Head, Neck, and Thorax Assessment

Coverage

• Head and neck, eyes, ears, nose and sinuses, mouth and throat, thorax and lungs, breast and lymphatic system, heart and neck vessels are assessed.

Head and Neck Assessment

• Focuses on the cranium, face, thyroid gland, and lymph nodes in the head and neck.
• Sensory organs (eyes, ears, nose & mouth) are covered separately.

Cranium

• Houses and protects the brain and sensory organs.
• Eight bones make it up.
• Cranial bones joined by sagittal, coronal, squamosal, and lambdoid sutures are immovable in adults

Facial Bones

• Give shape to the face.
• Fourteen bones make its up, including the maxilla, zygomatic, inferior conchae, nasal, lacrimal, palatine, vomer, mandible (jaw).

Subjective Data Collection

• Questions focus on gathering information for potential current health concerns, past family history and lifestyle,

Neck Pain

• May accompany issues with muscles, the cervical spinal cord, or arthritis.

Headaches

• Vascular (migraine), muscle contraction (tension), traction, or inflammatory causes related them.

Facial pain

• Sharp, shooting, piercing facial pains lasting seconds to minutes indicate trigeminal neuralgia (tic douloureux).
• Pain occurs over the divisions of the fifth trigeminal cranial nerve (ophthalmic, maxillary, and mandibular areas).

Difficulty Moving Head or Neck

• May limit mobility and impact daily activities due to muscle tension, vertebral joint dysfunction, or other head/neck disorders.

Lumps or Lesions

• May indicate cancer if they do not heal or disappear.

Dizziness, Lightheadedness, or Loss of Consciousness

• May be signs of impending stroke

Weakness or Numbness

• Sudden weakness of the face, arms, or legs on one side may also be an impending sign of a stroke

Trauma or Surgeries

• Previous trauma or surgeries may cause chronic pain or limit movement, also affect the muscles, nerves, and/or vascular system.

Family History

• Key medications and substances should be considered in context of head and neck pain

Head and Neck Cancer

• Genetic predisposition can be a risk factor

Lifestyle & Health Practices

• Focus on smoking status, alcohol and drug usage, recreational activities (sports), and work, typical posture.

Lymph Nodes

• Filters lymph (a fluid with excess tissue fluid), produces lymphocytes and antibodies.
• Filtering helps remove bacteria and tumors in the lymph.

Routine Physical Screening (Objective Data)

• Head is inspected for size, shape, and configuration
• Temporal arteries are palpated

Head Size and Shape

• Normocephalic: Head is symmetric, round, erect, in midline, and related to body size with no visible lesions.
• Microcephaly : Smaller head size
• Acromegaly : Skull and facial bones are larger and thicker
• Hydrocephalus: Abnormal increase in head size in young child

Temporal Artery Palpation

• Elastic and non-tender, hardness, thickness, and tenderness with inflammation may be temporal arteritis.

Facial Movements

• Symmetric movements (raising/lowering eyebrows, closing/opening tightly, smiling, frowning, puffing cheeks) indicate proper cranial nerve function.
• Asymmetric movements or involuntary movements may indicate neurological issues.

Inspection of the Face

• Symmetry, features, movement, expression, and skin condition are expected.
• If drooping on one side, assess for stroke signs.

Facial Symmetry Deviations

• Drooping, weakness, or paralysis one side indicates a stroke or Bell palsy.
• Asymmetric eyebrows could be abnormal features

Joint Palpitation - Mandibular

• Normally there is no swelling, tenderness, or crepitation w/movement.
• Mouth opens/closes fully (3-6 cm), lower jaw moves laterally 1-2 cm each direction.
• Limited range of motion, swelling, tenderness, or crepitation may indicate temporomandibular joint (TMJ) syndrome.

Assessing Stroke

• Use face arms speech time ( F.A.S.T) to quickly assess
• Act fast when symptoms are seen by calling 911

Vertigo related to Posterior Circulation

• Room is spinning
• There is inbalance
• Arm and leg weakness is on either side
• Slurred speech is present
• There is double vision or vision problems
• May be a headache accompanied by Nausea with or without vomiting

The Neck

• Inspected and assessed for trachea and thyroid

Trachea Palpation

• Trachea is assessed for midline.
• Nonpalpable tissue is described. If issue is palpable consistence should be firm, smooth and meaty without nodules or enlargement,

Trachea Abnormalities

• Pulled to the affected side due to atelectasis, fibrosis, or pleural adhesions.
• Pushed to the unaffected side due to tumor, enlarged thyroid lobe, pneumothorax, or aortic aneurysm.
• Enlarged or nodular thyroid tissue, or landmarks deviating from midline, suggest abnormal growth.

Inspecting and Movement of Neck Structures

• Client's extended neck is observed for position, symmetry, bulges, and masses as the client swallows a small sip of water, the thyroid + cricoid cartilage should visibly move symmetrically

Cervical vertebrae

• Inspected for prominence or swelling in absence of C7 vertebrae

Neck Range of motion:

• Neck smooth/ controlled w/45-degree flexion, 55-degree extension, 40-degree lateral abduction, and 70-degree rotation.

Dowager's hump Considerations

• Cervical curvature increases in older clients due to kyphosis, fat accumulates on the cervical vertebrae.

Enlargement Lymphadenopathy Lymphoma

• Key abnormal findings of the neck and head

Spasmodic Contraction Torticolis

• May limit contraction of neck muscle

Thyroid Goiter

• Neck swelling/enlargement of thyroid gland

Auscultation of the thyroid glands

• Only performed when thyroid is not palpable do to bulging and swishing sounds

Normal/Unpalpable Lymph Nodes

• With palpation of the thyroid No swelling/enlargement and tenderness

Eyes

• Extraocular muscle test is done, where the client follows the direction, to test the cranial nerve

Eyebrow and Eyelid Distrubution Testing

• Assessed for hair loss, scaling flakiness, lice and ticks

Eyelashes Testing

• Assessed for eyelash inversion or version, crusting or infestation

Lacrimal Punctation Testing

• Assessed for upper / lower eyelids protecting the eye, edema, lesions, asymmetry of lid, Ptosis and for Tumors

Conjunctiva Testing

• Assessed for any membranes or issues lining the eyelid

Bulbar

• Assessed for Raynaud disease, conjunctivitis, the color and consistency

Pre/Post Auricular Notes Testing

• Assessing the ears with pre or post issues related to sounds/ hearing