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144 Cards in this Set
- Front
- Back
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Describe assessment technique and normal findings of the face.
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GENERAL INSPECTION AND PALPATION
Look at Facial expression & appearance: Inspect for symmetry N = approp. to situation, generally symmetrical Cultural variations important to remember |
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Describe assessment technique of the facial features
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Inspect eyebrows, eyes, palpebral fissure (CN III), mouth, nasolabial fold for symmetry, involuntary movement, edema, masses or lesions
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Describe normal findings of the facial features
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head upright, still features or slightly asymmetrical
no edema, no masses, lesions |
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Describe assessment technique and normal findings of the skin of the face
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Inspect for color, pigmentation, texture, lesions
Normal findings: texture smooth (age variation) no masses,lesions,tenderness Variation: jaundice, cyanosis, pallor |
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Describe assessment technique for CN VII and V
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Inspect and palpate for involuntary movements
CN VII (Facial) Sensory and motor assessment: Sensory: apply sugar or salt to ant. 2/3 of tongue on each side (not routinely tested) Motor: facial movements: wrinkle forehead, close eyes, show teeth, puff cheeks, whistle. Observe for symmetry, tremor. |
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what would normal findings be for CN VII
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Approp. identification of substance. Execution of movements without tremor, movements symmetrical.
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describe appropriate exam techniques for the sensory aspect of CN V
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Trigeminal
Sensory: Test tactile and pain sensation of all three branches: ophthalmic, maxillary, mandibular. Apply sharp & dull sensation with pt. eyes closed; ask pt. to localize & describe sensation (what and where to you feel it). Note symmetry. (tell your pt what is sharp and what is dull first to define) |
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describe appropriate exam techniques for the motor aspect of CN V
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Palpate masseter & temporal muscles as client bites down; palpate jaw resistance. Corneal reflex not routinely tested (done to assess brain death, less reflex in contact wearers). (looking for bilaterally equally strong contraction of the masseter and temporal muscles)
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what are the three branches of the Trigeminal Nerve (CN V)
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Ophthalmic branch
Maxillary branch Madibular branches |
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what are normal findings for CN V
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Sensory perception approp. for all three branches bilaterally. Looking for Equal, strong contraction of masseter & temporal muscles bilaterally.
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describe assessment techniques for general inspection and palpation of the head starting with the temporal arteries
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Temporal arteries: Palpate for hardness, tenderness. Auscultate for bruit (turbulent blood flow) with bell of stethoscope.
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what are normal findings upon inspection of the temporal arteries
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Normal findings:
palpable reg. rhythm no tenderness, no bruit symmetrical, “intensity 2+”, rate and rhythm |
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describe assessment techniques for general inspection and palpation of the head: tempromandibular joint
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Palpate joint for swelling, tenderness while patient moves through range of motion (ROM): opens and closes mouth, moves joint from side to side
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what are normal findings upon inspection of the TMJ?
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smooth movement
no swelling, tenderness snap, click may be present normally (be concerned if pain with clicking) Variation: arthritis |
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describe assessment techniques for the general inspection and palpation of the head in general
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Inspect size, shape, symmetry, position, unusual movement, contour.
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whatare normal findings upon inspection of the head in general?
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normocephalic with gently curved frontal & parietal prominences
symmetrical, midline no involuntary movements may see some irregularities near suture lines abnormal variation: hydrocephalus (water on the brain) |
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acromegaly and paget's disease may exhibit what signs
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abnormalties in head size and contour
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describe general inspection and palpation techniques for the hair.
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Inspect by parting in several places and observing for quantity, distribution, texture, pattern of loss, color of hair. Remove hair piece if approp. Observe use of dyes, cleanliness of hair/scalp.
