HEENT assessment

[00:00:00]just crop the beginning.

[00:00:02]All right. So, my name is Grace. I'm going to be the nurse practitioner today. This is my patient, Kate. We're going to be doing our um head, ears, eyes, nose, throat, and neck exam today.

[00:00:15]Okay. So, first I'm going to take a look at the head as a whole. So, the head looks normal. It's midline. Um doesn't appear to have any trauma. Now, I'm going to inspect the scalp here. see if there's any redness, any lesions, anything on the scalp, which I don't see. And now I'm going to palpate for any lumps, bumps, any lesions that I can feel here. I'm feeling the contour of the head, which looks good.

[00:00:45]Perfect. And now I'm going to look at the face. The face looks symmetrical.

[00:00:49]Smile symmetrical. Can you raise your eyebrows up for me? Good. Everything's symmetrical there. Um, now I'm going to palpate the sinuses. So, first we're going to feel the frontal sinus. Any pain here?

[00:01:03]>> And then the maxillary. Any pain here?

[00:01:06]>> Okay, good. So, no sinus pain. Um, and now we're going to palpate the temporal arteries to just make sure that they're even, and bilateral, which they are. And then I'm just going to palpate the salivary glands here. Any tenderness there?

[00:01:26]>> No. Okay. So, now we're going to move on to the neck exam. First, I'm just going to look at the neck. I don't see any visible swelling, any redness. It's pretty asymmetrical. We're just going to test your range of motion. So, can you just do a circle?

[00:01:41]Good. Any pain there?

[00:01:43]>> Nope.

[00:01:43]>> Okay. And then ear to ear, ear to shoulder. Any pain?

[00:01:48]>> Okay. Now, we're going to inspect the trachea. The trachea appears to be midline. Um, and then just swallow for me.

[00:01:56]Good elevation of the hyoid bone. Um, and now I'm going to palpate your lymph nodes. Okay. So, first I'm going to start pre-uricular lymph nodes right in front of the ears. Go to post uricular right behind the ears. Then we go into um tonsular then submandibular and submental.

[00:02:22]Good. I don't feel any swelling there.

[00:02:24]Then we're going to feel the occipital which is back here and then the cervical, the anterior cervical.

[00:02:38]And then we're going to feel the superclavicular.

[00:02:41]Nothing here. And then the infra clavvicular here. Okay, good. So nothing, no tenderness that I feel anywhere.

[00:02:49]>> Okay, good. Um, so next I'm going to be just feeling your spine. So your cervical spinal process. Any pain as I feel along the spine here?

[00:02:59]>> Nope.

[00:03:00]>> Okay. Any pain as I go down? Nope.

[00:03:02]>> I'm feeling the muscles next to the spine. I'm not feeling any bumps or muscle spasms. Any pain?

[00:03:09]>> Good. Um, I'm going to palpate again your thyroid. I'm not feeling any enlargement or any bumps that shouldn't be there. And As we saw before, the swallow was was perfect. Um, and so now I'm going to go back and oscultate a couple parts. So, first I'm going to oscultate the temporal artery for any brewy.

[00:03:36]There's no brewies heard there. Now, close your eyes. I'm going to I'm going to oscultate for a brewy here and then oscultate for a brewy in the thyroid.

[00:03:48]Nothing there. Good. All right. Now, we're going to assess your TMJ. So, just open and close your mouth. Close. Open.

[00:03:57]Close. I'm not feeling any crepiness crepus or any clacking, clanking. Do you have any tenderness when I do that?

[00:04:05]Good. All right. So, next we're going to move on to the eye exam. So, first we're going to do vision. So, we're going to use this card. Take this card in your hand. Hold it out right in front of you like that. And you're going to close one eye, put one hand over. Yep. And then read the bottom line there.

[00:04:24]>> L T F P H.

[00:04:27]>> Perfect. Now switch hands, switch eyes.

[00:04:31]LT FP H.

[00:04:33]>> Okay. Perfect. Now we're going to do the nearsighted exam on the Rosenberg chart.

[00:04:39]So, you're going to do the same thing with whichever is the lowest line that you can see that you can read correctly.

[00:04:51]>> 9378 26.

[00:04:58]Oh, I should go all the way.

[00:04:59]>> No, that's fine.

[00:05:00]>> 937826.

[00:05:04]>> Okay. So, that would show that you have 2025 vision.

[00:05:10]Okay. And then I am just going to um do an assessment of your extraocular movements. So first you're going to follow my finger and keep your head straight. So we're going to go up down center side up down center to this side.

[00:05:31]Up down center. Perfect. Any pain in your eyes with that? Good. And I didn't notice any this stagmas going on. And then the next one, you're going to look at my nose and then I am going to hold fingers up. You're going to calculate how many fingers I have. So combine the numbers. Four, six. Yes, correct. Good job. So that was assessing our extraocular movements as well as our um peripheral vision.

[00:06:01]So next we're going to just move on to inspection of the eyes. So, first I'm going to look at the eyebrows. And the eyebrows appear to be straight. Um, she was able to raise her eyebrows and they were even and symmetrical. Then I take a look at the eyes. The contour looks normal. I don't The scalera is white. I don't see any yellow or redness in the eyes. Um, now I'm going to take a look at the conjunctiva. So, look up.

