H.A.

• Key components of a head assessment:

  • Headache history: Inquire about frequency, duration, characteristics, triggers, patterns, and impact on daily activities
  • Vision: Test visual acuity, check for changes, blurriness, double vision, assess peripheral vision and visual fields
  • Hearing: Evaluate hearing using a tuning fork or audiometer, ask about hearing loss, tinnitus, vertigo
  • Facial symmetry: Inspect for asymmetry, drooping, assess facial expressions for weakness or paralysis
• • Neurological assessment: Evaluate coordination, balance, gait, check for motor or sensory deficits
  • Mental status examination: Assess orientation, memory, attention, cognitive function, mood, affect
• • Cranial nerves examination: Evaluate each of the 12 cranial nerves, assess eye movements, facial sensation, movement, and other functions
  • Temporal arteries and skull inspection: Palpate temporal arteries for tenderness, inspect skull for abnormalities
  • Neck mobility: Assess range of motion, check for stiffness, pain, limitations
  • Lymph nodes: Palpate for swelling or tenderness
  • Thyroid gland: Palpate for enlargement or nodules
  • Mouth and throat examination: Inspect oral cavity for lesions, discolorations, assess teeth, gums, throat for redness, swelling, signs of infection
• Additional assessments for specific parts of the head:

  • Hair and scalp: Inspect for lesions, lumps, abnormal masses, assess hair condition
  • Eyes: Check pupillary reactions, extraocular movements, presence of conjunctival redness, discharge, swelling
  • Nose: Inspect for deformities, asymmetry, nasal discharge, bleeding, signs of infection
  • Ears: Inspect for abnormalities, assess ear canal, tympanic membrane, hearing acuity
  • Mouth and throat: Detailed examination of oral mucosa, tonsils, posterior pharynx, check for lesions, masses
• • Temporomandibular joint (TMJ): Assess for tenderness, clicking, limitations in movement
  • Sinuses: Palpate frontal, maxillary sinuses for tenderness, signs of congestion, infection
  • Cervical spine: Assess range of motion, palpate for abnormalities, tenderness, masses
  • Skin: Inspect for rashes, lesions, discolorations, signs of sun damage
  • Vascular system: Assess carotid arteries for bruits, pulsations in temporal, head arteries
  • Olfactory function: Assess sense of smell using common scents
• Normal findings and potential abnormalities during a head assessment:

  • Hair and scalp: Normal findings - clean, well-groomed hair; Abnormalities - hair loss, lice, scalp lesions
  • Eyes: Normal findings - symmetrical appearance, equal pupils, brisk reactions to light; Abnormalities - asymmetry, abnormal pupillary reactions, redness, swelling
  • Nose: Normal findings - symmetrical appearance, clear nasal passages; Abnormalities - deformities, nasal discharge, congestion
• • Cranial nerves: Normal findings - normal function of all 12 cranial nerves; Abnormalities - deficits in function, facial asymmetry, swallowing issues
  • Neck: Normal findings - full range of motion, no palpable masses; Abnormalities - limited motion, enlarged lymph nodes, stiffness
  • Vascular system: Normal findings - no bruits over carotid arteries; Abnormalities - bruits indicating vascular issues
  • Mental status: Normal findings - oriented, coherent responses; Abnormalities - confusion, altered mental status
• • Ears: Normal findings - symmetrical appearance, intact tympanic membrane; Abnormalities - deformities, discharge, signs of infection
  • Mouth and throat: Normal findings - moist, pink oral mucosa; Abnormalities - lesions, dental issues, redness, swelling
  • Face: Normal findings - symmetrical features, expressive movements; Abnormalities - asymmetry, weakness, abnormal expressions
  • Temporal arteries: Normal findings - no tenderness or swelling; Abnormalities - tenderness, swelling indicating temporal arteritis
• • Skin: Normal findings - even tone, no lesions; Abnormalities - lesions, discolorations
• • Nose assessment: Inspect for deformities, nasal issues, congestion
  • Ears assessment: Check for symmetry, abnormalities, ear canal, tympanic membrane
  • Mouth and throat assessment: Inspect oral cavity, tongue, throat for lesions, abnormalities
  • Facial nerve assessment: Evaluate facial symmetry, expressions, movements
  • Temporal arteries assessment: Palpate for tenderness, swelling
  • Cranial nerves examination: Systematic assessment of all 12 cranial nerves
  • Neck assessment: Inspect for masses, abnormalities, palpate lymph nodes, assess range of motion
• • Vascular system assessment: Palpate carotid arteries, assess pulsations, jugular veins
  • Thyroid gland assessment: Palpate for enlargement, nodules, signs of dysfunction
  • Skin assessment: Inspect for lesions, rashes, discolorations, sun damage
  • Neurological and mental status assessment: Evaluate coordination, balance, gait, mental functions
  • Olfactory function assessment: Test sense of smell using common scents
  • Temporomandibular joint assessment: Check for tenderness, limitations, clicking sounds
• Considerations and steps for conducting a head physical assessment:

  • Preparation: Ensure comfort, privacy, hand hygiene, informed consent
  • Introduction and patient history: Introduce, obtain detailed medical history
  • General inspection: Observe appearance, behavior, signs of distress
  • Hair and scalp assessment: Inspect for lesions, infestations, hair condition
  • Eyes assessment: Check symmetry, alignment, eyelids, conjunctiva, signs of redness
  • Pupillary assessment: Examine size, equality, light reactions, anisocoria
  • Extraocular movements: Assess eye movements, limitations, nystagmus
• Objective data to consider during a neural assessment:

  • Mental status examination: Orientation, level of consciousness, attention, memory, mood
  • Cranial nerve assessment: Visual acuity, pupillary response, extraocular movements, facial sensation, motor function, hearing, taste, swallowing
  • Motor system assessment: Muscle strength, coordination, balance, range of motion, tremors
  • Sensory system assessment: Light touch, sharp/dull discrimination, proprioception, vibration sense, discriminative touch, temperature, pain
• • Reflex assessment: Deep tendon reflexes, superficial reflexes, Babinski reflex
  • Coordination
• Deep tendon reflexes that are assessed include patellar reflex and Achilles reflex
• Superficial reflexes that are assessed include plantar reflex
• Babinski reflex, also known as plantar response in infants, is evaluated
• Coordination and Balance tests include:

  • Finger-to-nose test for coordination assessment
  • Heel-to-shin test for coordination and balance assessment
  • Rapid alternating movements for coordination assessment
• Gait Assessment involves observing the patient's gait for abnormalities like ataxia or spasticity
• Assessment of Autonomic Function includes:

  • Blood pressure and heart rate measurements in lying, sitting, and standing positions
  • Pupillary response to accommodation
  • Evaluation of skin color, temperature, and moisture
  • Assessment of bowel and bladder function
• Cerebellar Function Assessment includes:

  • Assessing finger-to-nose test for dysmetria
  • Checking for intention tremors
• Mini-Mental State Examination (MMSE) assesses cognitive function covering orientation, registration, attention and calculation, recall, and language
• Pain Assessment involves asking the patient to describe the location, quality, intensity, and duration of pain
• Peripheral Nerve Assessment includes:

  • Assessing peripheral nerves for signs of compression or injury
  • Evaluating for signs of neuropathy, such as diminished or absent reflexes
• Assessment of Muscle Tone involves observing for signs of hypertonia, hypotonia, or rigidity
• Assessment of Deep Sensation includes:

  • Joint position sense (proprioception)
  • Vibration sense using a tuning fork
• Assessment of Cranial Nerve XII (Hypoglossal) involves assessing tongue movements and symmetry, checking for any signs of atrophy or fasciculations
• Plaque:

  • A raised, flat-topped area on the skin larger than 1 centimeter in diameter, often resulting from the merging of papules
• Pustule:

  • A small, pus-filled lesion on the skin that may be red at the base and contain yellow or white pus
• Erosion:

  • Loss of the superficial layers of the skin, often resulting from the rupture of a vesicle or pustule
• Ulcer:

  • A deeper loss of skin that extends into the dermis or subcutaneous tissue, often associated with tissue necrosis
• Scale:

  • Dry, flaky, or exfoliated skin that can vary in size and may be associated with conditions such as psoriasis or dry skin
• Crust:

  • Dried blood, serum, or pus on the surface of the skin, forming as a result of the healing process
• Fissure:

  • A linear crack or groove in the skin, often associated with dry or thickened skin
• Wheal (Hive):

  • A raised, erythematous lesion with a transient appearance, often associated with allergic reactions and varying in size
• Petechiae:

  • Small, pinpoint, red or purple spots on the skin caused by bleeding beneath the skin, not blanching when pressed
• Ecchymosis:

  • Larger bruise-like patches of bleeding beneath the skin, changing color as they heal, resulting from blood vessel rupture
• Lichenification:

  • Thickening and hardening of the skin with accentuated skin markings, often due to chronic scratching or rubbing
• Excoriation:

  • Superficial loss of skin due to scratching or rubbing, often linear and associated with pruritus
• Keloid:

  • An overgrowth of scar tissue extending beyond the boundaries of the original wound, raised and may have a firm, rubbery consistency