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describe normal findings upon inspection of head hair
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Hair covers scalp (Variation: alopecia - may be normal or assoc. with disease) ( distribution)
Hair neither excessively oily or dry; note if change in texture of hair - Color variation: graying associated with age or may be assoc. with illness |
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describe assessment techniques for inspection of the scalp and normal findings
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nspect scalp for coverage, masses, lesions, scaliness; palpate for masses, lesions, tenderness
Normal Findings: Scalp is freely moveable over skull, no masses, lesions or tenderness |
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describe assessment techniques for inpection and palpation of the lymph nodes, sublinqual area, and salivary glands
Normal Findings |
Inspect & palpate for visible lymph nodes, symmetry, stability, (salivary glands: parotid and submandibular gland
sublingual, enlargement, masses, lesions, tenderness Normal Findings: symmetrical, no masses, lesions, no glandular enlargement or tenderness |
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describe how to assess the sternocleidomastoid & trapezius muscles
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Test muscle function by performing ROM of neck:
flexing chin to chest, lateral rotation, hyperextension of neck backward, lateral bending. |
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How to assess CN XI? (spinal accessory)
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Sternocleidomastoid: Turn head side to side against resistance
Trapezius: Shrug shoulders (CN XI) against resistance |
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what do normal findings look like for CN XI strength and function assessment?
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Muscle function: N = smooth, coordinated movements bilaterally without pain
Muscle strength (CN XI) : N = strong contraction of muscles bilaterally without pain, spasm, tenderness |
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How to assess the midline cartilages of the neck?
Normal Findings |
Inspect/palpate thyroid cartilage, cricoid cartilage, tracheal rings for symmetry & tenderness.
Normal findings: smooth, nontender, symmetrical |
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How to inspect the trachea and normal findings
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Inspect/palpate for midline position
Normal Findings: trachea midline |
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How to inspect the posterior neck
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Inspect/palpate for masses, swelling, tenderness, symmetry
cervical vertebrae and related soft tissue trapezius & sternocleidomastoid muscles occipital area, mastoid process |
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normal findings for the posterior neck
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symmetrical
no masses, lesions, tenderness no swelling |
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How to assess the thryroid gland?
Normal findings? |
Inspect first, then palpate:
Assess for size, symmetry, consistency, enlargement swelling, nodules or masses, bruits, tenderness. Also note systemic effects. As client sips water, observe rise and fall of gland. Tangential (from the side) lighting may help to observe gland. N = no bulging, symmetrical |
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when palpating the thyroid gland, what do you feel for?
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Palpate for size, shape, consistency, tenderness, nodules.
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what are normal findings for thryroid gland assessment?
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nonpalpable, or only slightly palpable
no nodules/masses, nontender moveable if palpable, meaty/rubbery consistency; size = distal phalanx of thumb Auscultate: If necessary for bruits; normally none |
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what do you need to tell about the function of the thyroid gland?
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The physical characteristics (size, shape) of the thyroid gland are diagnostically important, but tell you little about thyroid function. (Get a blood work up to diagnose fxn of the gland)
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where are lymph nodes located in the head?
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preauricular (in front of ears), postauricular, occipital, parotid, submandibular, submental, sublingual
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where are lymph nodes located in the neck?
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ant. and post. cervical chain (lie on either side of the sternocleidomastoid muscle), internal jugular chain, posterior cervical spinal nerve chain, supraclavicular
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how to assess lymph nodes of head and neck
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Inspect/palpate for size, shape, mobility, consistency, tenderness. (matted together or discreet?)
Use pads of fingers in circular motion; palpate simultaneously (except carotid). N = nonpalpable, nonvisible If you find a lymph node, report where it is, how big is it, mobility, tenderness, matted together or discreet, etc. |
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how should you inspect/palpate lymph nodes of head and neck?
What's normal, what do you do if you find a lymph node? |
Inspect/palpate for size, shape, mobility, consistency, tenderness. (matted together or discreet?)
Use pads of fingers in circular motion; palpate simultaneously (except carotid). N = nonpalpable, nonvisible If you find a lymph node,Look for source of infection or neoplasm in the area that the lymph node drains and report where it is, how big is it, mobility, tenderness, matted together or discreet, etc. |
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what are some variations from the normal lymph nodes?
