensation over the face |
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Term
| What does Cranial Nerve 7 ( facial) do |
|
Definition
motor
-raise eyebrows
-smile, frown, and show teeth
-close eyes tightly
-puff out cheeks
sensory
-taste: anterior 2/3 of tongue |
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|
Term
| what do you do with palpating the head |
|
Definition
-palpate using a gentle rotary motion
-proceed from front to back
-skull and scalp:
Contour: smooth
symmetry
tenderness
scalp movement
- hair as previously discussed
-palpate for lymph nodes |
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|
Term
| when examining the sinuses make sure that you |
|
Definition
- inspect the area over the frontal(forhead) and maxillary (cheeks/ under eyes) sinuses:transillumination ( shining a light through the body) may be done if a probelm is suspected
-palpate over the frontal and maxillary sinuses
-percuss over the frontal and maxillary sinuses |
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Term
| inspecting the neck we inpect in: |
|
Definition
-usual anatomic position
-slight hyperextension
*hyperextension-exaggerated exstention >180
*extension- movement that increases the angle of a joint to 180; straightening the joint
* ALSO inspect the neck as the person swallows with neck hyperextended |
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Term
| What do we inspect for in the neck |
|
Definition
* symmetry
* alignment of trachea
* fullness
* masses, webbing, skin folds
* jugular vein distention
* carotid artery distention
* cranial Nerve 11 ( spinal accessory)
which gives us the ability to shrug shoulders with and without resistance and turn head |
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Term
|
Definition
spinal accessory
ability to shrug shoulders with and without resistance and turn head |
|
|
Term
| what do we palpate with the neck |
|
Definition
the trachea
*position
*tugging
lymph nodes |
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|
Term
| how do we test Visual acuity |
|
Definition
* cranial nerve 2 ( optic)
* allows the person to use glasses or contact lenses ( you as a nurse are interested in the persons best corrected vision)
* position the person 20 feet in front of the snellen chart ( or hold a Rosenbaum pocket card 14 inch " reading" distance)
-Have the person cover one eye at a time with a card
-Ask the person to read progressively smaller letters until they can go no further
-Record the smallest line the person read successfully
-Repeat with the other eye
-Repeat with both eyes
Visual acuity is reported as a pair of numbers (e.g., 20/20) where the first number is how far the person is from the chart and the second number is the distance from which the "normal“ eye can read a line of letters
For example, 20/40 means that at 20 feet the person can only read letters a "normal" person can read from twice that distance |
|
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Term
|
Definition
|
|
Term
|
Definition
Observe the person for ptosis, exophthalmos (protruding eye ball out of the socket), lesions, deformities, or asymmetry
Ask the person to look up and pull down both lower eyelids to inspect the conjunctiva and sclera
Next spread each eye open with your thumb and index finger
Ask the person to look to each side, upward and downward to expose the entire bulbar surface.
