ASSESSMENT

HEAD AND NECK

 PREPARING THE CLIENT
• Instruct to remove any wig, hat, hair ornaments, coins,
rubber bands, jewelry and head or neck scarves
• Ask the client to sit in an upright position with the neck
and shoulders held back and straight.
• Explain the need to remain still during most of the
inspection and palpation
• Explain the need to move and bend the neck for
examination of muscles and for palpation of thyroid gland
• Beware : some clients feel
anxious as you palpate lymph
nodes especially if they have
history of cancer that cause
enlargement of lymph nodes.
Tell the client what you are
doing and share your assessment
findings
 Cultural considerations
• Some southeast asian prohibit touching
of head or touching the feet before the
head.
• Variation in head shape, nose heights
and width, nasolabial and ear dimension
differs in individuals
 General routine screening
• Inspect head for size, shape, and configuration
• Palpate temporal arteries
• Palpate temporomandibular joint for swelling, tenderness or
crepitation
• Inspect neck movement, position, symmetry, lumps massess
• Palpate trachea for position
• Palpate thyroid for enlargement, lumps, massess
• Palpare for any enlarged tender lymph nodes
• Auscultate for bruits over thyroid if enlarged
 HEAD AND NECK
ASSESSMENT
-CRANIUM/SKULL
-FACE
-THYROID GLAND
-LYMPH NODES
-SENSORY ORGANS- EYES, EARS, NOSE,
AND MOUTH
 TECHNIQUES TO USE

• INSPECTION
• PALPATION
• AUSCULTATION
• Evaluation of overlying protective structures
(cranium and facial bones)
• Head and facial bones abnormalities
• Asymmetry
• Structural changes
• Tenderness
• Detect enlarged or tender lymph nodes
• Thyroid enlargement, nodules, masses or tenderness
• Abnormalities in neck and facial muscles
 THE HEAD
2 SUBSECTIONS: CRANIUM AND FACE
-CRANIUM
-FRONTAL (1)
-PARIETAL (2)
-TEMPORAL (2)
-OCCIPITAL (1)
-ETHMOID (1)
-SPHENOID(1)
 Inspection and Palpation
of the Scalp
• Inspect
• Lesions or masses
• Normal findings
• Scalp is shiny, intact, without
lesions or masses
• Abnormal findings
• Bleeding, lesions, masses,
hematomas
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 Assessment of the Face
• Inspection
• Shape
• Symmetry
• Normal findings
• Symmetrical features
• Palpebral fissures equal
• Shape can be oval, round, or slightly square
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 INSPECTION OF HEAD
• SIZE,SHAPE AND CONFIGURATION
• NOTE FOR NEUROLOGIC DISORDERS ---JERKING
MOVEMENTS-
• Involuntary nodding- aortic insufficiency
• Head tilting to one side- unilateral vision or hearing
deficiency or shortening of the sternomastoid muscle
• SYMMETRY, FEATURES, MOVEMENT,
EXPRESSION AND SKIN CONDITION
 Assessment of the Face

• Abnormal findings
• Deformed or absent structures
• Asymmetry
• More or less pronounced facial features
• Diseases which may alter facial features:
• Bell’s palsy, A temporary disorder affecting cranial nerve
VII and producing a unilateral facial paralysis

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• acromegaly
• An enlargement of the skull and
cranial bones due to increased growth
hormone
• hydrocephalus
• The enlargement of the head
caused by inadequate drainage of
cerebrospinal fluid, resulting in
abnormal growth of the skull 17
NORMOCEPHALIC
MICROCEPHALY
 Early acromegaly. Note the coarsening of
features with broadening of the nasal alar and
prominence of the zygomatic arches

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ACROMEGALY
PAGETS DISEASE/LION FACE
BELL PALSY
Left facial palsy. Faces include asymmetry of one side of
the face, eyelid not closing completely, drooping lower
eyelid and corner of mouth, and loss of nasolabial fold.

