HEAD AND NECK

ASSESSMENT
 Learning Objectives:
• At the end of virtual discussion, the students
will be able to”
1. Discuss Collection of Subjective Data: The
Nursing Health History.
2. Use the correct technique to perform a
Physical assessment of the head and neck.
3. Analyze head and neck data obtained from
the interview and physical assessment.
 Collecting Subjective data: The
Nursing health History
• History of Present Health Concern
PAIN
a. Do you experience neck pain?
- Use COLDSPA , to further explore any neck pain.
Be sure to ask about precipitating events ( illness
or injury), severity, and associated symptoms.
- Character, Onset, Location, Duration, Severity,
Pattern, Associated Factors(COLDSPA)
b. Do you experienced headache
c. Do you have any facial pain?
Rationale:
PAIN
• Neck pain accompany muscular problems or
cervical spinal cord problems.
• Stress and tension may increase neck pain
• Sudden head and neck pain seen with
elevated temperature and neck stiffness may
be a sign of meningeal inflammation
Rationale:
Headache
- A precise description of the symptoms can
help to determine possible causes of the
discomfort.
Facial pain
- Trigeminal neuralgia is manifested by sharp,
shooting, piercing facial pain that last from
seconds to minutes.
OLDER ADULT CONSIDERATION:
• Older clients who have arthritis or
osteoporosis may experience neck pain and a
decreased range of motion.
Other symptoms:
a. Do you have any difficulty moving your head
or neck
b. Have you noticed any lumps or lesions on
your head or neck that do not heal or
disappear? Describe their appearance. Do you
have a cough our any difficulty swallowing?
c. Have you experienced any dizziness,
lightheadedness, spinning sensation, blurred
vision, or loss of consciousness?
d. Have you noticed a change in the texture of
you skin, hair or nails?
e. Have you had any weakness or numbness in
you face, arms or legs or on either side of your
body?
 PAST HEALTH HISTORY
• Describe any previous head or neck problems
( trauma, injury, falls) you had.
• How were they treated ( surgery, medication,
physical therapy) What were the results?
• Have you ever undergone radiation therapy
for a problem in your neck region?
Rationale:
Radiation therapy has been linked to the
development of thyroid cancer.
Radiation to the neck area may also cause
esophageal strictures, leading to difficulty with
swallowing.
 FAMILY HISTORY
• Do you find that you have headache when you
take any of the following medications?
Rationale: some prescription and non
prescription medicines may cause headache.
• Is there a history of head or neck cancer in
your family?
Rationale: genetic predisposition is a risk factor
for head and neck cancers.
• Is there a history of migraine headaches in
your family?
Rationale: migraine headache commonly have a
familial association.
LIFESTYLE AND HEALTH PRACTICES
• Do you smoke or chew tobacco? If yes, how
much?
• Do you use a alcohol or recreational drugs?
Describe the type used and how much.
 COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
• Preparing the client:
- Instructing him or her to remove any wig, hat,
hair ornaments, pins, rubber bands, jewelry,
and head or neck scarves.
CULTURAL CONSIDERATIONS:take care to
consider cultural norms for touch when
assessing the head.(Cotton, 2013)
- Ask the client to sit in
upright position with the
back and shoulders held back
and straight.
• Explain the importance of remaining still
during most of the inspection and palpation of
the head and neck.
• However, explain the need for the client to
move and bend the neck for examination of
muscles and for palpation of the thyroid
gland.
• Be aware that some clients may be anxious as
you palpate the neck for lymph nodes,
especially if they have a history of cancer that
caused lymph node enlargement. Tell the
client what you are doing and share your
assessment findings.
• EQUIPMENT
- Small cup of water
- stethoscope
 ASSESSMENT PROCEDURE
• HEAD AND FACE
INSPECTION AND PALPATION
• Inspect the head
Normal findings: Head size and shape vary,
especially in accord with ethnicity. Usually the
head is symmetric, round, erect, and in midline
and appropriately related to body size
(normocephalic). No lesions are visible.
• Abnormal findings: An
abnormally small head is
called microcephaly
• The skull and facial bones
are larger and thicker in
acromegaly
• Inspect for involuntary movement
Normal findings:
Head should be held still and upright.
Abnormal findings:
Neurologic disorders may cause a horizontal
jerking movement.
An involuntary nodding movement maybe seen
in patients with aortic insufficiency.
• Palpate the head.
Normal findings: Note consistency
Abnormal findings: The head is normally hard
and smooth, without lesions.
• INSPECT FACE.
Inspect for symmetry, features movement,
expression, and skin condition.
Symmetry Facial Features:

