9.NECK ASSESSMENT.pptx

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1. Sal ale university college of sciences Department of adult health nursing Title : nursing assessment of neck Submit to: BIKILA T. ( MSc , assist . professor ) Presenter by : yadeta kebede adult health n . Id : 194/2023 June 2023 fitche

2. Outline Objective Introduction to neck and lymph glandular system Physical Examination of neck and lymphatic system Summary Reference

3. Objective At the end of these section the student will be identify normal and abnormal finding during physical examination of neck and lymphatic's. At the end of these section the student will be perform physical examination of neck and cervical spine. At the end of these section the student will be describe anatomy and function of lymphatic system.

4. Introduction The Neck is Contained within hyoid bone, muscle and several major blood vessels, the larynx, trachea, and the thyroid gland, which is in the anterior triangle of the neck, and cervical spine. The thyroid gland is the largest endocrine gland in the body and butterfly shaped gland in the front of neck. It produces thyroid hormones that increase the metabolic rate of most body cells. The cervical vertebrae (C1 to C7) are located in the posterior neck and support the cranium. The internal jugular veins and carotid arteries are located bilaterally, parallel and anterior to the sternomastoid muscles of neck. The external jugular vein lies diagonally over the surface of these neck muscles. N.B Note the patient speech . they should be able to speak clearly with no slurring due to tired or drunk. or garbled words or confuse person for listening.

5. THEANATOMY AND PHYSIOLOGY OF NECK The structure of the neck is composed of muscles, ligaments, and the cervical vertebrae. Contained within the neck are the hyoid bone, several major blood vessels, the larynx, trachea, and the thyroid gland, which is in the anterior triangle of the neck

6. Cont.………

7. Muscles and Cervical Vertebrae The steno mastoid (sternocleidomastoid) and trapezius muscles are two of the paired muscles that allow movement and provide support to the head and neck . The steno mastoid muscle rotates and flexes the head, whereas the trapezius muscle extends the head and moves the sternomastoid muscles.

8. Cont.… These two major muscles also form two triangles that provide important landmarks for assessment. The anterior triangle is located under the mandible, anterior to the sternomastoid muscle. The posterior triangle is located between the trapezius and steno mastoid muscles.

9. Cont.…. The cervical vertebrae (C1 through C7) are located in the posterior neck and support the cranium. The vertebra prominent is C7, which can easily be palpated when the neck is flexed. Using C7 as a landmark will help you to locate other vertebrae.

10. Larynx and pharynx Pharynx is the muscle lined space that connects the nose and mouth to the larynx and esophagus or eating tube. Larynx also known as the voice box ,a cylindrical grouping of cartilage , muscle ,and soft tissue that contain the vocal cords. The function of larynx and other vertebral is to protect the lower respiratory tract from aspirating food in to the trachea while breathing. If damage nerve of larynx hoarseness, difficulty in swallowing or breathing, or loss voice.

11. Thyroid Gland The thyroid gland is the largest endocrine gland in the bodyand butterfly shaped gland in the front of neck. It produces thyroid hormones that increase the metabolic rate of most body cells. The thyroid gland is surrounded by several structures that are important to palpate for accurate location of the thyroid gland

12. Cont.…….. The thyroid gland consists of two lateral lobes that curve posteriorly on both sides of the trachea and oesophagus and are mostly covered by the stern mastoid muscles. In about one-third of the population, there is a third lobe that extends upward from the isthmus or from one of the two lobes.

13. Cont.… These two thyroid lobes are connected by an isthmus that overlies the second and third tracheal rings below the cricoid cartilage. In about one-third of the population, there is a third lobe that extends upward from the isthmus or from one of the two lobes. These two thyroid lobes are connected by an isthmus that overlies the second and third tracheal rings below the cricoid cartilage.

14. Assessment of Neck Subjective and objective Data Neck Biographic data Chief compliant History of problems Neck pain Swelling Any trauma of neck

15. Cont.… History of Present Health Concern Pain Do you experience neck pain? Characte r: Describe how it feels. Onset : Did it begin after some strenuous activity, exercise, accident or a direct injury? Locations: Does it radiate to the back, arms, or shoulders? Duration: How long does it last? Does it come and go?

16. Cont.… Severity: Are you able to continue your daily schedule and sleep at night? Pattern: Does it tend to occur more with exercise or stress? Are there any activities that relieve it or make it worse? Associated Factors: Do you have any limitation of movement of your head or neck or arms with this pain? Do you have any numbness or tingling with it? Other Symptoms Do you have any difficulty moving your head or neck?

17. Cont.… Past Health History Describe any previous head or neck problems (trauma, injury, falls, surgery) Family History Is there a history of head or neck cancer in your family ? Socio economic status Psychological status (for suspect self sucides , hunging ) Nutritional status : eating hot food, acidic ingestion, or corrosive chemicals. Review of System.

