Question

I want my answer typed. For each assessment, please be sure to name the instruments that would be used in the process.

Head, Face, and Neck, including Regional Lymphatics
1)_ Describe in brief the assessment of the face in an 83 year-old male patient that suffers from uncontrolled hypertension; include one usual abnormal finding

Eyes & Ears
2)_ How to assess the ears in a 40 year-old male athlete with complaint of his “ears bothering” him; include one usual abnormal finding

Nose, Mouth, and Throat
3)_ Discuss cleft palate and its implications for the newborn

Answer 1

Physical examination is the core of assessing the patient. Assessing the head, face, and neck is a fundamental part of physical assessment.

In the first case of an 83-year-old male patient suffering from uncontrolled hypertension, the assessment of the head, face, neck, and regional lymphatics are as follows.

The assessment is done by observation and palpation using the hand and fingers of the assessor and the patient is in the sitting position. First and foremost the patient is asked regarding the history of the disease and the chief complaints and habits like smoking, chewing tobacco and, consumption of alcohol, and so on.

1. Head- Observe the size and shape of the head which should appear appropriate for the size and age of the patient that is termed as normal cephalic. Secondly. palpate the whole head using the five finger beds feeling for any lumps, tenderness, protrusions, etc.

Face - Firstly checking for the temporomandibular joint movement by placing the two fingertips on the temporomandibular area and ask the patient to open and close the mouth. The normal finding shows free movement without any pain or spasm, clicking, crepitus, or any pain. secondly, observe for the symmetry of the face by looking at the eyebrows, eyes, around the mouth and normally it should be all symmetrical in nature. If there is any drooping of any side it indicates stroke or any problem with cranial nerve VII, or bells palsy. Nextly, check for any swelling over the cheeks.

Neck-   Firstly checking for any swelling over the neck for salivary gland swelling. This is done by asking the patient to put up the jaw which extends the neck area for observation. And also check for any swelling at the base of the neck for thyroid gland swelling.

Regional lymph nodes - The lymph nodes of the neck are checked by the four fingertips in a circular motion. assess for preauricular lymph node just in front of the ears, Posterior auricular just behind the ears, Occipital right back on the occipital bone, submental right under the chin, submandibular on the submandibular region, superficial cervical and deep cervical, posterior cervical and clavicular lymph node so on. Normally lymph nodes are not felt if though felt it is soft. If there is any lymph node enlarged further investigation must be done.

Range of motion exercise by asking the patient to put up the chin, put down the chin, and turn to both sides. Check for cranial nerve 11.

For a patient with uncontrolled hypertension usual abnormal assessment will be a headache and even a problem with eyes - the retina.

2. Ears - Look for the symmetry, size, and location of the ears. Palpate the ear for any tenderness, or pain. Observe in front and back of the ears for any pressure ulcers, scratches, and so on.  Secondly assessing cranial nerve 8 by whispering something in the ears of the patient and ask repeating it. An internal ear examination is done by an otoscope. If there is an accumulation of ear vax it could be extremely bothering. Otitis media could be a cause of ear irritation as well.

3. Cleft palate and its implications -

Cleft palate is a birth defect that is characterized by the opening in the roof of the mouth which is caused by a lack of development of the tissue. This is usually diagnosed during pregnancy and visually after birth and is normally repaired between 9 and 14 months of age. The babies with cleft palate have difficulty for sucking so specially made bottles are used for feeding. They are also more at risk of getting ear infections than other kids. So it is very necessary to protect the babies from infection. Hence, assessing and managing the cleft palate at the right time is essential.