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02.04 Head/Neck Assessment

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Overview

  1. Head and neck abnormalities are rare, but could indicate significant disease processes

Nursing Points

General

  1. Small, barely noticeable asymmetry is normal
    1. One ear may be ever-so-slightly higher than the other
  2. Significant asymmetry or weakness on one side is considered abnormal

Assessment

  1. Head
    1. Inspect
      1. General symmetry
        1. Have patient make various faces to assess for asymmetry or one-sided weakness
      2. Size
        1. Abnormally large may indicate hydrocephalus, especially in children
      3. Shape
      4. Facial symmetry
        1. Eyebrows
        2. Nose
        3. Mouth
        4. Ears
      5. Make note of any abnormal features or movements
        1. i.e. twitching
    2. Palpate
      1. Scalp
        1. Symmetrical
        2. Mostly smooth
          1. Small bumps are normal
        3. Nontender
      2. Facial stability
        1. If trauma is suspected, assess for fractures by gently pressing on the cheeks
  2. Neck
    1. Inspect
      1. Symmetry
      2. Visible swelling or masses
        1. Goiter – thyroid issues
      3. Trachea should be midline
      4. Range of Motion
        1. Left to right
        2. Chin up and down
        3. Ears to shoulders
        4. Should all be smooth and well-controlled without pain
    2. Palpate
      1. TMJ – have patient open and close jaw
        1. Movement should be smooth with no clicking or tenderness
      2. Lymph nodes
        1. Preauricular – in front of ear
        2. Submandibular – below jaw
        3. Supraclavicular – above clavicle
          1. Almost always indicates malignancy
      3. Thyroid gland
        1. Should be midline, not swollen, nontender

Nursing Concepts

  1. Lymph node swelling
    1. May indicate infection
    2. Could indicate malignancy (lymphoma)

Patient Education

  1. Purpose for assessments and what you will be feeling for

Reference Links

Study Tools

Video Transcript

In this video we’re going to look at the head and neck assessment. Now, this assessment is mostly inspection, with a little bit of palpation. The truth is that head and neck abnormalities are very rare, but when you DO find abnormalities, they can indicate some serious disease processes, so it’s very important.

First, you want to be sitting or standing where you can face your patient directly, head on. The big thing you’ll be assessing is symmetry, so you need to be able to see both sides of their head and neck.

Start with inspection of the head – you’re looking for symmetry side to side, looking at the general size and shape. A little bit of asymmetry is normal, but make note of any significant asymmetry, any abnormal features, or any abnormal movements.

You can also have the patient smile, frown, puff out their cheeks, and raise their eyebrows to look for any asymmetry of movement or weakness on one side, which would never be normal.

Then you’ll palpate the scalp from the back to the front – be gentle, you’re feeling for any significant abnormalities or any tenderness. It should be mostly smooth and nontender.

Next you’ll inspect the neck. Again, looking for asymmetry. The trachea should be midline and there shouldn’t be any swelling or masses that might indicate goiter.

You want to inspect range of motion by having the patient look left and right, putting their chin up and down to their chest, then each ear to their shoulder. This movement should be smooth and they shouldn’t have any pain.

Then you’re going to palpate – you want to start with the temporomandibular joint – or TMJ – and have the patient open and close their mouth a few times. There should be no clicking or tenderness.

Then you want to palpate the thyroid gland while the patient swallows. It should be midline and nontender, and should move up and down smoothly.

Then finally you’re going to palpate for any swollen lymph nodes. Check the lymph nodes in front of the ears, below the jaw, and above the clavicle. You shouldn’t feel any lymph nodes and they should be nontender. If they are palpable, that could indicate some sort of infection, or in severe cases it could mean they have some sort of malignancy like lymphoma.

Again, head and neck abnormalities are rare, but they could indicate some significant problems – make sure you check out your outline for more details.
Now, go out and be your best selves today. And, as always, happy nursing!

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