head, face, neck - CH13

● Skull
○ identify skull bones
● Neck
○ focus on the ant. and post. triangles (fig 13.4)
○ trachea is midline
○ thyroid gland
● lymphatics
○ ignore names
○ They flow in a specific order (p255)
○ major part of immune system: detect and eliminate foreign substances from the
body
● developmental care
○ IGNORE
● Subjective data - Health history questions
○ “do you have regular headaches?” “How often?”
■ PQRSTU
■ medication use, preventative meds?
■ for females: are the headaches linked to menstruation?
■ coping methods?
■ head injury?
○ Aging adult: ROM exam may cause dizziness.
● Head
○ palpate skull for size and shape
○ you MUST palpate the temporal artery
■ use light pressure, try to do one at a time
■ if visible, note in chart
● Neck
○ symmetry
○ palpate the nodes-not likely
○ assess for pain and symmetry during ROM exam
○ ROM is tested actively (the PT moves through motions) and passively (examiner
moves the head through ROM)
○ make sure trachea is centered
○ listen for bruits if the thyroid is enlarged
Nutritional assessment - CH11
● optimal nutr. status - sufficient nutrients and calories to maintain body functions
● different at different ages
○ kids and adolescents need more nutrition and more protein
○ pregnancy and breastfeeding add a couple hundred calories
○ Adulthood caloric intake decreases
● nutritional screening is required in most hospitals
○ includes likes/dislikes
 ○ allergies
○ swallowing
○ can PT cook?
● Food pyramid
● Subjective data
○ eating patterns
■ might be difficult in the hospital
○ usual weight
■ recent rapid loss or gain can be significant
○ medications and supplements
■ protein powders, vitamins, st john’s wort
● Objective data
○ skin turgor and elasticity
○ BMI
○ waist/hip ratio
○ lab studies
■ hemoglobin/hematocrit - relative iron status
■ cholesterol and triglycerides - level of fat and shows cardiac disease risk
■ total lymphocyte - decrease if insufficient nutrition
■ serum proteins - overall marker of nutrition. insufficient protein and the
body starts breaking itself down
■ nitrogen levels - negative number shows in burns, or in periods of fasting
■ creatinine-height index - estimates protein depletion, also can be used for
kidney function test
● Abnormal findings
○ obesity
○ marasmus - protein-calorie malnutrition
○ kwashiorkor - protein malnutrition

Eyes - CH14
● Eyes are more important for ICU and ER nurses - looking for stroke
● pupillary light reflex
● subjective
○ changes in vision in recent past
○ pain, especially quick onset
○ strabismus - crossed eyes
○ diplopia - double vision
○ excessive tearing, eye crust? color?
○ glaucoma
■ family history
○ corrective lenses
○ self care practices
○ env. hazards?
○ aging adults
 ■ eye dryness
■ cataracts
■ have you changed your activity due to eyesight
● objective data
○ snellen test
○ penlight
○ extraocular function (H test)
■ follow finger over the 6 cardinal directions.
○ external structures
■ includes eyebrows - normal hair distribution
○ anterior features
■ pupils
● are they equal?
● PERRLA - Pupils are Equal, Round, Reactive to Light,
Accommodation
■ retina color - yellow pink
■ red light reflex - used to test for problems in babies
● Abnormalities
○ periorbital edema
■ swelling around the eye
○ exophthalmos
■ protruding eye
■ excess thyroid hoemone
○ Ptosis
■ drooping eyelid
■ CN III impairment
○ conjunctivitis
■ irritation of the conjunctiva

Ears - CH15
● structures
○ tympanic membrane separates outer and middle ear
● hearing loss
○ conductive: a mechanical failure
■ canal might be plugged
■ ear bones not moving right
○ sensorineural - damage to nerve
■ caused by medications
● equilibrium
○ cochlear problems can send incorrect signals to the brain
■ vertigo
● subjective data
○ earaches
■ have you had any recent or severe earaches
 ○ infections
■ may cause hearing loss
○ discharge
■ color?
■ thickness?
■ smell?
○ hearing loss
■ have you been diagnosed?
■ any prosthetics?
■ env. factors?
○ Tinnitus
■ ringing of the ear
○ self care behavior
■ q-tips not for cleaning ears
■ last hearing test
■ ear protection?
● objective data
○ external ear
■ size, shape
■ skin condition
● pressure ulcers
● color
■ tenderness
● especially the tragus
■ external meatus
● make sure it’s there
○ otoscopic exam
■ view external canal
● discharge
● swelling
● cerumen (ear wax)
■ tympanic membrane
● color
● intact
○ Test hearing acuity
■ weber - fork on top of head, which ear hears it better?
● All babies need to have a hearing test prior to discharge

Nose, mouth and throat - CH16

● sinuses
○ frontal
○ maxillary
○ ethmoid
○ sphenoid
● mouth
○ symmetry - problems can indicate stroke
● structure
○ aging adult
■ diminished smell and taste
■ if 10% weight decrease, PT needs new dentures
○ pregnancy
■ inc in estrogen inc nasal swelling
■ inc risk of bloody noses
● subjective data
○ frequent nose bleeds?
○ allergies
■ seasonal
■ hay fever
■ asthma
○ altered smell?
○ mouth
■ dysphagia - trouble swallowing?
■ self care behaviors
● dentist visits
● flossing, brushing
● aging adult:
○ denture care
● objective data
○ wear gloves
○ start at nose
■ symmetry
■ transillumination
○ tonsils
■ grading