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“Shotty nodes”: small (less than 1 cm), moveable, separate (discrete), nontender nodes found in normal healthy person
Infection: Enlarged, tender, matted or discrete Malignancy: Hard, nontender, discrete or matted |
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what are the four parts of vision that form the retinal image?
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refraction
accommodation constriction of the pupil convergence of the eyes |
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describe refraction in the formation of the retinal image
what structures are used and must be clear healthy and in tact? |
Bending of light rays from one transparent medium to another. (the following must be clear, healthy and in tact)
In the eye, the structures used are: cornea aqueous humor (btw cornea and lens lens vitreous humor (behind lens) |
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describe accommodation in the formation of the retinal image
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Allows the eye to focus on near objects by increasing the curvature of the lens.
This is accomplished by contraction of the ciliary muscles that causes the elastic lens to bulge. |
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describe constricting the pupils in the formation of the retinal image
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Prevents divergent light rays from coming in through peripheral portion of cornea & lens.
- Pupillary constriction is accomplished by contraction of the iris - Pupil also constricts with bright light and near objects |
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describe converging the eyes inward in the formation of the retinal image
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Allows single, binocular vision
- Accomplished by six extraocular eye muscles – 4 rectus and 2 oblique |
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Trace the path of an image through the eye to the brain
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Refraction, accommodation, pupillary constriction, convergence
Image formed on retina (reversed, upside down Optic Nerve (CNII) Optic Chiasm Optic tract Occipital lobe of brain |
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how to assess eyes, begin with:
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Assess macular area of retina, transparent structures of eye
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How to assess CN II
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Snellen Chart = Standardized numbers at end of each line of letters which indicate degree of visual acuity
With client 20 feet from chart, ask client to read smallest line of print possible, one eye at a time – then both (with and without correction). Record reading at end of line which client can read more than 1/2 the letters. Numerator is always “20” (standard testing distance) Denominator is distance from which the normal eye can read letters on that line. |
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what is normal findings in the Snellen Chart assessment?
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N = 20/20 without corrective lenses
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recording findings in the Snellen chart assessment should include:
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Note with or without correction
Abbreviations (these abbreviations NOT allowed in acute care environment): O.D. ( oculus dexter – right eye) O.S. ( oculus sinister – left eye ) O.U. (oculus uterque – both eyes) |
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tips for using the Snellen Chart include:
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use well-lighted room
client must stand/sit 20 ft. from chart at eye level test one eye at a time initially, then both eyes together cover eye with opaque card test with/without corrective lenses, except reading glasses if unable to read largest letter, check for perception of hand or light at 12” |
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How to test for near vision:
What is normal? |
Jaeger or Rosenbaum chart
Hold approx 14 inches from eye – this distance equals the print size on a 20-foot chart. Normal = 14/14 in each eye |
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what is hyperopia
what is myopia |
hyperopia (farsighted)
myopia (nearsighted) |
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what is presbyopia
what is diplopia what is considered legally blind? |
presbyopia - inability of lenses to accommodate due to weak ciliary muscles, and inability to bulge with near vision. Leads to hyperopia (farsighted).
diplopia - double vision due to weakness of extraocular muscles legally blind -20/200 with correction |
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how to assess for peripheral vision:
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Visual Fields Confrontation Test(CN II): Test for peripheral vision by comparing your own peripheral vision with that of your clients.
only estimates large field defects assumes your vision is normal N = you and client can see object enter at the same time (visual field equal to examiners)(assess from behind the pt.) |
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What pneumonic can you use to remember the innervation of the extraocular muscles
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LR6SO4
lateral rectus innervated by cn 6, superior oblique innervated by cn 4, all the rest are innervated by cn 3 |
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how to assess extraocular muscle function
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(CN III, IV, VI): Test function of each muscle by asking client to move eyes (keep head still) through six cardinal positions of gaze.
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To test the extraocular muscle function:
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Test function of each muscle by asking client to move eyes (keep head still) through six cardinal positions of gaze.
