Head, Face, Neck, Lymphatics HA Exam #2

to protect the brain and special sensory organs
4 cranial bones
3 sutures
14 facial bones

a specialist
kids are resilient to head trauma
joints are immovable

many apperances and expressions that reflect

facial muscles mediated by CN VII

Facial

smile, pucker lips
show teeth, puff cheeks out
test for BILATERALLY

unilateral paralysis
only half of the face

3 sensory branches branches of cranial nerve V

Trigeminal

close eyes
wisp cotton ball across cheek
break tongue depressor and lightly touch cheek
have pt determine sharp or dull

base of the skull and inferior border of the mandible to the clavicle

CN XI

Acessory spinal nerve

shrug shoulders against resistance (arms on shoulders)
turn head while hand on cheek

an extensive vessel system
major part of immune system -> spleen -> ruptured causes impaired immune response
vessels allow flow of clear fluid
nodes are small, clusters of tissue
greatest supply is in head and neck
drainage is directional (toward blood stream)
subclavian veins are the 'dump' back into the bloodstream

use finger pads and move in a circular motion

Do you ever have headaches?
"Worst headache of my life"
never had a headache before -> notify provider immediately

Thunderclap Headache
new severe HA, esp over 50
HA triggered by coughing, sneezing, straining, sexual intercourse
HA triggered by change in position (lying to standing)
Prior HA pattern that now changes significantly (worsen, never goes away)
HA with systemic signs/symptoms (fever, rash, neck stiffness, weight loss, personality changes)

severe, reaching maximum intensity in minutes

results after a direct below to the skull causes the brain to shift rapidly back and forth inside

presyncope
vertigo
disequilibrium

a light-headed, swimming sensation or feeling of fainting or falling caused by decreased blood flow to brain or heart irregularity causing decreased cardiac output

true rotational spinning often from labyrinthine-vestibular disorder in inner ear

shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits

OLDCARTS
associated symptoms? precipitating factors? limited ROM? (meningitis can't put chin to neck)

feel with hands
tenderness = acute infection

difficulty swallowing
use NG tube

cancer is often disfiguring

symmetric
no pain
Normocephalic -> normal size and shape

TMJ -> Temporal Mandibular Joint
chew less and feel for popping

facial structures
symmetric
note any abnormality (tic)

symmetry (anterior and posterior)
ROM
Muscle strength CN XI (spinal accessory)

midline
tracheal shift (leftight)

auscultate thyroid for bruit, if enlarged
often you cannot palpate an adult's thyroid

not palpable

Small
Moveable
Discrete
Soft
Non-Tender

enlarged (>1 cm)
warm-tender
freely moveable

hard
non-tender
fixed