18. physical examination of neck Assessment of neck assists the nurse to detect enlarged or tender lymph nodes. Thyroid enlargement, nodules, masses, or tenderness may be detected by palpating the thyroid gland. Palpation may also detect abnormalities of the neck and facial muscles.

19. Cultural Considerations Preparing the Client Prepare the client for the head and neck examination by instructing him or her to remove any wig, hat, hair ornaments, pins, rubber bands, jewellery, and head or neck scarves Ask the client to sit in an upright position with the back and shoulders held back and straight.

20. Cont.… Tell the client what you are doing and share your assessment findings. Equipment Small cup of water Stethoscope

21. INSPECTION Inspect the neck. movement symmetry masses. swelling . NORMAL FINDINGS Neck is symmetric, with head cantered and without bulging masses.

22. Cont.… Swelling, enlarged masses or nodules may indicate an enlarged thyroid gland, inflammation of lymph nodes, and a tumour.

23. Assessment Procedure Inspect movement of the neck structures. Ask the client to swallow a small sip of water. Observe the movement of the thyroid cartilage, thyroid gland. Normal Findings The thyroid cartilage, cricoid cartilage move upward symmetrically as the client swallows.

24. Cont.… Abnormal Findings Asymmetric movement or generalized enlargement of the thyroid gland is considered abnormal. PALPATION Palpate the trachea. Place your finger in the sternal notch. Feel each side of the notch and palpate the tracheal rings. The first upper ring above the smooth tracheal rings is the cricoid cartilage.

25. Cont.… Normal Findings Trachea is midline. Abnormal Findings The trachea may be pulled to the affected side in cases of large atelectasis, fibrosis or pleural adhesions. The trachea is pushed to the unaffected side in cases of a tumor , enlarged thyroid lobe, pneumothorax, or with an aortic aneurysm .

26. Auscultation Auscultate the thyroid only if you find an enlarged thyroid gland during inspection or palpation. Place the bell of the stethoscope over the lateral lobes of the thyroid gland . Ask the client to hold his or her breath (to obscure any tracheal breath sounds while you auscultate ). Normal Findings No bruits are auscultated Abnormal Findings A soft, blowing, swishing sound auscultated over the thyroid lobes is often heard in hyperthyroidism because of an increase in blood flow through the thyroid arteries.

27. Lymphatic system Lymphatic system is essential drainage system which is accessory to venous system. Most tissue fluid formed at the arterial end of capillaries is absorbed back into the blood by venous end capillaries and rest of tissue fluid (10- 20%) is absorbed by lymphatics.

28. Cont.… Larger particles like proteins and particulate matter can be removed from the tissue fluid only by the lymphatic. Therefore, lymphatic system may be regarded as drainage system of “coarse type” & venous system as “fine type ” Tissue fluid flowing in the lymphatic are called lymph.( clear fluid) It passes through filters called (lymph nodes) placed in the course of lymphatic .

29. Anatomy of lymphatic system Each lymph node is a bean shaped organ, with an outer connective tissue frame work, which dips into the structure forming numerous Septa

30. FUNCTION They are centres of lymphocyte production . Both B-lymphocytes and T-lymphocytes are produced here by multiplication of pre-existing lymphocytes. Filter the products from lymph such as bacteria and other particulate matter and to prevent their entry into systemic circulation. The antibodies produced by the B-Lymphocytes are carried to the circulation and indirectly help in mounting an immune response.

31. COMPONENTS OF LYMPHATIC SYSTEM Lymph vessels Central lymphoid organs: Bone marrow and Thymus Peripheral lymphoid organs: Lymph nodes, Spleen and Tonsils Circulating lymphocytes

32. Lymphadenopathy lymph nodes which are abnormal in size, number or consistency and is often used as a synonym for swollen or enlarged lymph nodes. Classified : Generalised - 2 or more non contiguous area. Localised - involve one area.

33. Causes of Enlargement of Lymph Node Inflammatory Acute or chronic lymphadenitis Infection Tuberculosis Filariares Secondary syphilis Infectious mononucleosis Haematological Hodgkins disease Non- hodgkins lymphoma Chronic lymphatic leukaemia

34. Cont.… Neoplastic Carcinoma Sarcoma Immunological Aids Drug reaction Systemic lupus Erythromatosus Rheumatoid arthritis

35. Clinical examination History age duration group first affected pain fever pressure effects past history Family history primary focus loss of appetite & wt. loss

36. Local examination Inspection - position, size , skin over lying swelling , pressure effects. Palpation- inspector findings , consistency, matted or not , fixity to surrounding structures , drainage area.

37. General examination Lymph nodes in other parts of the body Age : Tuberculosis and syphilis , primary malignant lymphomas affect young age . Duration: Short (acute lymphadenitis) Group affected first : E.g.: cervical group affects first in Hodgkin's disease , tuberculosis etc. where as inguinal lymph node affects first in filariases .