[00:06:28]And those are moist and pink. So, they look good. Um, the eyelashes don't have any crusting. There's no redness anywhere. The lacrial glands look good.

[00:06:38]There's no in what seems to be infection, redness or discharge coming from the lacrimal glands.

[00:06:45]Um, the iris appears intact and we were just going to do a quick pupil exam.

[00:06:52]So, keep stay at my looking at my nose and flash the light in.

[00:06:58]pupils are reacting to light and they're equal in size. So that's perfect for the pupils.

[00:07:07]And then we're going to move on to the eye exam with the opthalmoscope.

[00:07:14]So this kind of gives us a look at the internal discs, the optic discs and the lens.

[00:07:23]I can get this up. Okay. So, right now I'm just seeing if I can see the red light, which I can. And I'm going to go closer to the patient's eye, making sure that I don't come too close.

[00:07:38]I see the the lens is intact. The retina, I'm looking at the retinal arteries and the blood vessels. The blood vessels appear to be intact and throughout.

[00:07:53]And the macula also appears intact.

[00:07:58]And I'm seeing that red light reflection. Good. Okay. So, the eye exam looked good. Now, I'm going to inspect your ears. Take a look at both of your ears. And I'm looking from the front.

[00:08:09]Both of the ears look symmetrical. I'm not seeing any um drainage or discharge from the oracle of either of the ears.

[00:08:17]Um and I'm just going to pull on the back here. Are you having any tenderness when I do this? Going to pull up. No pain.

[00:08:26]Okay, good. And now I'm going to inspect the ear canals with the otoscope.

[00:08:33]So, there were no signs of infection, but I'm going to take a more of a look.

[00:08:37]So, I'm going to pull up the pin up.

[00:08:40]Pull it up and back. Insert into the ear. And I'm seeing a pearly white temp to pink membrane with a little bit of ear wax, but no redness.

[00:08:53]No foreign bodies. Notice. I'm going to take a look at the other one.

[00:08:59]Same thing. No foreign bodies.

[00:09:01]Pearly white tempanic membrane. Clear ear canal.

[00:09:06]That looks good.

[00:09:08]So, next we're going to do our hearing exam. So, first we're going to do what's called the Weber test. I'm going to use this tuning fork and I'm just going to place it right above your head. And what you're going to do is tell me if you can hear the vibration in both ears.

[00:09:28]>> Mhm.

[00:09:28]>> Yeah. Good. Just going to do it one more time. Make sure.

[00:09:35]Good. Okay. Now, we're going to do the rind test, which is similar. I'm going to place this right behind your ear.

[00:09:46]When you stop hearing it, I'm going to move it close to your ear and you tell me when you hear it again. So, tell me when you stop hearing it and then tell me when you start hearing it.

[00:10:01]Yeah. All right. Stop.

[00:10:06]Okay, good. I'm going to do it the same thing on the other side.

[00:10:14]Applying it right to the mastoid process.

[00:10:19]Okay, stop.

[00:10:24]Stop. Oh, sorry. I thought you heard it.

[00:10:27]Perfect. Good ears.

[00:10:30]All right. So, the last thing I'm going to do is the whisper test. So, I'm going to plug one ear, say a word, and you repeat the word. I'm going to use a two-cllable word. So, I'm going to whisper it, and you tell me what I'm saying. So, I'm plugging the left ear.

[00:10:46]Apple.

[00:10:46]>> Apple.

[00:10:47]>> Good. I'm do this one. Pling this ear.

[00:10:52]Orange.

[00:10:52]>> Orange.

[00:10:53]>> Good job. All right. our patient her earing hearing is intact. Next, we're going to move on to the nose. First, we're going to um inspect the nose. I don't see any obvious fractures of the nose. It appears midline. Not seeing any lesions or redness. I'm going to palpate the nose. Not feeling any swelling or tenderness here. No deformities. Um and next, I'm going to assess for patency of the nasler airways. So, I'm going to olude one and breathe in the other.

[00:11:27]Good. We hear have good arration here and good arration in the left one as well. Next, I'm just going to take a light. I'm going to have you tilt your head back a little bit. I'm just going to take a look at your nasal canal. So, the nasal mucosa is pink, moist, and there's clear passageways.

[00:11:50]Not seeing any bleeding or redness there.

[00:11:54]Good. And the septum is also midline. We don't see any deviated septum here. So the nose looks good. Next, I'm going to move on to the mouth. So the lips are even. They're midline. They're not a they're as sorry, they're not asymmetrical.

[00:12:12]Um there's no lesions or crusting or bleeding, anything that would be we would be concerned about. Um and next I'm going to have you open your mouth and stick out your tongue. Perfect. So the tongue you can close. So the tongue is pink. She can stick it out midline which is checking our cranial nerve seven. Um and smile with your teeth. So, the teeth are intact and there is no um missing teeth. There's no trauma to any of the teeth and the alignment is looking good. So, next we're just going to look at the uvula. So, stick your tongue out and say ah.

[00:12:58]Good. So, the uvula went up when she said ah. And her gums I could also see are intact. There's no gingivitis. Um, and everything looks good for that. And then I also was taking a look at the tonsils that we would also feel here.

[00:13:15]And there's no aiththemma or swelling in the tonsils at all. Um, and that concludes our exam.