Exam 10: Skin, Hair, Nails, Head, Face, and Neck, Including Regional Lymphatics

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Describe the significant features of the head.

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The skull is a rigid bony box that protects the brain and special sense organs, and it includes the bones of the cranium and the face. Note the location of these bones: frontal, parietal, occipital, and temporal. The cranium is supported by the cervical vertebrae. Fourteen facial bones also articulate at sutures, except the mandible-which has a movable joint, the temporomandibular joint-anterior to each ear. The temporal artery lies superior to the temporalis muscle and has a palpable pulsation anterior to the ear. The sublingual and submandibular salivary glands are accessible to examination, whereas the parotid glands are not normally palpable.

Describe the assessment that would follow the palpation of an abnormal lymph node.

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The examiner should be familiar with the direction of the drainage patterns of the system. The area proximal (upstream) to the location of the abnormal node is explored.

Identify relevant developmental care for the head and neck.

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At birth, the head is larger than the chest circumference. During infancy, trunk growth predominates, and head size changes in proportion to body height. Lymphoid tissue is well developed at birth and reaches adult size by age 6 years. At age 10 or 11 years of age, the lymph tissue exceeds adult size and then slowly atrophies. During pregnancy, the thyroid enlarges as a result of hyperplasia and increased vascularity. In the older adult, the facial bones and orbits appear more prominent from decreased elasticity and subcutaneous fat.

Complete an assessment of hair, skin, and nails using appropriate technique for all developmental stages.

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Describe the significant differences between the skin of the very young, the older adult, and the healthy adult.

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Incorporate health promotion concepts when performing an assessment of the head, face, and neck.

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Describe the differentiation between normal and abnormal skin color for various ethnic groups.

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Incorporate health promotion concepts when performing an assessment of the hair, skin, and nails.

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Cite examples of health care implications presented by skin alterations.

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Identify the structures and landmarks of the neck.

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List the names of the lymph nodes of the neck and their locations.

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Relate the anatomic structures of the skin to its functions.

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State the significance of skin tone changes.

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