Health Assessment Lecture 4: Head and Neck

Health Assessment - Lecture 4: Assessment of Head and Neck

• Subjective Data:
  • Headaches: Timing (onset, duration, frequency), Location (frontal, temporal, behind eyes, band-like, sinus, occipital), Type (tension - occipital, frontal, band-like tightness; migraines - supraorbital, frontotemporal; cluster - around eye, forehead, cheek), Quality (throbbing, pounding, shooting - migraines), Severity (mild, moderate, severe), Medications (contraceptives, bronchodilators, nitrates), Associated factors (nausea, vomiting, vision changes, neck pain, stomach problems), Aggravated and relieving factors, Effort to treat & coping strategies.
  • Head Injury: Onset (setting - helmet/hard hat use, before injury - dizzy, lightheaded, seizure, after injury), Location (where head hit), Discharge (nose/mouth), History of illness, Associated symptoms, Effort to treat.
  • Dizziness: Determine exact meaning (lightheadedness, swimming sensation, feeling of falling/spinning - vertigo).
  • Neck Pain: Onset, Location, Associated symptoms, Precipitating factors.
  • Lumps or swelling in neck: Any recent infection? Any tenderness? (acute infection), Difficulty swallowing (dysphagia), Smoker? (increased risk of respiratory & oral cancer), History of thyroid problems?
  • Hx of head or neck surgery:

Inspection of Head and Face - Objective Data

• Inspect and Palpate the Skull: Size and Shape (assess shape by palpating scalp):
  • Head size/shape varies with ethnicity.
  • Normocephalic (round, symmetrical, appropriately related to body size) - normal finding.
  • Deformities (microcephaly - small head, macrocephaly - large head) - abnormal finding.
• Inspect the Face:
  • Facial expression (inspect face & noting facial expression):
    • Normal - appropriate to situation and behavior.
    • Abnormal - tense, rigid muscles (anxiety), flat affect (depression), excessive smiling (inappropriate).
  • Facial Structures (Symmetric):
    • Eyebrows, palpebral fissures, nasolabial folds, & sides of the mouth.
    • Asymmetry - abnormal finding (central brain lesion or cranial nerve VII damage).
    • Exophthalmos, pigmentation, periorbital edema, involuntary movements/tics, or excessive blinking - abnormal finding.

Inspect & Palpate the Neck - Objective Data

• Symmetry:
  • Normal - centered, held erect, symmetrical accessory muscles.
  • Abnormal - head tilt with muscle spasm, rigid head and neck (arthritic/arthritis).
• Range of Motion (ROM):
  • Normal - smooth and controlled motion.
  • Abnormal - pain with any movement, limited movement (cervical arthritis, arthritic neck).
• Test muscle strength and carotid artery pulsation.
• Note enlargement of salivary and thyroid glands.
• Lymph Nodes:
  • Use gentle pressure, palpate with both hands.
  • Note location, size, shape, mobility, consistency, tenderness.
  • Normal - soft, discrete, non-tender, movable lymph nodes, non-palpable salivary glands.
  • Abnormal (lymphadenopathy) - enlargement of lymph nodes > 1 cm (infection, allergy, or neoplasm).
  • Different lymph node locations (preauricular, posterior auricular, occipital, submental, submandibular, jugulodigastric, superficial cervical, deep cervical, posterior cervical, supraclavicular).
• Trachea:
  • Normal- midline, symmetric spaces on both sides.
  • Abnormal- shifted towards affected side (e.g., atelectasis, pleural adhesions, or fibrosis [indication of possible illness]); shifted to unaffected side (e.g., pneumothorax, aortic aneurysm, tumor, or unilateral thyroid lobe enlargement).
• Thyroid Gland:
  • Anterior or Posterior approach (palpate).
  • Normal - not palpable.
  • Abnormal - enlarged, auscultate for bruit (soft, pulsatile, blowing sound—heard best with stethoscope bell); enlarged lobes are easily palpated before swelling or tenderness, nodules/lumps.

This quiz focuses on the key elements of assessing head and neck conditions, including subjective data related to headaches, head injuries, and dizziness. It covers characteristics such as timing, location, type, quality, severity, and associated factors. Understanding these assessments is crucial for accurate diagnosis and treatment planning.