38. Cont.… Pain : Acute and chronic infection are painful where as painless in syphilis , primary malignant lymphomas and secondary carcinoma. Fever: evening rise of temperature is characteristic feature of TB. Periodic fever in filarial (once in month). Number: single or multiple. A few conditions are known to produce generalised involvement of lymph nodes like Hodgkin's disease , Tb Lympho sarcoma , sarcoidosis .

39. Cont.… Primary focus : when ever lymph node enlarged, it is usual practice to look for primary focus in drainage area of lymph nodes. This should be done in acute and chronic septic lymphadenitis. Loss of appetite & wt.: in case of malignant lymphadenopathies. Family history : sometimes history of tbc in families

40. Inspection Position : cervical group e.g. Tbc Epitro chlear and occipital e.g. Secondary syphilis. Skin over the swelling: In acute lymphadenitis skin becomes inflamed with redness, oedema, brawny induration. Skin over Tuberculous lymphadenitis and cold abscess remains “cold” in true sense till they reach a point of bursting when skin becomes red and glossy.

41. Cont.… Over rapidly growing lymph sarcoma skin becomes tense, shining , with dilated subcutaneous veins. Pressure effects : Careful inspection must be made of whole body to detect any pressure effect due to enlargement of lymph nodes. Oedema & swelling of upper limb- enlargement of axillary lymph nodes. Oedema & swelling of lower limb- enlargement of inguinal lymph nodes. Swelling & venous engorgement of face and neck may occur due to pressure effect of lymph nodes at the root of the neck.

42. Cont.… Most of the lymph nodes are best palpated with the examiner standing behind the patient who is comfortably seated in a dental chair Palpation of the lymph nodes is ideally done commencing from the most superior lymph node and then working down to the clavicle region. Nodes are palpated for consistency, size, tenderness, and local Rise In Temperature Consistency – Enlarged lymph nodes should be carefully palpated with palmar aspects of 3 fingers. While rolling the fingers against the swelling slight pressure is maintained to know the actual consistency.

43. METHOD OF PALPATION: Pre auricular lymph nodes- they are palpated anterior to the tragus of ear. Normal finding There is no swelling or enlargement and no Tenderness. Abnormal finding Enlarged nodes are indication of abnormality.

44. Cont.… Post auricular lymph nodes: are palpated behind the ear , on the mastoid process. Normal finding There is no swelling or enlargement and no Tenderness Abnormal finding Enlarged and tenderness nodes are abnormal

45. Cont.. Occipital nodes palpated at the base or lower border of skull Normal finding There is no swelling or enlargement and no Tenderness Abnormal finding Enlarged and tenderness nodes are abnormal

46. Submental nodes They are palpated under the chin The clinician can stand behind the patient to palpate. The patient is instructed to bend his/her neck slightly forward so that the muscles and fascia in that regions relax .

47. Cont.… Fingers of both hands can be placed just below the chin, under the lower border of mandible and the lymph nodes should be tried to be cupped with fingers Abnormal finding Enlarged and tenderness nodes are abnormal

48. Submandibular nodes Are palpated at the lower border of the mandible approximately at the angle of the mandible. The patient is instructed to passively flex the neck towards the side that is being examined. This maneuverer helps relaxing the muscles and fascia of neck, thereby allowing easy examination.

49. Cont.… The palmar aspect of the fingers is pushed on to the soft tissue below the mandible near the midline, then the clinician should then move the fingers laterally to draw the nodes outwards and trap them against the lower border of the mandible . Normal finding There is no swelling or enlargement and no Tenderne Abnormal finding Enlarged and tenderness nodes are abnormal

50. Cont.… Anterior Cervical: (both superficial and deep): Nodes that lie both on top of and beneath the sternocleidomastoid muscles (SCM) on either side of the neck, from the angle of the jaw to the top of the clavicle . Normal finding There is no swelling or enlargement and no Tenderness Abnormal finding Enlarged and tenderness nodes are abnormal

51. Cont.… Posterior Cervical: Extend in a line posterior to the SCMs but in front of the trapezius, from the level of the mastoid bone to the clavicle . Normal finding There is no swelling or enlargement and no Tenderness Abnormal finding Enlarged and tenderness nodes are abnormal

52. INVESTIGATIONS Complete Blood Count Chest Radiography Serological investigation Nodal Biopsy Fine Needle Aspiration cytology . C. T. Scan M.R.I

53. summary The structure of the neck is composed of muscles, ligaments, and the cervical vertebrae. Neck examination include inspection palpation and Auscultation Knowledge of lymph nodes is important to prognosticate the probable involvement certain lymph nodes in case of known site of tumour or infection.

54. Reference 1. Health Assessment in Nursing Janet R. Weber, RN, EdD 6 th edition 2. Nursing Health Assessment a critical thinking, case studies approach 2 nd edition 3. Text book of head and neck anatomy – Hiatt, Gartner 4/E

55. THANK YOU.