Head, Neck and Related Lymphatics

Purpose and Interview

Purpose
Assess condition of clients head, neck, thyroid gland, and lymph nodes by gathering
subjective and objective data.
Use collected data to help assess clients general health.
Differentiate expected from unexpected findings in physical assessment.
Interview Assessment. Begin your assessment with a focused interview with the client.
Among the questions you might ask:
Do you have any problems that affect your scalp?
Describe the condition of your scalp today. Is it different from 2 months ago, 2 years
ago?
Have you experienced hair loss gradual, sudden, symmetrical. Have you experienced
recent change in texture, appearance?
Is there anyone in your family who has had a problem with their scalp or a problem that
affected their scalp?
Do you have any problems that affect your neck or thyroid (or trachea)?
Neck pain, limitation of motion
Lumps or swelling
History of head or neck injury
Is there anyone in your family who has had a problem with their thyroid (or trachea)?
Equipment and Preparation
Equipment
Examination gloves as indicated
Glass of water
Stethoscope
Preparation
Knowledge of norms or expected findings is essential in determining the meaning of the
data as one proceeds.
Identify client and introduce self.
Explain each step of the procedure, including specific instructions about what is
expected of the client. For example, the removal of hats and jewelry may be required for
a thorough assessment.
Explain the purposes of each procedure and when and if discomfort will accompany any
procedure. Tell the client to inform you of any discomfort or difficulty at any point during
the assessment.
Provide for client privacy.
Perform hand hygiene and adhere to standard precautions.

Expected Findings
Head, Hair, and Face
The head should be held erect with no tremors or jerky movements.
The eyes, ears, nose, and mouth should be symmetrically placed.
The nasolabial folds should be equal.
The palpebral fissures should be equal.

The top of the ear should be equal to the canthi of the eyes.
All movements of the head, face, and eyes should be smooth and with purpose.
No tenderness with palpation of the head and scalp.
Skin should be intact.
Temporal arteries are palpated and reveal strong steady pulsation.
When client moves his head, there should be no pain or limitation of movement.

Neck, Thyroid, and Lymphatics

The trachea is midline and straight.
As the client swallows, you will not feel the thyroid gland, although in some clients with
long, thin necks, you may be able to feel the isthmus.
Lymph nodes are either non-palpable, or soft, small, round, and mobile, and non-tender
to the touch.
The carotid arterys pulsations can frequently be observed.
The carotid pulse is regular, full, and smooth.
Unexpected Findings
Head, Hair, and Face
Hair reveals uneven growth pattern, flakes, or scalp crusing.
Evidence of nits in the hair or other manifestation.
Irregular or unusual shaped head or face.
Tremors or unusual movements of the head such as rhythmic bobbing.
Odd or unusual facial features.
Head of unexpected size either too large or too small.
Temporal artery is weak, thready, pounding, or has bruits.
Neck, Thyroid, and Lymphatics
Neck pains or limitations in range of motion during
movement of the neck.
Weak, thready, or bounding carotid pulse.
Tracheal deviation due to an enlarged thyroid gland or
mediastinal shift.
Enlarged or nodular thyroid gland.
Palpable and/or tender lymph nodes. Document their location, size, shape, if they
are fixed or
mobile, and if they are tender. To learn more about the unexpected findings explore
the visual
media to the left.

Considerations
Lifespan
Infants and Children
Approach
The approach and techniques used in examining the head and
neck system of the infant and child is the same as for all other
clients.
Findings
Measure head circumference and compare to expected size for
the age. See the fact sheet connected to the Measurement Skill for
the expected sizes.
Evaluate the sutures and fontanels. In infants younger than 6
months, the anterior fontanel should not exceed 4 cm. The fontanel

should become smaller and should be completely closed by the time the child reaches 18 to
24 months.
The neck is short in infants and begins to lengthen by 3 or 4 years.
While the thyroid gland in the infant and young child is not routinely palpated, if
evaluation is determined necessary, the technique used for adults should be used.
Pregnant Women
Approach
The approach and techniques used in examining the head and neck of the pregnant
woman are the same as for all other clients.
Findings
Beginning about 16 weeks gestation, some pregnant women may develop blotchy,
hyperpigmentation areas on the face. This mask of pregnancy may become worse as the
pregnancy matures, but it will generally fade after delivery.
The thyroid may be palpable during pregnancy due to hypertrophy.
Older Adult
Approach
The approach and techniques used in examining the head and neck system of the older
adult are the same as for all other clients. Findings
Hair quality and quantity may change as the individual ages. Thinning and or balding is a
common finding.
The face may appear thin with sunken eyes and cheek bones.
Neck range of motion may be limited.