Mee

• Head and Neck Assessment

  1. Gather equipment

  2. Introduce self

  3. Identify client and perform hand hygiene

  4. Explain procedure to client

  5. Assist client to gown
• Inspect head


  • Size, shape and configuration
• Inspect for involuntary movement


  • Head should be held still and upright
• Abnormal head movements


  • Horizontal jerking movement (neurologic disorder)
  • Involuntary nodding (aortic insufficiency)
  • Tilted to one side (unilateral vision loss or hearing deficiency)
• Palpate head


  • Normally hard and smooth without lesions
• Abnormal head palpation


  • Lesions or lumps on the head may indicate recent trauma or cancer
• Inspect face


  • Symmetric with round oval, elongated or square appearance. No abnormal movements noted. In older clients, facial wrinkles are prominent because subcutaneous fat decreases with age
• Abnormal face


  • Asymmetry in front of the earlobes (parotid gland enlargement)
  • Unusual or asymmetric orofacial movements (organic disease or neurologic problem)
  • Drooping of one side of the face (CVA or Bell's Palsy)
  • A masklike face (Parkinson's disease)
  • A sunken face with depressed eyes and hollow cheeks (cachexia)
  • A pale, swollen face (nephrotic syndrome)
• Palpate temporal artery


  • Elastic and not tender. Strength of pulsation may be decreased in older client
• Abnormal temporal artery


  • Hard, thick and tender with inflammation as seen with temporal arteritis (inflammation of the temporal arteries may lead to blindness)
• Palpate temporomandibular joint


  • 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


  • Limited ROM, swelling, tenderness or crepitation may indicate TMJ Syndrome
• Inspect neck


  • Symmetric with head centered and without bulging masses. The posterior triangle of the neck is formed by the sternocleidomastoid muscle, trapezius muscle and base of the clavicle
• Abnormal neck


  • Swelling, enlarged masses, or nodules may indicate an enlarged thyroid gland, inflammation of lymph nodes or tumor
• Inspect neck movement


  • The thyroid cartilage, cricoid cartilage and thyroid gland move upward symmetrically as the client swallows
• Abnormal neck movement


  • Asymmetric movement or generalized enlargement of the thyroid gland
• Inspect cervical vertebrae


  • C7 is usually visible and palpable. Fat may accumulate around the cervical vertebrae (especially in women) - sometimes called dowager's hump
• Abnormal cervical vertebrae


  • Prominence or swellings other than the C7 vertebrae
• Inspect range of motion

  • Neck movements should be smooth and controlled with 45-degree flexion, 55-degree extension, 40-degree lateral abduction and 70-degree rotation. Older clients usually have somewhat decreased flexion, extension, lateral bending and rotation of the neck, usually due to arthritis
• Abnormal range of motion


  • Stiffness, rigidity, and limited mobility (spasm, inflammation, or cervical arthritis)
• Palpate trachea


  • Trachea is midline
• Abnormal trachea


  • Trachea may be pulled to one side in cases of a tumor, thyroid gland enlargement, aortic aneurysm, pneumothorax, atelectasis or fibrosis
• Palpate thyroid gland


  Stand behind client, ask them to lower chin to chest and turn neck slightly right. Place thumbs on nape of neck with other fingers on either side of trachea below cricoid cartilage. Use left fingers to push trachea right, then use right fingers to feel deeply in front of sternomastoid muscle
• Normal thyroid gland


  • Unless client is extremely thin with long neck, thyroid gland is usually not palpable
• Abnormal thyroid gland


  • In diffuse enlargement like hyperthyroidism, Grave's disease or an endemic goiter, the thyroid gland may be palpated
• Auscultate thyroid gland


  • No bruits
• Abnormal thyroid auscultation


  • A soft blowing sound auscultated over the thyroid lobes (hyperthyroidism)
• Palpate lymph nodes


  Have client remain seated upright. Palpate lymph nodes with finger pads in slow walking, gentle, circular motion. Ask client to bend head slightly toward side being palpated to relax muscles. Compare lymph nodes that occur bilaterally
• Normal lymph nodes


  • Round, smaller than 1 cm, not palpable. Delimitation (position/boundary): discrete. Mobility: Mobile both from side to side and up and down. Consistency: Somewhat more fibrotic and fattier in older clients; soft. No swelling or enlargement and no tenderness
• Abnormal lymph nodes


  • Enlarged/Exceeds 1 cm (lymph adenopathy)
  • Confluent (merged): chronic infection
  • Enlarged and fixed in one place: metastatic disease
  • Hard and tender: metastatic disease
• Lymph node locations


  • Preauricular nodes (front of ears)
  • Postauricular nodes (behind the ears)
  • Occipital nodes (posterior base of the skull)
  • Tonsillar nodes (angle of the mandible, on the anterior edge of the sternocleidomastoid muscle)
  • Submandibular nodes (medical border of the mandible)
  • Submental nodes (a few centimeters behind the tip of the mandible)
  • Superficial cervical nodes (superficial to the sternomastoid muscle)
  • Posterior cervical nodes (posterior to the sternomastoid and anterior to the trapezius in the posterior triangle)
  • Deep cervical chain nodes (deep within and around the sternocleidomastoid muscle)
  • Supraclavicular nodes (hook fingers or clavicles and feel deeply between the clavicles and the sternocleidomastoid muscles)
• Ear Assessment


  1. Inspect the auricle, tragus, and lobule

  2. Palpate the auricle and mastoid process

  3. Inspect the external auditory canal with the otoscope

  4. Inspect the tympanic membrane, using the otoscope

  5. Perform the Valsalva maneuver

  6. Perform the whisper test

  7. Perform the Weber test

  8. Perform the Rinne test

  9. Perform the Romberg test
• Normal Findings - Auricle, tragus, lobule


  • Equal in size bilaterally (Normally 4-10 cm)
  • Auricle aligns with the corner of each eye and within a 10-degree angle of the vertical position
  • Earlobes may be free, attached or soldered
• Normal Findings - Skin


  • Smooth with no lesions, lumps or nodules
  • Color is consistent with facial color
  • No discharge
• Abnormal Findings - Auricle, tragus, lobule


  • Smaller than 4cm or larger than 10 cm
  • Misaligned or low set ears: chromosomal defects or MR
  • Enlarged preauricular and post auricular lymph nodes: infection
  • Tophi (nontender, hard, cream- colored nodules on the helix or antihelix, containing uric acid crystals: Gout
• Abnormal Findings - Skin

  • Blocked sebaceous glands: postauricular cyst
  • Ulcerated , crusted nodules that bleed: Cancer
  • Redness, swelling, scaling or itching: otitis externa
  • Pale blue ear color: frostbite
• Normal Findings - Palpation


  • Not tender
• Abnormal Findings - Palpation


  • A painful auricle or tragus (otitis externa or postauricular cyst)
  • Tenderness over the mastoid (mastoiditis)
  • Tenderness behind the ear (otitis media)
• Normal Findings - External Auditory Canal


  • Small amount of odorless cerumen is the only discharge normally present
  • Cerumen may be yellow, orange , gray, black and soft, moist, flaky, or even hard
  • Dry ear wax is more likely to become impacted
• Abnormal Findings - External Auditory Canal

  • Foul smelling sticky yellow discharge: otitis externa
  • Impacted foreign body, bloody purulent discharge: otitis media with ruptured tympanic membrane
  • Blood or watery discharge (CSF): skull trauma