NSG 3012 Week 2 Discussion – Head and Neck Assessment

NSG 3012 Week 2 Discussion – Head and Neck Assessment

Based on the patient’s history of a motor vehicle accident three days prior to admission, a CT scan of the head without contrast is indicated to rule out a brain bleed. Additionally, a CT of the cervical spine could also be completed at the same time based on the decreased range of motion in the neck.

We need to rule out a bleed in the brain as the cause of the nystagmus, sweating, and vertigo. Even if an examination of the ears revealed a ruptured tympanic membrane, the CT is still indicated because of the MVA. A bleed could cause acute cerebellar ataxia, whose symptoms include vertigo and nystagmus. A CT of the cervical spine will reveal any fractures in the vertebrae that could be the cause of decreased range of motion in the neck. Medication reconciliation is important to determine if the patient is taking any blood thinners such as warfarin, Xarelto, or Lovenox for example.

Once a bleed in the brain has been ruled out, the vertigo, hearing loss, sweating, and nystagmus can be treated symptomatically, and a diagnosis of ruptured tympanic membrane can be confirmed with an ear examination. A clear c-spine CT rules out a fracture as the cause of limited ROM in the neck, and a physical exam can confirm muscular tension and a diagnosis of whiplash that can be treated with a soft cervical collar, prescription muscle relaxants, and anti-inflammatories.

NSG 3012 Week 2 Discussion – Head and Neck Assessment

Based on the symptoms and the patient’s statement about baseball, I would suspect the patient is using smokeless tobacco. It would be important to teach the patient that smokeless tobacco can cause serious health problems, including addiction, cancer, cavities, gum disease, heart disease, and pre-cancerous mouth lesions (Mayo Clinic Staff, 2011). Slanting palpebral fissures can be a sign of craniofacial syndrome; however, the chance of this not being diagnosed well before the patient attains the age of 17 is relatively small. They can occur naturally based on ethnicity, especially in people of Asian descent (Jarvis, 2012).

The optic disc margins may become blurred and indistinct because of hypertension, which could be related to the use of smokeless tobacco products or could be related to increased ocular pressure. Referral to an ophthalmologist would be indicated for further evaluation.

References

Jarvis, C. (2012). Physical Examination and Health Assessment [VitalSouce bookshelf version]. Retrieved from http://digitalbookshelf.southuniversity.edu/books/978-1-4377-0151- 7/id/B9781437701517000145_f0160

Mayo Clinic Staff. (2011). Quit smoking. Retrieved October 24, 2014, from http://www.mayoclinic.org/healthy-living/quit-smoking/in-depth/chewing-tobacco/art- 20047428

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NSG 3012 Week 2 Discussion – Head and Neck Assessment

A 50-year-old woman is admitted with chief complaints of headache and decreased range of motion in her neck. She also complains of vertigo, hearing loss in one ear, profuse sweating, and uncontrollable eye movements. Her past medical history indicates that she was in a motor vehicle accident three days before her admission.

What are the possible causes of these symptoms?

What specific diagnostic testing would you recommend?

Why? What conditions should be ruled out? Why?

How would you distinguish between these conditions?