Note any discoloration, redness, discharge, or lesions
Note any deformity of the iris or lesion cornea |
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Term
| how do you test a persons visual fields |
|
Definition
Cranial Nerve II
Stand two feet in front of the person and have them look into your eyes
Hold your hands to the side half way between you and the person
Wiggle the fingers on one hand
Ask the person to indicate which side they see your fingers move
Repeat two or three times to test both temporal fields
To test for neglect, on some trials wiggle your right and left fingers simultaneously
The person should see movement in both hands
If an abnormality is suspected, test the four quadrants of each eye while asking the person to cover the opposite eye with a card |
|
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Term
| how do you perform corneal light reflex test? what does asymmetry suggest |
|
Definition
Shine a light from directly in front of the person
The corneal reflections should be near the center of the pupils
Asymmetry suggests extraocular muscle pathology |
|
|
Term
| extraocular movements (EOM) deals with what three cranial nerves |
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Definition
| cranial nerve 3 (oculomotor) , cranial nerve 4 ( Trochlear), and cranial never 6 (abducens) |
|
|
Term
| how do you test Extraocular Movements (EOM) |
|
Definition
Stand or sit 3 to 6 feet in front of the person
Ask the person to follow your finger with their eyes without moving their head
Check gaze in the six cardinal directions using a six-sided cross or "H" pattern
Hold in the 4 corners momentarily to check for nystagmus
Check convergence by moving your finger toward the bridge of the person's nose |
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|
Term
| What cranial nerve does pupillary reactions deal with |
|
Definition
|
|
Term
| How do you test pupillary reactions |
|
Definition
cranial nerve 2
* dim the room lights as necesary
* ask the person to look into the distance
* shine a light obliquely into each pupil in turn
Once in each eye, observing response in that eye (direct)
A second time in each eye, observing response in opposite eye (consensual)
Record pupil size in mm and any asymmetry or irregularity |
|
|
Term
| How do you check pupillary reactions dealing with accomodations ( near reactions) |
|
Definition
* hold your finger about 10 cm from the person's nose
* bring your finger in toward the nose and watch for pupillary constriction as you near the nose. |
|
|
Term
|
Definition
is a common abreviation used to describe pupillary reactions, stands for " Pupils equal round reactive to light and accomodations"
- The use of this term is so routine that it is often used incorrectly
if you do not specifically check the accommodations reaction then use the term PERRL instead |
|
|
Term
| what is only visible using the ophthalmoscope (5) |
|
Definition
| the fundus of the eye which includes the macula, fovea, optic disc, retina, renial vessel |
|
|
Term
| what do you do when using the ophthalmoscope |
|
Definition
Darken the room as much as possible
Adjust the ophthalmoscope so that the light is no brighter than necessary
Adjust the aperture to a plain white circle
Set the diopter dial to zero unless you have determined a better setting for your eyes |
|
|
Term
| How do you properly use the opthalmoscope |
|
Definition
position your hand so that your index finger is free to manipulate the diopter dial
-Alternatively, you may hold it to use your thumb for adjusting diopters |
|
|
Term
| what do you do as a nurse when using the ophthalmoscope on a patient |
|
Definition
Use your left hand and left eye to examine the person's left eye
Use your right hand and right eye to examine the person's right eye
Place your free hand on the person's shoulder for better control.
Ask the person to stare at a point on the wall or corner of the room.
Look through the ophthalmoscope and shine the light into the person's eye from about two feet away
You should see the retina as a "red reflex." Follow the red color to move within a few inches of the person's eye |
|
|
Term
| What does cranial nerve 8 deal with |
|
Definition
|
|
Term
| what three tests do we do in order to check auditory acuity |
|
Definition
Cranial Nerve VIII (Acoustic)
Whisper Test
Stand 1-2 feet away and whisper monosyllabic and bisyllabic words
Weber Test
Strike tuning fork an place on top of the head
Sound should be heard equally well in both ears
Strike tuning fork an place on mastoid (bone conduction)
When sound no longer heard – move tuning fork in front of the ear (air conduction)
