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Sensory Assessment
- eyes need to closed
- pain: sharp/ dull
- light touch: hyperthesia =lots of sensation!
- vibration: low pitched tuning fork
- mono-filament: can't feel = peripheral neuropathy
- proprioception/ position sense/ kinethesia
- sterognosis: object in palm & they tell you what it is
- graphethesia
-
Health History Questions; Head. neck & lymph
- Headaches
- Head injuries did they loose LOC
- dizziness
- neck pain
- lumps & swelling
-
Inspect & palpate head
- normocephalic
- microcephalic
- macrocephalic
- symmetrical
-
Inspect & palpate Neck
- symmetry of muscles
- range of motion
- lymph nodes - advanced technique
- trachea @ midline
- thyroid - advanced technique
-
Developmental considerations for Head
children and infants have bigger heads compared to body size= more prone to head injury
-
Palpating lymph nodes
- normal: <1cm & nonpalpable
- lymphadenopathy: >1cm/ infection, allergies or cancer
- Infection: enlarged, painful, tender, warm, movable, maybe bilateral
- Malignant: enlarged, non tender, unilateral, fixed, hard to palpate
-
Head & Neck Abnormality
- Acromegally: excess growth hormone; pituitary tumor, facial bone over growth
- CVA/stroke: asymmetry, whole body
- Bell's palsy: asymmetry, only affect face
- multiple thyroid nodues
- thyromegaly
- assymmetry
-
Eye subjective information
- pain: sudden = 911
- difficulty w/ vision: decreased acuity, blurry, blindspots = tumor, halo = glaucoma
- photophobia
- strabismus (misalignment)
- redness
- swelling
- water discharge = possible infection
- past hx & self care
-
Eye Test Tools
- snellen chart
- hand held vision screen
- card to cover eye
- pen light
- opthalmoscope
-
Eye Acuity Tests
- Snellen chart: stand 20ft away, numerator = distance away, nominator = line read, smaller = better
- E chart: for children & pts that don't know the alphabet
-
Near Vision & Visual fields test
- Near vision test: hold chart 14 inches away, 14/14 if they get it all right
- - presbyopia: when they have to move it farther to read it
Visual fields: right & left eye/ confrontation test. When they cover one eye and something comes from the side, they'll say when they can see it, not very accurate
-
Eye Muscle Function Tests
- Corneal light reflex: when the light reflect in the same spot on both eyes
- cover test: cover 1 eye, pt look forward then take away cover, if covered eye moves into position = muscle weakness
- extraoccular movements/ EOMS/ 6 cardinal fields of gaze
-
Strabismus & Phoria
- Strabismus: disparity in eye alignment
- Phoria: mild eye weakness
-
Inspect Extraoccular structures
- Eyebrows: symmetrical
- Eyelids & lashes
- eyeball alignment
- conjunctiva & white sclera
- lacrimal apparatus
-
Inspect anterior eyeball structures
- cornea: clear w/ lens underneath
- iris & pupil: flat & round
- -size, shape & eual
- -pupillary light reflext
- -accommodation
-
PERRLA
- pupils
- equal
- round
- reactive to
- light
- accomodation
-
Developmental Considerations
- older adults:
- - decreased vision
- -deceased peripheral vision
- - decreased tears, dry eyes
- Arcus senilis: white ring on top of eyes, not medically significant
-
Eye Abnormalities
- exopthalmos: eyes buldges out; b/c Graves disease, hyperthyroidism
- Conjunctivitis: pink eye
- Periorbital edema: w/ renal failure, allergic rx, CHF
- Presbyopia
- Lid lag: hyperthyroidism
- macular degeneration: loss of central vision
-
Ear Subjective information
- ear aches
- infections
- discharge/ otorrehea
- hearing loss, sudden = refer
- tinnitus; ringing
- vertigo; loss of balance
- hearing & screening protection
- amt of ear wax
-
Tools for Ear Inspection
- Advanced technique;
- 3yrs or older = pull up & back
- younger = down & back
-
Objective Data Ear Inspection & palpation
- Placement & alignment: low set ear might indicate mental illness/ kidney problems
- hearing acuity: whisper test
-
Types of Hearing Loss
- conduction: transmission of sound into ear, cause- wax/ otosclerosis
- Sensorineural: defect in inner ear, cause: CN8 impairment, aging, ototoxic drugs, loud noises.
-
Developmental considerations; ears
- otoscope last for infants
- presbycusis in older adults
- otitis media, ear infections in children, they might have speech impairment
-
Nose, Mouth & throat Subjective Data
- nose discharge: color & amt
- colds
- sinus pain
- hx, of nose bleeds (epistaxis)
- allergies
- changes in smell
- sore throat
- bleeding gums
- tooth aches
- hoarseness; how long
- dysphagia
- xerostomia/ decrease saliva
- smoking & alcohol
- altered taste
- self care
-
Inspection of Mouth
- gingivitis
- gingival hyperplasia- dilantin/ pregnancy
- oropharynx
- buccal mucosa- ulcers
- cyanosis of lips
-
Early Signs of dehydration in Elderly
- dry mucosa,
- breathing through mouth
- furrowed tongue
- acute confusion
-
Oropharynx grading
- I: see anterior & posterior pillars
- II: see only anterior, covers posterior
- III: touches uvula
- IV: kissing tonsils
-
Abnormal Nose Mouth & Throat
- Leukoplakia: cancerous, refer
- cadidiasis/ Thrush
- yeast infection
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