Head to Neck Assessment

• Head and neck assessment focuses on the cranium, face, thyroid gland, and lymph nodes contained within the head and neck and the sensory organs (eyes, ears, nose, and mouth).
• The throat is normally pink, without exudate or lesions.
• The normal tonsils and pharynx are seen in the mouth.
• Yellowish mucus on the throat may be seen, with postnasal sinus drainage.
• A bright red throat with white or yellow exudate indicates pharyngitis.
• Expressed drainage from the puncta on palpation occurs with duct blockage.
• When light is directed into the unaffected eye, both pupils constrict.
• An inequality in pupil size of less than 0.5 mm occurs in 20% of clients, a condition called anisocoria, which is normal.
• Areas of roughness or dryness on the cornea are often associated with injury or allergic responses.
• Typical abnormal findings include irregularly shaped irises, miosis, mydriasis, and anisocoria.
• Monocular blindness can be detected when light directed to the blind eye results in no response in either pupil.
• The iris is typically round, flat, and evenly colored.
• If the difference in pupil size changes throughout pupillary response tests, the inequality of size is abnormal.
• Pupils are normally equal in size (3 to 5 mm).
• The cornea is transparent, with no opacities.
• The oblique view of the cornea shows a smooth and overall moist surface; the lens is free of opacities.
• The ear is the sense organ of hearing and equilibrium.
• When palpating the nasolacrimal duct, no drainage should be noted from the puncta when palpating the nasolacrimal duct.
• The normal direct pupillary response is constriction.
• The pupil, round with a regular border, is centered in the iris.
• Near visual acuity is 14/14 (with or without corrective lenses), which means that the client can read what the normal eye can read from a distance of 14 inches.
• Extraocular muscles control the direction of eye movement.
• Presbyopia (impaired near vision) is indicated when the client moves the chart away from the eyes to focus on the print, it is caused by decreased accommodation.
• The lacrimal apparatus consists of tear (lacrimal) glands and ducts.
• Myopia (impaired far vision) is present when the second number in the test result is larger than the first (20/40), with the higher the second number, the poorer the vision.
• Normal visual field degrees are approximately as follows: Inferior: 70 degrees, Superior: 50 degrees, Temporal: 90 degrees, Nasal: 60 degrees.
• The eyeball is located in the eye orbit, a round, bony hollow formed by several different bones of the skull.
• The bony orbit and fat cushion protect the eyeball.
• A delayed or absent perception of the examiner’s finger in the visual field test indicates reduced peripheral vision.
• Normal distant visual acuity is 20/20 with or without corrective lenses, which means that the client can distinguish what the person with normal vision can distinguish from 20 feet away.
• The corneal light reflex test assesses parallel alignment of the eyes, by shining a penlight approximately 12 inches from the client’s face and noting the light reflected on the corneas, the reflection of light on the corneas should be in the exact same spot on each eye, which indicates parallel alignment.
• A cushion of fat surrounds the eye in the orbit.
• A client is considered legally blind when vision in the better eye with corrective lenses is 20/200 or less.
• A soft, blowing, swishing sound auscultated over the thyroid lobes is often heard in hyperthyroidism because of an increase in blood flow through the thyroid arteries.
• The bell of the stethoscope should be placed over the lateral lobes of the thyroid gland.
• The thyroid cartilage and cricoid cartilage move upward symmetrically as the client swallows.
• Head and neck cancer includes cancers of the mouth, nose, sinuses, salivary glands, throat, and lymph nodes in the neck.
• Neck structures move upward and downward during swallowing.
• Lymph nodes of the head and neck should not be enlarged or tender and no swelling or enlargement should be noted during inspection.
• Neck movement should be smooth and controlled with 45 - degree flexion, 55 - degree extension, 40 - degree lateral abduction, and 70 - degree rotation.