AC 2x > BC |
|
|
Term
| How do we inspect the external ears? |
|
Definition
inspect the auricles ( should be aligned) and move them around gently, ask the person if this is painful
* palpate the mastoid process for tenderness or deforitity |
|
|
Term
|
Definition
* hold the otoscope with your thumb and fingers so that the ulnar aspect of your had makes contact with the person
* Straighten the canal
- Adults: pull the ear upward and backward
- children: pull the ear downward and backwards
* Inserts the otoscope to a point just beyond the protective hairs in the ear canal
* use the largest speculum that will fit comfortably
* Inspect the ear canal noting redness, drainage, or foreign body. |
|
|
Term
| does the otoscope exam inspect the middle ear structure? |
|
Definition
|
|
Term
| What do you look for when inspecting the oropharynx? |
|
Definition
lips:
-color
-moisture
-ulcers
-lesions
-cracking
-edema
Buccal Mucosa
-color
-ulcers
-white patches
-plaques
-nodules
Teeth
-occultions
-condition and number
Gums
-color
-edema
-bleeding
Hard and Soft Palates
-color
-configuration
Cranial Nerve XII (hypoglossal)
tongue movement for speech and articulation
(l,t,n)
* swallowing
Tonsillar area
-presence
-color
-uvula position
-swelling
-exudate
Cranial nerve X ( vagus)
-hard and soft palate rise with phonation
Cranial nerve 9 ( glossopharyngeal)
-gag rflex
-taste posterir 1/3 of tongue
-swallowng and phonation |
|
|
Term
| what is the cranial nerve 12 do |
|
Definition
| hypoglossal deals with the tongue movement for speech and articulation |
|
|
Term
| what is the cranial nerve 10 do |
|
Definition
| (vagus)hard and soft palate rise with phonation |
|
|
Term
| what is the cranial nerve 9 do |
|
Definition
glossopharyngeal
-gag reflex
-taste: posterior 1/3 of tongue
-swallowing and phonation |
|
|
Term
| What do you inspect on the nose |
|
Definition
* external structures
-symmetry
-size
-septal deviation
* cranial nerve 1 ( olfactory)
-sense of smell
* Internal structues
-tilt person's head backward
-use nasal speculum to examine the interiors of the nares , and examine for:
color
exudate
polyps
sites of recent bleeding
septal deviation
* In the absence of a nasal speculum, you will only be able to observe the lower turbinates |
|
|
Term
| Neonates and infant deviations |
|
Definition
* skull bones are soft and seperated
-sutures: ossification begins at 6 years of age : sagittal, coronal, lambdoidal
* Fontanels
-anterior: ossify by around 18-24 months of age
-posterior: ossify by around 2-3 months of age
Head circumference very important up to two years of age
Transillumination of the skull
Not done as much as in the past
Drooling is common up to on year of age
Check for cleft lip and palate
Neonates are obligatory nose breathers
Maxillary and ethmoid sinuses very small
Eustachian (connects the middle ear to the throat, purpose is to equalize middle ear pressure with enviromental pressure) tube is wide, short, and more horizontal
Prone to otitis media
Ear infection
Deciduous teeth (baby teeth) appear between 6 and 24 months |
|
|
Term
| what are three neonatal variations at birth |
|
Definition
Molding
Overlapping cranial bones
Caput Succedaneum
Soft tissue swelling
Crosses the suture lines
Cephalhematoma
Bleeding into the periosteum
Does not cross the suture lines |
|
|
Term
| what are the developmental variations with children |
|
Definition
Subtle changes in facial appearance throughout
Achieves visual acuity of 20/20 by 6 years of age
Bruits are common in children up to age 5 or in children with anemia
The thyroid of a young child may be palpable
Should not be tender
Watch for “allergic salute”
Crease at the juncture between the cartilage and bone of the nose
Maxillary sinuses may be palpated |
|
|
Term
| develope variations for adolescents |
|
Definition
Males
The nose and cricoid cartilage enlarge
Facial hair develops
First on the upper lip, then on cheeks, lower lip, and chin |
|
|
Term
| Preganancy developmental variations |
|
Definition
Thyroid often enlarges
May hear a thyroid bruit
Chloasma (melasma)
Edema and erythema of the nose and pharynx are common
Epistaxis
Nasal “stuffiness”
Hypertrophy of the gums
May bleed with brushing |
|
|
Term
| Elderly developmental variations |
|
Definition
Thyroid may feel more nodular or irregular on palpation
Be careful with range of motion
Skin changes on the face and neck
Buccal and nasal mucosa dryer
Increased coarse nasal hairs (especially in men)
Presbyopia (change in accommodation)
Lens is more rigid, ciliary muscles of iris weaker |
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|