NF: Symmetrical NF: Features vary

AF: Asymmetrical. Face Symmetrical, centered
is asymmetrical with head position
AF: swollen face – nephrotic;
Bell’s Palsy and syndrome ;
mask face in moon shape with red
Parkinson disease. cheeks, facial hair –
Cushing’s syndrome
• OLDER CONSIDERATIONS:
• Facial wrinkles are prominent because
subcutaneous fat decrease with age.
• The lower face may shrink and the mouth
maybe drawn inward as a result of resorption
of mandibular bone, also an age-related
process.
• Palpate the temporal artery.
Which is located between the top of the ear and
the eye.
Normal findings: the temporal artery is elastic and
not tender
Abnormal findings: an acute condition is seen when
the temporal artery is hard, thick, and tender with
inflammation, as seen with temporal arteritis (
inflammation of the temporal arteries that may
lead to blindness)
• Palpate the temporomandibular joint(TMJ)
- To assess the TMJ, place your index finger over
the front of each ear as you ask the client to
open the mouth
Normal findings:
-there is swelling, tenderness, crepitation with
movement.
Mouth opens and closes fully.
Lower jaw moves laterally 1-2 cm in each direction.
Abnormal findings:
Limited range of motion, swelling, tenderness, or
crepitation may indicate TMJ. Syndrome.
 THE NECK
• INSPECTION
Inspect the neck.
-observe the client’s slightly extended neck for
position, symmetry, and lumps or masses.
- Shine a light from the side of the neck across to
highlight any swelling.
Appearance
Normal Findings: Smooth
Abnormal Findings: Asymmetrical head position, masses or
scars present. Swelling.
• Normal findings: neck is symmetric, with head
centered and without bulging masses.
• Abnormal findings: swelling, enlarged masses
or nodules may indicate an enlarged thyroid
gland, inflammation of lymph nodes, or tumor
Inspect movement of the neck structures.
Ask the client to swallow a small sip of water. Observe
the movement of the thyroid cartilage, thyroid
gland .
Normal findings: the thyroid cartilage and cricoid
cartilage move upward symmetrically as the client
swallows.
Abnormal findings: Asymmetric movement or
generalized enlargement of the thyroid gland is
considered abnormal.
• Inspect the cervical vertebrae. Ask the client
to flex the neck (chin to chest)
Normal findings: C7 ( vertebrae prominence) is
usually visible and palpable.
Abnormal findings: Prominence or swelling
other than the C7 vertebrae may be normal.
• Inspect range of motion.
Ask client to turn the head to the right and to
the left( chin to shoulder), touch each ear to the
shoulder, touch chin to chest, and lift the chin to
the ceiling.
Normal findings: Normally neck movement
should be smooth and controlled with 45 degree
flexion, 55 degree extension, 40 degree lateral
abduction, and 70 degree rotation.
• Abnormal findings: muscles spasm ,
inflammation, or cervical arthritis may cause
stiffness, rigidity, and limited mobility of the
neck, which may affect daily functioning.
• PALPATION
Palpate the trachea.
Place your finger in the sternal notch. Feel each side of the
notch and palpate the tracheal rings. The first upper ring
above the smooth tracheal rings is the cricoid cartilage.
Normal findings:
Trachea is midline.
Abnormal findings:
The trachea may be pulled to the affected side in cases of
large atelectasis, fibrosis or pleural adhesions. The trachea is
pushed to the unaffected side in cases of a tumor, enlarged
thyroid lobe, pneumothorax, or with an aortic aneurysm.
• Palpate the thyroid gland.
Locate key landmarks with
your index finger and thumb:
Normal findings:
Landmarks are positioned
midline.
Abnormal findings:
Landmarks deviate from
midline or are obscured
because of masses or
abnormal growths.
• Hyoid bone ( arch-shaped bone)
• Thyroid cartilage
• Cricoid cartillage
• THE NECK
Ask the client to swallow as you palpate the
right side of the gland. Reverse the technique to
palpate the left lobe of the thyroid.
Normal findings:
Glandular thyroid tissue may be felt rising
underneath your fingers. Lobes should feel
smooth, rubbery, and free of nodules.
AUSCULTATION
• Auscultate the thyroid only if you find an
enlarged thyroid gland during inspection or
palpation.
Normal findings: No bruits are auscultated
Abnormal findings:
• A soft blowing swishing sound auscultated
over the thyroid lobes.
LYMPH NODES OF THE HEAD AND NECK
Palpate the lymph nodes.
Normal findings:
-There is no swelling or enlargement and no tenderness

REFERENCE:
• Weber, Janet R., Kelly, Jane H. (2018). Health
Assessment in Nursing. 6th edition. Lippincott
Williams & Wilkins. Wolter Kluwer Health. pgs. 280-
302