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.

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

1. 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.

2. 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?

B. Dizziness

1. Questions

9. Describe your dizzy feeling. Is it lightheadedness or an unsteady balance? Spinning sensation? Is the room spinning or are you spinning?

10. Does it occur when you stand up quickly from a lying or sitting position?

11. Other symptoms such as ringing in the ears, hearing changes?

1 Neck Pain

2. Questions

12. How did the pain start? Any injury to the neck? lifting?

13. Any headache or fever?

14. Any limitations to the range of motion? Stiffness?

15. Numbness or tingling sensation in shoulders, arms, or hands?

2 Lumps

3 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?

I. Subjective Information (Nose)

10 Discharge

1. Questions

Describe the discharge

Thin, watery?

Bloody?

What color is it?

Continuous or intermittent?

What medications have you tried to relieve it?

11 Obstruction or Nasal Congestion

2. Questions

22. On one side or both?

23. Any injury to your nose?

24. Any other symptoms?

25. How often?

26. Do you have any allergies?

27. Any sinus pain or pressure?

28. What medications have you tried?

12 Epistaxis

3. Questions

29. How often?

30. How much blood?

31. Color of the blood? Red or brown?

32. From one or both nostrils?

33. Aggravated by anything?

34. What does it take to stop them?

35. Do you take coumadin or aspirin? How often?

II. Subjective Information (Mouth and Throat)

13 Sore Throat

1. Questions

36. How long have you had it?

37. Any other symptoms?

38. Is it worse when you get up in the morning?

39. Have you had a throat culture?

14 Sores or Lesions

2. Questions

40. How long have you had it?

41. Single or multiple lesions?

42. Is it associated with anything?

43. How have you tried to treat it?

44. Do you smoke or chew tobacco?

II. 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

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

15 External Nose

3. Inspect for deformity, asymmetry, inflammation or skin lesions

16 Nasal Cavity

4. Nasal speculum to open the vestibule and a penlight to illuminate the cavity

5. Otoscope

6. Nasal mucosa: normal:

7. Abnormal:

17 Sinus Areas

8. Palpate

a) Normal:

b) Abnormal:

9. Transillumination

a) Used for sinus inflammation

b) Limited usefulness

c) Normal: diffuse red glow

d) Abnormal: no illumination

18 Mouth

10. Inspection

11. Lips:

12. Teeth:

13. Gums:

14. Abnormalities:

a) Herpes simplex I

b) Carcinoma

c) Gingivitis

d) Gingival hyperplasia (phenytoin)

e) Canker sore

19 Tongue: color, surface characteristics, and moisture

20 Throat: use tongue blade and penlight

15. tonsils

III. 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

21 Acute rhinitis

runny nose or with purulent discharge

nasal congestion

sneezing

nasal cavity:

22 Allergic rhinitis

rhinorrhea

may also have congestion

itchy nose and watery

sneezing

nasal cavity:

usually seasonal

23 Sinusitis

purulent discharge

fever

malaise

sinus pain, pressure and tenderness

nasal cavity:

24 Pharyngitis

sore throat

fever

tonsillur exudate

pharynx is beefy red color

swollen lymph nodes

ages 3-15

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