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MOON SHAPE –CUSHING
SYNDROME
 Cushing syndrome. Faces include a rounded or
“moon-shaped” face with thin, erythematous
skin. Hirsutism may also be present, especially if
the condition is caused by an adrenal cancer

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EXOPTHALMOS
Hyperthyroid facies. Note fine, moist skin with
fine hair, prominent eyes and lid retraction, and
staring or startled expression

28
 Down syndrome. Note depressed nasal bridge,
epicanthal folds, mongoloid slant of eyes, low-set
ears, and large tongue

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Hydrocephalus, with characteristic enlarged
head, bulging fontanel, dilated scalp veins,

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 PALPATION OF HEAD
• NOTE FOR CONSISTENCY- Normally hard
and smooth without lesion
• PALPATE TEMPORAL ARTERY – elastic and
not tender
hard, thick and tender with inflammation –
temporal arteritis ---- lead to blindness
 PALPATION OF HEAD

• PALPATE THE
TEMPOROMANDIBULAR JOINT
(TMJ)
TMJ SYNDROME- limited ROM,
swelling, tenderness, crepitation
 Mandible
• Palpate and auscultate the temporo-mandibular joint
when the client opens and closes the mouth
• Normal findings
• No discomfort, joint articulates smoothly without
clicking or crepitus
• Abnormal findings
• Pain, tenderness, crepitus
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NECK
38
39
 Neck
• Inspection
• Palpation
• Normal findings
• Full ROM, pain free, symmetrical muscles, no
masses
• Abnormal findings
• Limited ROM, pain, asymmetrical muscles,
masses 40
 INSPECTION

• Symmetry, masses/lumps
----swelling, enlarge mass or
nodules indicates enlarged
thyroid gland , inflammation of
lymph nodes, tumor
INSPECTION OF THE NECK
STRUCTURES MOVEMENT
• The client swallow a small sip of water –
observe movement of the thyroid
cartilage, thyroid gland
Normal: thyroid cartilage and cricoid
cartilage move upward symmetrically as
the client swallows
 Inspection of cervical
vertebrae
• visible and palpable
• Swelling-abnormal
 Inspection of ROM

• Smooth and controlled with 45degree

flexion and 55 degree extension
• Note for muscle spasms, stiffness,
ridigity, limited mobility of neck ---
cervical arthritis
PALPATE THE THYROID
GLAND
 Thyroid Gland
• Inspection
• Palpation Abnormal findings
Mass
• Auscultation Enlarged gland
Goiter
Normal findings Asymmetrical
Symmetrical movement with
swallowing enlargement
Adam’s apple more pronounced Presence of a nodule
in males
No masses, tenderness, or
or bruit
enlargement
Absent bruit 47
 PALPATE THE THYROID
GLAND
• Midline ----deviate if there is mass
• Lobes- smooth, firm and non tender
• The R lobe is 25% larger than the
left lobe
 PALPATE THE THYROID
GLAND
• Hyperthyroidism- TG palpated
• Thyroiditis- enlarged and tender
• Rapid enlargement of single
nodules- suggests malignancy
 Thyroid disorders

• Hyperthyroidism
• Excessive production and
secretion of thyroid hormone
• Most common cause is the
grave’s disease
• Increased metabolism,
enlargement of thyroid gland
and exopthalmus
• Hypothyroidism
• Decreased production
of thyroid hormone
• Client seem to be
slow motion with a
decreased affect
• Thyroid cancer
• Changes in the voice
and difficulty
swallowing
AUSCULTATION OF
THYROID GLAND
 AUSCULTATION OF
THYROID GLAND
• Done if noted an enlargement of the gland
• Place the bell of stethoscope over the lateral
lobes of t.gland.
• No bruits -normal
• A soft, blowing swishing sound over the
thyroid lobes in hyperthyroidism
 Lymph Nodes
• Inspection • Submental
• Palpation • Submandibular
• Location • Anterior and
posterior cervical
• Preauricular chains
• Postauricular • Tonsilar
• Occipital • Supraclavicular55
56
 Lymph Nodes
• Normal findings
• Unable to palpate or see nodes
• Abnormal findings
• Enlarged nodes
• Able to palpate or see nodes
• Tenderness
• Firm, hard nodes 57
 PALPATION OF LYMPH
NODES
• Abnormal: enlarged, swelling,
tenderness, hardness, immobility
• Supraclavicular nodes- left side –
metastasis form a malignancy
(abdomen and thorax)
 lymphoma
• Group of disorders characterized by malignant
neoplasms of the lymph tissue
• Malignant lymphomas- large lymph nodes, discrete,
nontender, and firm to rubbery, unilateral and localized
• HODGKIN’S DISEASE- painless, progressive
enlargement of lymphoid tissue
 PALPATION OF TRACHEA
• Trachea is midline
• Pulled to the affected side -
atelectasis , fibrosis, pleural
adhesions
• Pushed on unaffected side- tumor,
enlarged thyroid lobe,
pneumothorax, aortic aneurism
Position of the thumbs to evaluate the midline position of the
trachea

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HEADACHES