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Week 5: Assessment of Head, Neck, Eyes, Ears, Nose, and Throat
Emily, age 15, is brought to your clinic complaining of chills, aches, and a sore throat. Without any testing, consider all of the possible diagnoses. It could be a cold, the flu, bronchitis, or even something more serious, such as meningitis or mononucleosis. Assessing the actual cause will involve much more than simple visual inspection. Some conditions are so subtle that they require the use of special instruments and tests in addition to a trained eye and ear.

This week, you will explore how to assess the head, neck, eyes, ears, nose, and throat. Whether dealing with a detached retina, sinusitis, or meningitis, advanced practice nurses need to know the proper assessment techniques in order to form accurate diagnoses.

Learning Objectives
Students will:
Apply assessment skills to diagnose eye, ears, and throat conditions
Apply concepts, theories, and principles relating to health assessment techniques and diagnoses for the head, neck, eyes, ears, nose, and throat
Photo Credit: Patrick Heagney/E+/Getty Images

Learning Resources
Required Readings
Note: To access this week's required library resources, please click on the link to the Course Readings List, found in the Course Materials section of your Syllabus.

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S.,  Stewart, R. W. (2015). Seidel's guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 10, “Head and Neck” (pp. 184-203)


This chapter reviews the anatomy and physiology of the head and neck. The authors also describe the procedures for conducting a physical examination of the head and neck.


Chapter 11, “Eyes” (pp. 204-230)


In this chapter, the authors describe the anatomy and function of the eyes. In addition, the authors explain the steps involved in conducting a physical examination of the eyes.


Chapter 12, “Ears, Nose, and Throat” (pp. 231-259)


The authors of this chapter detail the proper procedures for conducting a physical exam of the ears, nose, and throat. The chapter also provides pictures and descriptions of common abnormalities in the ears, nose, and throat.
Dains, J. E., Baumann, L. C.,  Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.

Chapter 15, “Earache” (pp. 174–183)


This chapter covers the main questions that need to be asked about the patient’s condition prior to the physical examination, as well as how these questions lead to a focused physical examination.


Chapter 21, “Hoarseness” (pp. 248-255)


This chapter focuses on the most common causes of hoarseness. It provides strategies for evaluating the patient both through questions and through physical exams.


Chapter 25, “Nasal Symptoms and Sinus Congestion” (pp.301-309)


In this chapter, the authors highlight the key questions to ask about the patients symptoms, the key parts of the physical examination, and potential laboratory work that might be needed to provide an accurate diagnosis of nasal and sinus conditions.


Chapter 30, “Red Eye” (pp. 357-368)


The focus of this chapter is on how to determine the cause of red eyes in a patient, including key symptoms to consider and possible diagnoses.


Chapter 32, “Sore Throat” (pp. 381-389)


A sore throat is one most common concerns patients describe. This chapter includes questions to ask when taking the patient’s history, things to look for while conducting the physical exam, and possible causes for the sore throat.


Chapter 38, “Vision Loss” (pp. 446-457)


This chapter highlights the causes of vision loss and how the causes of the condition can be diagnosed.
Sullivan,  D. D. (2019). Guide to clinical documentation (3rd ed.). Philadelphia,  PA: F. A. Davis.

Chapter 3, "SOAP Notes" (pp. 45-57)
Note: Download the seven documents (Adult Examination Checklists and Physical Exam Summaries) below, and use them as you practice conducting assessments of the head, neck, eyes, ears, nose, and throat.

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for head, face, and neck. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Adult Examination Checklist: Guide for Head, Face, and Neck was published as a companion to Seidel's guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for eye assessment. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Adult Examination Checklist: Guide for Eye Assessment was published as a companion to Seidel's guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for ear assessment. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Adult Examination Checklist: Guide for Ear Assessment was published as a companion to Seidel's guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Adult examination checklist: Guide for nose, paranasal sinuses, mouth, oropharynx. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Adult Examination Checklist: Guide for Nose, Paranasal Sinuses, Mouth, Oropharynx was published as a companion toSeidel's guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Ears, nose, and throat. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Ears, Nose, and Throat Physical Exam Summary was published as a companion to Seidel's guide to physical examination(8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Eyes. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Eyes Physical Exam Summary was published as a companion to Seidel's guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Seidel, H. M., Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2011). Physical exam summary: Head, face, and neck. In Mosby's guide to physical examination (7th ed.). St. Louis, MO: Elsevier Mosby.



This Head and Neck Physical Exam Summary was published as a companion to Seidel's guide to physical examination (8th ed.), by Ball, J. W., Dains, J. E., & Flynn, J. A. Copyright Elsevier (2015). From https://evolve.elsevier.com/

Bedell, H. E., & Stevenson, S. B. (2013). Eye movement testing in clinical examination. Vision Research 90, 32–37. doi:10.1016/j.visres.2013.02.001. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000217

Rubin, G. S. (2013). Measuring reading performance. Vision Research 90, 43–51. doi:10.1016/j.visres.2013.02.015. Retrieved from http://www.sciencedirect.com/science/article/pii/S0042698913000436

Harmes, K. M., Blackwood, R. A., Burrows, H. L., Cooke, J. M., Harrison, R. V., & Passamani, P. P. (2013). Otitis media: Diagnosis and treatment. American Family Physicians, 88(7), 435–440. Retrieved from http://www.aafp.org/journals/afp.html



Otolaryngology Houston. (2014). Imaging of maxillary sinusitis (X-ray, CT, and MRI). Retrieved from http://www.ghorayeb.com/ImagingMaxillarySinusitis.html



This website provides medical images of sinusitis, including X-rays, CT scans, and MRIs (magnetic resonance imaging).

Document: Episodic/Focused SOAP Note Exemplar (Word document)

Document: Episodic/Focused SOAP Note Template (Word document)

Required Media
Online media for Seidel's Guide to Physical Examination

It is highly recommended that you access and view the resources included with the course text, Seidel's Guide to Physical Examination. Focus on the videos and animations in Chapters 10, 11, and 12 that relate to the assessment of the head, neck, eyes, ears, nose, and throat. 


Optional Resources
LeBlond, R. F., Brown, D. D., & DeGowin, R. L. (2014). DeGowin’s diagnostic examination (10th ed.). New York, NY: McGraw Hill Medical.

Chapter 7, “The Head and Neck” (pp. 178–301)


This chapter describes head and neck examinations that can be made with general clinical resources. Also, the authors detail syndromes of common head and neck conditions.**********************

Discussion: Assessing the Ears, Nose, and Throat
Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test.

In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions.

Note: you will have case one...  your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case.

Case 1: Nose Focused Exam 
Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he's taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.


To prepare:

With regard to the case study you were assigned:

Review this week's Learning Resources and consider the insights they provide.
Consider what history would be necessary to collect from the patient.
Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient's condition. How would the results be used to make a diagnosis?
Identify at least 5 possible conditions that may be considered in a differential diagnosis for the patient.
Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned.

By Day 3
Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient's differential diagnosis and justify why you selected each.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the "Post to Discussion Question" link and then select "Create Thread" to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!