Health Assessment:

Assessment of the Head & Neck

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Objectives:
 Review the anatomy of head and neck
 Obtain the problem-focused history on head
and neck
 Identify subjective data collected from the
client on head and neck
 Collect objective data from the client on head
and neck

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 Temporal a.

Parotid Gland
Submandibular
Sternomastoid muscle Gland
Internal jugular vein Sublingual Gland

External jugular vein External Carotid a.

Internal Carotid a.

Common Carotid a.

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Sternomastoid m.

Trapezius m. Ant. Triangle

Post. Triangle

Clavicle

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 Hyoid bone
Cricoid cartilage

Isthmus of thyroid Thyroid cartilage

Sternomastoid m. Thyroid gland

Manubrium

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 Link with lymphatic vessel of
the Lymphatic System
 Are small ball-shaped organ
of the immune system,
distributed widely
throughout the body.
 Act as filters for lymph and
engulf pathogens, preventing
harmful substances from
entering the circulation.
 They may get inflamed or
enlarged in conditions like
infection or cancer.

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 Thyroid gland is one of
the endocrine glands
◦ produce hormones
(thyroxine, T4 & Isthmus
triiodothyronine, T3) that of thyroid
stimulate rate of cellular
metabolism.
◦ located in the middle of the
lower neck, below the
cricoid cartilage.
◦ shaped like a "bow tie,"
having two halves (lobes)
 a right lobe and a left
lobe joined by an
"isthmus”, at the level of
2nd & 3rd tracheal rings.

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 CC (List some examples)
 HPI (History of present illness)
 ROS (Review of Body System)
 PMH
 FH
 Medications
 Allergies
 Psychosocial history
 Occupational/environmental hazards
 Exercise
 Functional abilities
 Sleep and nutrition
 Habits

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 Inspection and palpation of
the skull
◦ Size, shape, contour, tenderness
and intactness
◦ Normal protrusions:
 Forehead, lateral edge of parietal
bone, occipital bone, mastoid
Microcephaly = abnormally small head
process behind each ear
◦ Temporal area
 Temporomandibular joint (anterior
to each ear)
 Temporal artery (above cheek bone,
between eye & top of ear).
 Inspect Hair & Scalp:
◦ Quantity, texture of hair, lumps,
scale of scalp Marcocephaly = abnormally big head

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  Inspection and palpation of the face
◦ Facial structure, expression (asymmetry,
involuntory movement, etc), oedema/masses.
◦ Refer to integumental and Sensory Systems

Hypothyroidism
Hyperthyroidism

Exophthalmos
Periorbital edema 12
 Cushing Syndrome:
◦ increased adrenal hormone production (ACTH) or chronic
steroid use---- “moon” face, prominent jowls, red cheeks,
excessive hair on upper lip, lower cheeks, & chin, acneiform
rash on chest
 Hyperthyroidism: (hypothalamus>>Signal to Pituitary gland>>secrete
TSH which regulate production of T3 & T4)
◦ “Goiter”: increase in size of thyroid gland & occur with
hyperthyroidism, or hypothyroidism. May also appear with
infrequent blinking & staring appearance, together with
nervousness, muscle cramps tachycardiac, SOB, excessive
sweating, etc.
 Myxedema (hypothyroidism):
◦ severe hypothyroidism has dull, puffy face with dry skin, dry
coarse hair & eyebrows, periorbital oedema, non-pitting
oedema.

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 Acneiform

Moon Face

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 Inspect:
◦ Symmetry: in relation to head position, as well as
the neck muscle.
◦ Masses or scars?
◦ Enlargement of parotid or submandibular
glands?
◦ Any visible lymph nodes.

 ROM

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 Palpation of Lymph Nodes
◦ Use gentle circular motion of fingerpads.
◦ Normally, the salivary glands are not
palpable.
◦ Lymph nodes may or may not be palpate.
◦ If they are palpable, they should be soft,
mobile, nontender & bilaterally equal.
(Cervical nodes are usually palpable in
healthy persons)
◦ Enlarged, tender & firm but freely movable
may suggest an infection of the head or
throat.

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 Palpation of Lymph Nodes(cont’d)
◦ Malignancy may be suspected when nodes are
unilateral, hard, asymmetry, fixed &
nontender.
◦ Beginning with preauricular LN in front of the
ear, palpate the 10 groups of LNs in a
systematic way.
◦ Use both hands to palpate, comparing both
sides

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 Feel sequence of nodes:
◦ Pre-auricular
◦ Posterior auricular
Posterior Preauricular
◦ Occipital auricular
◦ Submental
◦ Submandibular Occipital
◦ Jugulodigastric Jugulodigastric
Submandibula
◦ Superficial Cervical Superficial r
◦ Deep cervical (tip head to the cervical
Submental
side being examined)
◦ Posterior Cervical
◦ Chain Supraclavicular
(hunch shoulders & elbows
Posterior cervical
forward) Deep Cervical
Chain
Supraclavicular

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 Inspect Trachea:
◦ Deviation from normal
midline; then feel for
deviation----? Problem
in thorax. Hyoid
◦ Compare both sides: Cricoid bone
space between trachea Cartilage
Thyroid
& sternomastoid cartilage
Isthmus of
muscle. thyroid
Thyroid
Sternomastoid gland
muscle
Trachea
Clavicle

Manubrium

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 Inspect Thyroid Gland:
◦ Tangential lighting may be
required.
◦ Tip head slightly backward.
◦ Inspect region below cricoid
cartilage

◦ Instruct client to raise chin up

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 Palpation
◦ Normally not palpable in
normal adult.
◦ Size, shape, consistency,
tenderness, and presence of
nodules.
◦ Normal size of thyroid gland is a
little larger than the size of
thumb pad:
 Right> left
 If it’s felt, should be nontender,
small, soft, smooth & move
freely during swallowing
◦ Tender thyroid may be an
indication of infection.

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 Auscultation:

◦ Required if the thyroid gland is enlarged, for the

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 Barkauskas, V. H., Stoltenberg-Allen, K., Baumann, L. C., &
Darling-Fisher, C. (1994). Health & physical assessment
(Chapter 18). St. Louis: Mosby
 Bickley, 2007, chapter 6.
 Giddens, J.F., & Wilson, S. F. (2005). Health assessment for
nursing practice (3rd ed.). St. Louis: Elsevier Mosby.
 Jarvis, 2008, Chapters 13
 Kozier et al., 2008, chapter 30

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