HAS - HEAD AND NECK

• Head and neck assessment focuses on

  • the cranium
  • face, thyroid gland
  • lymph nodes contained within the head and neck

  
• The sensory organs (eyes, ears, nose, and mouth) are discussed in separate chapters
• Cranium


  The framework of the head that houses and protects the brain and major sensory organs
• Face


  Facial bones that give shape to the face
• Facial bones


  • Maxilla (2)
  • Zygomatic (cheek) (2)
  • Inferior conchae (2)
  • Nasal (2)
  • Lacrimal (2)
  • Palatine (2)
  • Vomer (1)
  • Mandible (jaw) (1)
• Neck


  Composed of muscles, ligaments, and cervical vertebrae. Contains the hyoid bone, major blood vessels, larynx, trachea, and thyroid gland

  
• Sternocleidomastoid and Trapezius muscles

  • Paired muscles that allow movement and provide support to the head and neck
• Cervical vertebrae (C1 through C7)


  Located in the posterior neck and support the cranium. The vertebra prominens is C7 which can easily be palpated when the neck is flexed

  
• Lymph nodes


  Filter lymph, a clear substance composed mostly of excess tissue fluid, to remove bacteria and tumor cells. They also produce lymphocytes and antibodies as a defense against invasion by foreign substances, assisting with the body's immunity
• Sebaceous Head


  • Deformities from trauma
• Inspect the face


  Inspect for symmetry, features, movement, expression, and skin condition
• If drooping of one side of the face is noted

  Assess for other signs of stroke using RECOGNIZING SYMPTOMS OF STROKE
• Normal facial features


  • The face is symmetric with a round, oval, elongated, or square appearance. No abnormal movements noted
• Abnormal facial features


  • Drooping, weakness, or paralysis on one side of the face may result from a stroke (cerebrovascular accident, CVA) and usually is seen with paralysis or weakness of other parts on that side of the body
  • Drooping, weakness, or paralysis on one side of the face may also result from a neurologic condition known as Bell palsy
• Normal facial features


  • Symmetric facial features
  • Equally distributed eyebrow hair
  • Palpebral fissures are equal in size
• Abnormal facial features


  • Asymmetric features
  • Exophthalmos
  • Moon Face
  • Thinning of Eyebrows
• Normal eye inspection


  • No edema
  • Eyes are not sunken

  
• Abnormal eye inspection

  • Periorbital Edema
  • Sunken eyes, cheeks, and temples

  
• Normal facial movements


  • Symmetric facial movements
  • Raise or lower both eyebrows
  • Both eyes are blinking
  • Both eyes are able to close tightly
  • Can smile and show teeth
  • Frown
  • Puff the cheeks
• Abnormal facial movements


  • Asymmetric facial movements
  • Involuntary facial movements
• Symptoms of stroke beyond FAST


  • Sudden NUMBNESS or weakness of face, arm, or leg, especially on one side of the body
  • Sudden CONFUSION, trouble speaking or understanding speech
  • Sudden TROUBLE SEEING in one or both eyes
  • Sudden TROUBLE WALKING, dizziness, loss of balance or coordination
  • Sudden SEVERE HEADACHE with no known cause
• Symptoms of stroke in the posterior circulation

  • Vertigo, feels like the room is spinning
  • Imbalance
  • One-sided arm or leg weakness
  • Slurred speech or dysarthria
  • Double vision or other vision problems
  • A headache
  • Nausea and/or vomiting
• Normal temporal artery


  • The temporal artery is elastic and not tender
• Abnormal temporal artery


  • An acute urgent 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)
• Normal temporomandibular joint (TMJ)

  • No swelling, tenderness, or crepitation with movement
  • Mouth opens and closes fully (3–6 cm between upper and lower teeth)
  • Lower jaw moves laterally 1–2 cm in each direction
• Abnormal temporomandibular joint (TMJ)


  • Limited range of motion, swelling, tenderness, or crepitation may indicate TMJ syndrome
• When assessing TMJ syndrome, be sure to explore the client's history of headaches, if any
• Normal neck inspection


  • Neck is symmetric
  • Head centered
  • Without bulging masses
• Abnormal neck inspection

  • Swelling
  • Enlarged masses—or nodules—may indicate an enlarged thyroid gland inflammation of lymph nodes, or a tumor

  
• Normal neck movement


  • The thyroid cartilage and cricoid cartilage move upward symmetrically as the client swallows

  
• Abnormal neck movement


  • Asymmetric movement or generalized enlargement of the thyroid gland is considered abnormal

  
• Normal cervical vertebrae inspection

  • C7 (vertebrae prominens) is usually visible and palpable
• Abnormal cervical vertebrae inspection

  • Prominence or swellings other than the C7 vertebrae may be abnormal
• Normal neck range of motion

  • Neck movement should be smooth and controlled with 45-degree flexion, 55-degree extension, 40-degree lateral abduction, and 70-degree rotation
• Abnormal neck range of motion

  • Muscle spasms, inflammation
  • Cervical arthritis may cause stiffness, rigidity, and limited mobility of the neck, which may affect daily functioning
• Normal trachea palpation


  • Trachea is midline
• Abnormal trachea palpation


  • 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 case of a tumor, enlarged thyroid lobe, pneumothorax, or with an aortic aneurysm
• Normal thyroid gland palpation

  • Landmarks are positioned midline

  
• Abnormal thyroid gland palpation

  • Landmarks deviate from midline or are obscured because of masses or abnormal growths

  
• Normal thyroid auscultation


  • No bruits are auscultated