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					                              HEENT Assessment
                                   NUR 216
                              September 14, 2006



                      Head, Neck, and Face

Main bones of the cranium
•Frontal

•Temporal

•Parietal

•Occipital

Major structures of the neck
•Sternocleidomastoid muscle



•Trapezius muscle



•Thyroid gland


•Carotid arteries & jugular veins


•Cervical lymph nodes


•Cervical vertebrae


Assessment of the head
•Inspect
–hair
–scalp


                                                   1
–skull
–face
–skin

•Palpate
–scalp
–skull
–__________________ artery


Assessment of the neck
•Inspection
–general
–specific (thyroid)
•Range of motion
•Strength ( _________ )
•Palpate
– _____________________
– ____________________

How to Examine CN XI: Spinal Accessory – Sternocleidomastoid Muscle


How to Examine the Temporomandibular Joint


How to Palpate the Thyroid Gland from Anterior Position


How to Palpate the Thyroid Gland from the Posterior Position


Anterior View of Thyroid in Asian Female with Goiter


How to Examine the Preauricular Nodes, Tonsillar Nodes, and Parotid
Salivary Glands




                                                                      2
Assessment of the face
•CN V - _____________________

–_____________ function

–______________ function

•CN _____- facial

–motor function

–sensory function


•CN ________ & _______ - glossopharyngeal & _____________
•CN _______ - _______________ accessory
•CN Xll - _____________________l

How to Examine CN V: Trigeminal Nerve – Sensory



How to Examine CN V: Trigeminal Nerve – Motor



CN VII: Facial Motor



How to Examine CN XI: Spinal Accessory – Trapezius Muscle




                              The Eye
Basic Anatomy of the Eye
•Eyelids and eyelashes
•Extraocular muscles
•Conjunctiva
•Lacrimal glands
•Sclera


                                                            3
•Cornea
•Anterior Chamber
•Iris & Pupil
•Retina
–__________________
–__________________
–__________________
–   __________________




The Extraocular Muscles and their Cranial Nerves

The retina & retinal structures
•Optic disc & physiologic cup
–located on the ________ _______ ___ ________ __________.
–Retinal vessels
–__________ sets of retinal vessels emerge from the _____ ______and extend
outward, becoming smaller at the periphery
•Retinal background
–___________-_________on color
•Macula
–located ____________l to the optic disc



Variations in Visual Function
•Visual acuity
–Decreased vision
–Blindness
•Defects in color
•Diplopia
•Discharge
•Floaters
•Eye pain
•Tearing or dryness
•Discharge
•Redness

Examination of the eye


                                                                         4
–Visual Acuity
•_______ vision - ___________ chart
•_________ vision - ________________ chart
–Visual fields ____________________test
•indicates the functioning of the _____________ area
–Extraocular movements
•________ cardinal fields of gaze
•corneal light reflex
•cover-uncover test


Examination of the eye (continued)
•External structures
–eyelids & eyelashes        - anterior chamber
–conjunctiva
–lacrimal apparatus
–sclera
– iris
–cornea
– pupil

Examination of the eye (continued)
•Opthalmoscopic examination
- Red reflex               - Retinal background
 - Optic disc                     regularity
–size & shape                     color
–color                    presence of
–margins                          microaneurysms,
–physiologic cup                  hemorrhages, exudates
- Retinal vessels                 - Macula & fovea centralis
–color                    regularity
–arteriolar light reflex          color
–arteriole -vein ratio
–arteriovenous crossing characteristic

The Opthalmoscope
•Two dials
–one adjusts the light apertures and filters
–the other changes the lenses to correct for the refractory errors for both the
examiner and the patient



                                                                                  5
•Aperture
–small -used for the undialted eye
–large - used for the dilated eye
•Filters (green)
–used to visualize blood vessels and hemorrhages



Diagnostic Fields of Gaze
•Superior rectus ________

•Lateral rectus ________

•Inferior rectus _________

•Inferior oblique __________

•Medial recti ____________

•Superior Oblique ___________




                   Ears, Nose, &Throat (ENT)
•Ear structure
–external ear
•innervated by CN ____& ______
–middle ear
•innervated by CN _____
–inner ear
•innervated by CN _________


•Nose structure CN _________
–nasal bones
–part of the maxilla
–cartilage
•Oral cavity structure
 CN ____, ______, _____, ______, ______, & ________
–buccal mucosa
–lips
–tongue




                                                       6
–hard    & soft palate
–teeth
–salivary   glands


Ear &Nose assessment
•Ear
•Inspection:
–auricle
–external canal
–tympanic membrane
–hearing

•AC     vs. BC



•Nose & parasinuses Inspection:
–anterior  & posterior surfaces
–test for nasal obstruction
–inside of nose
•mucosa
•turbinates




•Palpate
–sinuses
–transillumination


Anatomy of External Ear Structures


Inspection of the External Ear in an Adult



Anatomy of the Middle Ear



Anatomy of the Inner Ear




                                             7
Pathways of Hearing


Rinne Test – Bone Conduction



Weber Test

Anatomy of the Tympanic Membrane

Ossicles
Normal Right Tympanic Membrane

Assessment of the nose
Assessment of the nasal turbinates




Assessing Cranial Nerve I



Assessment of the cranial sinuses
How to Examine the Frontal Sinuses


How to Examine the Maxillary Sinuses




                            The Oral Cavity


Salivary Glands



Tonsils and their size grading




                                              8
Oral mucosa Assessment
•Inspect
–lips
–oral mucosa
–gums & teeth
–roof of mouth
–tongue & floor of mouth
–pharynx




                           9

				
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