Six cardinal positions of gaze: move clockwise or make ‘H’ |
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normal findings for extraocular muscle fxn:
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eyes parallel without nystagmus (rapid twitching of the eye)
small nystagmus is normal in lateral position |
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assess the lids by?
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assess for lid lag and ptosis by observing eyes in neutral position
Variation: lid lag (wide open eye – can see the schlera), ptosis (eyelid drooping) , diplopia |
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Which cranial nerve is likely to be paralized in this photo?
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Ptosis b/c cnIII innervates the eyelid
Pupillary dilation b/c cn III innervates the pupil? |
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Describe the Corneal Light Reflex
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Assesses parallelism of anterior & posterior axes of two eyes by observing reflection of light from cornea. Shine light toward bridge of nose from 12-15”.
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what are normal findings for the corneal light reflex test?
what should you do if not normal? |
N = light reflected symmetrically (12:00 bilaterally)
If unsymmetrical, perform cover-uncover test |
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How to assess the external eye structures: eyelids
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inspect/palpate for symmetry, edema, color, masses, lesions, tenderness, coverage
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what are normal findings for the eyelid assessment?
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palpebral fissue (space btw upper and lower lid) equal
no edema no masses, lesions, tenderness Variation:exopthalmos |
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what are normal findings for:
eyelashes eyebrows |
Eyelashes: (inspect)
N = evenly distributed, symmetrical, curve outward Eyebrows: (inspect) N = evenly distributed, symmetrical |
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How to assess the conjuctiva:
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Bulbar conjunctiva (lies over sclera & merges with cornea) & palpebral conjunctiva (lines eyelids).
Inspect for color, discharge, lesions, thickening, masses, vascular pattern. Separate eyelids - look up down and to each side. DO NOT perform upper eyelid eversion! |
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what are normal findings for the palpebral conjunctiva assessment
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N = transparent; shiny pink/red vascular bed visible underneath
no lesions, masses, no discharge, moist, no excessive redness; may see few small blood vessels |
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what are normal findings for the bulbar conjunctiva assessment
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N = transparent; white visible from sclera underneath
no lesions, masses, no discharge, moist, no excessive redness; may see few small blood vessels |
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what are normal findings for the sclera assessment
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N = white, no swelling/lesions, smooth
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How to assess the cornea
normal findings? |
inspect using oblique lighting
N = shiny, transparent , smooth, no irregularities |
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what are some variations of the cornea?
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Variation: arcus senilis (white ring around cornea) (normal in elderly, not normal in young = high lipids) (corneal arcus), astigmatism
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How to inspect the lens.
Normal findings? Variations? |
Lens: (inspect using oblique lighting) N = transparent, shiny Variation: cataract - opacities in the lens
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how to assess the anterior chamber of the eye
Normal findings? variations? |
use oblique lighting
N = transparent Variation: glaucoma. Start screening at age 20. |
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How to assess the lacrimal apparatus.
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Inspect for dryness, excessive tearing; palpate for blockage
Inspect and palpate puncta for swelling, redness, d/c Inspect & palpate sac for tenderness, patency, regurgitation (use gloved finger to press against sac) |
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normal findings in the lacrimal apparatus assessment?
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no excessive tearing, dryness
puncta without swelling or tenderness, no D/C, color pink sac patent, nontender, no regurgitation |
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normal findings in iris assessment?
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N = round, clearly defined, regular borders
Size/shape: N = 2-6mm (with light), round, equal |
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what are some variations in pupil assessments
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Variation: anisocoria (unequal), miotic (tiny pupils), mydriatic (big pupils)
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you can assess which cranial nerves by shining light from the side and observing whether the pupil receiving light constricts, and the other eye should be equal
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CN II and III
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what is the difference between pupillary light reflection and corneal light reflection
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pupillary: light from side to observe pupil reactions
corneal light reflection: observing to see if the light dot in the two eyes are the same |
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what is another assessment technique for the pupils?
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Accommodation: convergence of eyes, constriction of pupils as pt. shifts gaze from distant to near object.
