Assessment Of The Nose, Mouth, And Throat

ASSESSMENT OF THE HEAD AND NECK

Rhonda M. Jones, Pharm.D. PHA 326 Patient Assessment

Objectives:

After this lecture, the student shall be able to:

1. Given an example patient case scenario, distinguish between normal and abnormal subjective symptoms and objective signs.

2. Define and describe the following terms: normocephalic, microcephalic, macrocephalic, aura, rhinorrhea, epistaxis, gingivitis, gingival hyperplasia, canker sore, acute rhinitis, allergic rhinitis, sinusitis, pharyngitis.

3. Describe and compare/contrast specific information that is obtained from the following: range of motion, use of the speculum or otoscope, palpation of sinus areas, transillumination.

4. Given an example patient case scenario, correlate abnormal patient symptoms and objective findings with possible causes (i.e., migraine, tension, and cluster headaches, acute rhinitis, allergic rhinitis, sinusitis, pharyngitis).

I. Subjective Information A. Headache 1. Questions  Onset: When did this kind of headache start? Gradual or suddenly?  Duration: When do they occur? How long do they last? How frequently do they occur? Is there any pattern to your headaches?  Location: Where do you feel it? Frontal, temporal, behind the eyes, a band around your head, sinus area, or occipital area? Is it on one side or all over?  Character: Throbbing or pounding? Aching or dull?  Precipitating factors: What brings on the headache? (tension, stress, alcohol, menstruation)  Relieving factors: What makes the headache go away?  Other symptoms: Any other symptoms? (nausea, vomiting, visual changes)  Do you have a history of high blood pressure?  What medications do you take?

03243dadca3c6febf33112c314c3a548.doc 1 11/27/2017 B. Dizziness 1. Questions  Describe your dizzy feeling. Is it lightheadedness or an unsteady balance? Spinning sensation? Is the room spinning or are you spinning?  Does it occur when you stand up quickly from a lying or sitting position?  Other symptoms such as ringing in the ears, hearing changes?

C. Neck Pain 1. Questions  How did the pain start? Any injury to the neck? lifting?  Any headache or fever?  Any limitations to the range of motion? Stiffness?  Numbness or tingling sensation in shoulders, arms, or hands?

D. Lumps 1. Questions  Any recent infection?  Any tenderness?  How long have you had it? Has it changed in size?  Any problems swallowing?  Do you smoke or chew tobacco?  How much alcohol do you drink on a weekly basis?

II. Subjective Information (Nose) A. Discharge 1. Questions  Describe the discharge  Thin, watery?  Bloody?  What color is it?  Continuous or intermittent?  What medications have you tried to relieve it?

B. Obstruction or Nasal Congestion 1. Questions  On one side or both?  Any injury to your nose?  Any other symptoms?  How often?  Do you have any allergies?  Any sinus pain or pressure?  What medications have you tried?

03243dadca3c6febf33112c314c3a548.doc 2 11/27/2017 C. Epistaxis 1. Questions  How often?  How much blood?  Color of the blood? Red or brown?  From one or both nostrils?  Aggravated by anything?  What does it take to stop them?  Do you take coumadin or aspirin? How often?

III. Subjective Information (Mouth and Throat) A. Sore Throat 1. Questions  How long have you had it?  Any other symptoms?  Is it worse when you get up in the morning?  Have you had a throat culture?

B. Sores or Lesions 1. Questions  How long have you had it?  Single or multiple lesions?  Is it associated with anything?  How have you tried to treat it?  Do you smoke or chew tobacco?

IV. Objective Data A. Head 1. Note the general size and shape 2. Normocephalic: a round, symmetric skull that is appropriately related to body size 3. Microcephalic: abnormally small head 4. Macrocephalic: abnormally large head

B. Neck 1. Range of Motion: a) Chin to the chest b) Turn head to the right and left c) Ear to the shoulder d) Head backward e) All motions should be smooth and controlled f) Note any pain, stiffness, rigidity or limited movement

03243dadca3c6febf33112c314c3a548.doc 3 11/27/2017 2. Lymph Nodes (fig. 10-22) a) Palpation: gentle, circular motion with fingerpads b) Both sides at the same side and compare c) Normal: discrete, soft, nontender, and movable d) Abnormalities (1) Acute infection: bilaterally enlarged, warm, tender, firm but movable (2) Cancer: unilaterally hard, nontender, and fixed (3) HIV: bilaterally enlarged, firm, nontender, and movable

C. External Nose 1. Inspect for deformity, asymmetry, inflammation or skin lesions

D. Nasal Cavity 1. Nasal speculum to open the vestibule and a penlight to illuminate the cavity 2. Otoscope 3. Nasal mucosa: normal: 4. Abnormal:

E. Sinus Areas 1. Palpate a) Normal: b) Abnormal:

2. Transillumination a) Used for sinus inflammation b) Limited usefulness c) Normal: diffuse red glow d) Abnormal: no illumination

F. Mouth 1. Inspection 2. Lips: 3. Teeth: 4. Gums: 5. Abnormalities: a) Herpes simplex I b) Carcinoma c) Gingivitis d) Gingival hyperplasia (phenytoin) e) Canker sore

G. Tongue: color, surface characteristics, and moisture

03243dadca3c6febf33112c314c3a548.doc 4 11/27/2017 H. Throat: use tongue blade and penlight 1. tonsils

V. Assessment A. Headaches 1. Migraine a) begins as a dull ache that intensifies over a period of minutes or hours to severe pain b) throbbing, pulsatile headache that lasts several hours to two or three days c) occurs typically once every few weeks d) may be unilateral or bilateral e) may also have nausea/vomiting and photophobia f) may have aura symptoms (lightheadedness, visual changes, flashes of light) g) may interfere with daily activities h) more common in young females (15-35 yo) i) may be associated with family history j) usually relieved by dark room, sleep, and medications

2. Tension a) most common type of headache b) dull, aching sensation bilaterally (nonpulsating) c) pain may be distributed as “hatband” around the head d) mild to moderate in severity e) no aura, nausea/vomiting or photophobia f) typically does not interfere with daily activities g) frequency of headache varies widely between patients h) relieved by relaxation techniques and medications

3. Cluster a) characteristic pattern of recurrence b) typically occur daily over a short period of time (several weeks or months) followed by a long period of remission c) more common as seasonal occurrence (fall and spring) d) more common in males than females e) severe, throbbing, unilateral pain that occurs behind the eye and radiates to the temple, cheek, or gums f) last for a short period of time (minutes to hours) g) may also have watery eye and runny nose h) no aura, nausea/vomiting, or photophobia

B. Acute rhinitis  runny nose or with purulent discharge  nasal congestion

03243dadca3c6febf33112c314c3a548.doc 5 11/27/2017  sneezing  nasal cavity:

C. Allergic rhinitis  rhinorrhea  may also have congestion  itchy nose and watery  sneezing  nasal cavity:  usually seasonal

D. Sinusitis  purulent discharge  fever  malaise  sinus pain, pressure and tenderness  nasal cavity:

E. Pharyngitis  sore throat  fever  tonsillur exudate  pharynx is beefy red color  swollen lymph nodes  ages 3-15

03243dadca3c6febf33112c314c3a548.doc 6 11/27/2017