Question

P.A is a 72-year-old female who presents to the family practice with her 40-year-old daughter. The daughter states that her mother has been confused lately, complaining of a headache, shortness of breath, and coughing. The cough has been persistent for 6 days, and a fever developed 2 days ago. The patient states that she is bringing up yellow-green mucus and has a cough, which gets worse at night. Vital signs are T 100.5, P 88, R 16, and BP 110/55. Lungs are positive bilaterally for wheezing, positive egophony. A chest x-ray reveals consolidation indicative of bacterial pneumonia. Labs and culture are pending for specific antigen. The nurse proceeds with the physical exam of the head, face, neck, and associated lymphatic system.

1. When performing a review of systems, the nurse obtains subjective data concerning the patient’s headache. What specific questions will assist the nurse in determining the cause of the headache?

The nurse proceeds to palpate the lymph nodes.

2. Which lymph nodes are located in the neck?

3. When performing the physical examination, what objective data should the nurse inspect and palpate for the head and neck?

4. How might the physical examination vary given the patient’s age?

Answer 1

1. Question like where is your headache located ?when did it start ? Does anything makes it better or worse ? Do you have nausea or vomiting with headache ? Did you hit your head prior to headache ? How often you have headache ? Is it dull , sharp or throbbing ? will assist the nurse in determining the cause of headache .

2. Cervical lymph nodes, the superficial cervical lymph nodes are on the neck but below the ear . The deep cervical nodes are under the muscles along the neck and the posterior nodes are on the neck but on the posterior side .

3. Inspect for any obvious deformities, asymmetry, masses, tracheal deviation. Palpation of the lymph nodes of the head and neck .Palpation of the parotid gland .Assessment of range of motion of the cervical spine .

Ask the patient to tilt their chin so that it is resting against their chest or to flex their neck. See meningism.Assessment of spinal accessory nerve function, ask the patient to move their head to the left and right, and to lift their shoulders against resistance. See cranial nerve palsies. Evaluation for jugular venous distention

4. According to given data , the patient is 74 years old , then due to age there will be decreased mobility and wear and tear of various parts and organs of the body . Hence the physical examination can be prolonged and done with due care to the geriatric patient . Henceforth the physical examination vary given the patient’s age .