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How do you document your assessment on the pupils?
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PERRLA -or- PERRL (Pupil Equal Round Reactive to Light and Accommodation)
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How to conduct an opthalmoscopic exam:
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Use large, round beam of light
Start at “0” diopters Use your right hand and right eye for patient’s right eye; get close Dark room important Start by looking for red reflex examin the ocular fundus |
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what are normal findings for the optic disc during an opthalmoscopic exam
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Optic disc: Normal Findings:
1.5 mm in size,round/sl. oval creamy yellow-pink margins sharp demarcated from retina |
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what are normal findings for vessels during an opthalmoscopic exam?
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Vessels: Normal Findings:
arterioles brighter red than veins, 25% smaller A:V ratio 2:3 Arterioles and veins cross and intertwine without change in caliber |
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what are normal findings for retinal background and macular area during an opthalmoscopic exam?
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Retinal background:
N = uniform color - light to dark red, without patches of light/discoloration Macular area: N = same as retinal area, sl. darker |
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trace the path of sound waves from the external ear to the brain
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1. Sound Waves Strike tympanic membrane
2. Vibrations transmitted through auditory ossicles of ear (malleus, incus, stapes) to 3. oval window 4. Vibrations travel to cochlea 5. then to the round window 6. CN VIII (acoustic) 7. Brain |
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what is the air conduction hearing pathway
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Transmission of sound through the ear canal, tympanic membrane, and ossicles to the cochlea and the auditory nerve. (conductive phase) (external and middle ear)
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what is the bone conduction hearing pathway
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Transmission of sound through the bone of skull to the cochlea and auditory nerve. Bypasses the external & middle ear.
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what is a normal finding during a hearing assessment?
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AC > BC, bilaterally equal lateralization
(air conduction is greater than bone conduction) |
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trace the path of sound waves from the external ear to the brain
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1. Sound Waves Strike tympanic membrane
2. Vibrations transmitted through auditory ossicles of ear (malleus, incus, stapes) to 3. oval window 4. Vibrations travel to cochlea 5. then to the round window 6. CN VIII (acoustic) 7. Brain |
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what is the air conduction hearing pathway
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Transmission of sound through the ear canal, tympanic membrane, and ossicles to the cochlea and the auditory nerve. (conductive phase) (external and middle ear)
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what is the bone conduction hearing pathway
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Transmission of sound through the bone of skull to the cochlea and auditory nerve. Bypasses the external & middle ear.
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what is a normal finding during a hearing assessment?
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AC > BC, bilaterally equal lateralization
(air conduction is greater than bone conduction) |
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how to assess the external ear
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Auricles (pinna): Inspect & Palpate. Manipulation of pinna can help detect external otitis – “swimmers ear very sensitive when touching the pinna)
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normal findings for external ear assessment
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helix should be at or slightly above a line extending from the eye to the occipital area
size appropriate to head symmetrical no masses, lesions, no tenderness |
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how to assess the external canal of the ear
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Inspect with and without otoscope – do this before auditory testing to make sure nothing blocking hearing
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what are normal findings for external ear canal assessment?
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sml. amt cerumen
no redness/swelling no foreign bodies no D/C |
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how to assess the tympanic membrane
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Inspect color, light reflex, landmarks (umbo, malleus, annulus) with otoscope
Otoscope tips: use largest speculum possible grasp auricle up and back for adult, down in kids/infants |
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normal findings for the tympanic membrane assessment
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Normal Findings:
shiny, transparent pearl gray, sl. concave conical, shiny, uniform light reflex: 5:00 (R) ear, 7:00 (L) ear nonbulging umbo (point where the max amt of concaveness. (no fluid behind Manubrium of malleus visualized annulus without perforation (in tact) Variation: otitis media |
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how to assess CN VIII?
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Gross Hearing test (Auditory Nerve)
Occlude one ear at a time; stand 1 - 2 feet behind pt. Patient repeats whispered word. Other test for CN VIII: Caloric test (not routinely done). Tests vestibular portion of CN VIII. |
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normal findings for the CN VIII assessment?
variations? |
Client able to repeat whispered word correctly at 1 - 2 feet, bilaterally equal.
