Advanced Health Assessment
Respond tooth’s peer posts. Response posts can include one or more of the following, insight on a solution to an identified peer challenge, pose questions relating to the peer post, and providing resources that may be helpful related to your peer’s post. PLEASE PLEASE PLEASE do not just “SUMMARIZE”. the post. New, insightful information is warranted and it is against rubric. Thank you!
REPLY TO RAMANDEEP’s post :
The purpose of this discussion is to discuss the various challenges which are encountered when performing a HEENT examination. Parts of the examination this week include but are not limited to the shape, symmetry, lesions, trauma for the head and face. The visualization and palpation of the external and internal ear as well as performing tests like Rinne and Weber for detecting hearing loss in the ears. The examination of the external eyes for symmetry, discharge, eyelids, eyelashes, as well as internal eyes with the help of an ophthalmoscope. The visualization and palpation of the external and internal nose for discharge, color, masses, septal deviation for the nose. The inspection of the mouth and throat, including dental hygiene, the pharynx, tongue, gums, teeth, buccal mucosa. Inspection and palpation of the neck to assess for any lumps or masses, assess lymph nodes and detect swelling or tracheal deviation.
To begin, COVID-19 has made it difficult for providers as well as patients to feel fully comfortable participating in this examination. A major reason for this is because, you are in contact with the persons mouth, nose and eyes, which are the primary source of transmission of the virus. In addition to this, it is difficult to even get access to HEENT specialists in areas where cases of COVID-19 are high. Many immunocompromised and elderly people rely on telemedicine to meet with their doctors, yet proper examination of the HEENT system through a digital platform is next to impossible, imposing a major challenge for providers as well as patients. Telemedicine devices show poor agreement in comparison to the in-person physical examination in terms of tonsil size measurement but exhibit moderate agreement on the coloration of the palate and cervical lymphadenopathy (Akhtar et. al., 2018).
In addition to this, another challenge is performing this examination on children. This is difficult because the tools and instrument’s may be scary for the little kids, and they may be scared when the provider approaches them. Ways to overcome this challenge include ensuring the parent is in the room, or even holding the child depending on the age. In addition to this, there is also a challenge of examining children with medical complexities, that is showing medical fragility and having complex chronic conditions (Huth et. al., 2018). There is evidence showing the lack of medical professionals who are adequately trained to comfortably handle this patient population, and not everyone who is a provider can examine these children (Huth et. al., 2018).
Other challenges when performing the HEENT examination include visualization of the body part, as it plays major role in detection of discrepancies and diagnosis of disease. It is essential for the provider to ensure there is adequate light, the patient is at level with the eyes, in the correct position as well as following commands and instructions. On the other hand, there are certain examinations which should be performed in the dark, where adequate light can in fact pose a challenge. This includes examining the eyes with an ophthalmoscope, and ensuring proper visualization of the red reflex, optic disk, retinal vessels, and other structures to rule out glaucoma and papilledema, amongst other issues (Bickley, Szilagyi & Hoffman, 2017). These things may become a challenge when the patient has language barriers, intellectual deficits, psychiatric issues, or simply does not have good rapport with the provider. Language barriers can lead to poor patient assessment, misdiagnosis, delayed treatment, and incomplete understanding of the patient condition and prescribed treatment (Moissac & Bowen, 2018).
Akhtar, M., Van Heukelom, P. G., Ahmed, A., Tranter, R. D., White, E., Shekem, N., … Mohr, N. M. (2018, October 1). Telemedicine Physical Examination Utilizing a Consumer Device Demonstrates Poor Concordance with In-Person Physical Examination in Emergency Department Patients with Sore Throat: A Prospective Blinded Study. Telemedicine journal and e-health : the official journal of the American Telemedicine Association. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205037/.
Bickley, L. S., Szilagyi, P. G., & Hoffman, R. M. (2017). Bates’ guide to physical examination and history taking (12th ed.). Wolters Kluwer.
Huth, K., Long-Gagne, S., Mader, J., & Sbrocchi, A. M. (2018, October 19). Approach to Clinical Assessment of Children With Medical Complexity. MedEdPORTAL : the journal of teaching and learning resources. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6342381/.
Moissac, D. de, & Bowen, S. (2018, April 18). Impact of Language Barriers on Quality of Care and Patient Safety for Official Language Minority Francophones in Canada – Danielle de Moissac, Sarah Bowen, 2019. SAGE Journals. https://journals.sagepub.com/doi/full/10.1177/2374373518769008.