Variations: Tinnitus (ringing) Vertigo (spinning room) Dizziness (light headed) |
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what is the 60/60 rule?
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Wear your earbuds no longer than 60 minutes at a level 60% of max volume. Dial down to a level “6” and take a break every hour!
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what test can be used to evaluate bone conduction
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Weber test: Used to evaluate bone conduction
Place activated tuning fork on skull; ask client if you can hear it, and if sound is clearer on one side or other N = bilateral equal lateralization |
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How will conductive hearing loss be identified during the weber test?
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problem with middle or external ear): sound lateralizes (travels laterally) to defective ear. (hear better on defective side)
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how will sensorineural hearing loss be identified during the weber test?
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problem with inner ear, CN VIII or auditory cerebral cortex due to aging, medications): sound lateralizes to better ear.
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Describe the Rinne Test
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also a technique to test for auditory acuity:
Used to evaluate bone and air conduction Place activated tuning fork against mastoid process until client can no longer hear sound; then move the fork to the auditory meatus N = AC > BC or AC : BC = 2:1 |
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if there is conductive hearing loss, during the Rinne test, air conduction will be
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the same as or lesser duration than bone conduction
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during the Rinne test, if air conduction is greater than bone conduction but the duration is less than 2 to 1, there is __________ hearing loss
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sensorineural
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how to assess external nose?
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External Exam: Inspect bridge, tip, vestible (where naris is located), septum for shape, size, color masses, lesions.
Inspect nares for flaring, D/C Inspect septum for deviation. (congenital) Palpate ridge & soft tissue for displacement, tenderness, masses. |
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normal findings for the external nose?
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septum with/without deviation
no masses, lesions, tenderness, no swelling no discharge no nasal flaring |
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how to assess the internal nose?
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Inspect vestible, septum, turbinates for color, discharge, m/l, exudate, swelling
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normal findings for the internal nose?
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redder than oral mucosa
mucoid drainage no masses, lesions, swelling |
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how to assess CN I?
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Smell:(CN I) Test one nares at a time with eyes closed.
N = correct identification of smell |
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what is patency? how to assess it?
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Patency: (openess) Occlude one nares at a time N = patent
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How to assess the sinuses, frontal and maxillary? Normal?
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Sinuses (frontal & maxillary): Palpate, percuss for tenderness
N = non tender |
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how to assess lips:
normal findings, variation |
Lips: Inspect & Palpate
Normal Findings: symmetrical no edema no m/l/t Variation: cyanosis |
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how to asess the anteroinferior area
normal findings |
Anteroinferior area (between lower lip & gum):
N = no masses, lesions, tenderness, pink |
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how to assess the buccal mucosa
normal findings |
Buccal mucosa (inside cheek):
N = no masses, lesions, tenderness, pink |
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How to assess Stenson's duct
normal findings |
Stenson’s duct (opening of parotid gland; located opposite upper second molar):
N = patent, no inflammation |
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How to assess the maxillary mucobuccal fold
normal findings |
Maxillary mucobuccal fold (area between upper lip & gum)
N = no masses, lesions, tenderness, pink |
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how to assess the tonge
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Use gauze & gloves to lift tongue and examine post. & lateral surfaces. Inspect & Palpate.
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normal findings for the tongue assessment
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no swelling
size approp. for developmental age color pink no coating/ulceration (thin white coating is normal) no masses, lesions, tenderness texture sl. rough Post and lateral tongue: N = no masses, lesions, tenderness Ventral tongue: Have pt. lift tongue to roof of mouth N = no swelling, masses, lesions, tenderness |
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How to asses CN XII
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CN XII (Hypoglossal):
Extend tongue - observe for deviation, tremors, limitation, midline Tongue strength - move tongue side to side against resistance N = no deviation/tremor/limitation; tongue midline and strong |
