Head and Neck Assessment PDF

Assessment of Head and Neck Teaching staff  Introduction Preparation Obtaining health history Ta Perfermining physical examination: * Skull ble * Face * Eyes of * Ear 02...

Assessment of Head and Neck Teaching staff  Introduction Preparation Obtaining health history Ta Perfermining physical examination: * Skull ble * Face * Eyes of * Ear 02 01 * Nose co * Mouth nt * Neck en ts  Introduction The head and neck examination is the portion of the physical examination done to observe for signs of head and neck disease or illness. The information gathered from the physical examination of the head and neck, along with the information from the history, is used by the physician to generate a differential diagnosis and treatment plan for the patient. The head and neck examination is often annotated as HEENT (head, eyes, ears, nose and throat) in clinical documentation shorthand  The head and neck examination is often annotated as HEENT (head, eyes, ears, nose and throat) in clinical documentation shorthand Component of head and neck assessment: Preparation Obtaining health history Perfermining physical examination: * Skull * Face * Eyes * Ear * Nose * Mouth * Neck  1. Preparation A. Prepare all the necessary equipment Examination gown Clean, nonsterile examination gloves Glass of water Penlight Otoscope Cotton wisp Wooden tongue blade B. Prepare the patient and the environment. Explain the procedure to the patient. Position the client appropriately. Ensure patient privacy. Instruct patient to drape himself/herself appropriately. Make sure environment is with adequate light and room temperature regulated. Wash hands. 2. Obtain comprehensive health history. Using focused interview, ask the patients questions related to: Pain or swelling History about nose and paranasal sinuses. History about presence and duration of trauma, nosebleeds, drainage, or congestion. Any previous surgery. Occupational exposures to chemicals, dust, or various gases should be documented. Any known respiratory allergens should be recorded. D. Conduct physical examination Physical examination of the head and neck requires the use of inspection, palpation and auscultation.  c: Physical Examination Techniques And Normal Findings The Head Procedure and Rationale Normal Findings Inspect and Palpate the Skull A. Size Normocephalic – denotes a Note: The general size and shape. round symmetric skull that is appropriately related to the body size. B. Shape To assess shape, place your fingers in the person’s hair and palpate the Feels smooth and symmetric. scalp. No tenderness upon palpation. C. Temporal Area Palpate the temporal artery above the zygomatic (cheek bone) between No tenderness noted. the eye and top of the ear. The temporomandibular joint is just above the temporal artery and anterior Smooth movement with no to the tragus. Palpate the joint as the person opens the mouth. limitation or tenderness.  Palpate the temporal artery Cranial bones Temporomandibular joint  Physical Examination Techniques And Normal Findings The Head Procedure and Rationale Normal Findings Inspect the Face Facial structures Inspect the face, noting the facial expression and its Facial structures appropriateness to behaviour or reported mood. should be symmetric. Inspect for any signs of trauma or previous facial surgery. Palpate the face for any tenderness or protrusions, and for any associated lymph node enlargement in the submandibular areas.  Physical Examination Techniques And Normal Findings EYES Procedure and Rationale Normal Findings Inspect External Ocular Structures A. General Vision functioning well enough to avoid Note person’s ability to move around obstacles and to respond to your the room. directions. Note also the facial expression. Inspect the eyes for size, All three should be symmetrical placement, alignment B. Note for eye swelling, or "bags Eyebrows under the eye,“ Eyebrows are present bilaterally, Look for symmetry between the two eyes. move symmetrically as the facial expression changes.  Physical Examination Techniques And Normal Findings THE EAR Procedure and Rationale Normal Findings Inspect and Palpate the External Ear A. Size and Shape Equal size bilaterally with no swelling or thickening. B. Skin Condition Skin color consistent with the person’s facial skin color. Skin is intact, with no lumps or lesions. C. Tenderness They should feel firm, and movement should produce no Move pinna and push on the pain. tragus. Palpate mastoid process. No pain.  Physical Examination Techniques And Normal Findings THE EAR Procedure and Rationale Normal Findings Inspect and Palpate the External Ear D. External Auditory Meatus No swelling, redness or discharge should be present. Note the size of the opening to direct your choice of speculum E. External Canal for the otoscope. Note any redness and swelling, lesions, foreign bodies or discharge. No redness, swelling lesions or foreign bodies If any discharge is present, note the color and is noted. odor. For persons with hearing aid, note any irritation on the canal wall from poorly fitting ear molds.  Physical Examination Techniques And Normal Findings THE EAR Procedure and Rationale Normal Findings TEST HEARING ACUITY Whispered Voice Test Stand arm’s length (2 feet) behind the person. Normally, the person repeats each number/ Test one ear at a time while masking hearing letter correctly after you say it. in the other ear to prevent sound transmission If the response is not correct, repeat the around the head. This is done by placing one whispered test using a different combination finger on the tragus and pushing it in and out of 3 numbers and letters. of the auditory meatus. Move your head to 1 A passing score is correct repetition of at to 2 feet from the person’s ear. least 3 of a possible 6 numbers/letters. Exhale fully and whisper slowly a set of 3  Physical Examination Techniques And Normal Findings The Nose Procedure and Rationale Inspect and Palpate the Nose Normal Findings External Nose Normally the nose is Inspect for deformity, asymmetry, symmetric, in the midline inflammation, or skin lesions. and in proportion to other facial features. No swelling, Test the patency of the nostrils. inflammation or skin This reveals any obstruction which later is lesions. explored with the nasal speculum. Push each nasal wing shut with your finger while asking the person to sniff inward through the other naris.  Physical Examination Techniques And Normal Findings The Nose Procedure and Rationale Normal Findings Palpate the Sinus Areas The person should feel firm pressure but no pain Using your thumbs, press the frontal sinuses by pressing firmly up and under the eyebrows and over the maxillary sinuses below the cheekbones. Take care not to press directly on the eyeballs. Test Olfactory nerve Ask patient to close his eyes and block one nostril and inhale a familiar aromatic substance through the other nostril Physical Examination Techniques And Normal Findings  Physical Examination Techniques And Normal Findings The Mouth Procedure and Rationale Normal Findings Inspect the Mouth Lips Inspect the lips for color, moisture, cracking Moist, soft and pink. or lesions. Retract the lips and note their Teeth and Gums inner surface as well. The condition of the teeth is an index of the Teeth normally look white, straight, evenly person’s health. spaced, and clean and free of debris or Inspect teeth and gums. Compare number of decay. Teeth are tight and well defined. teeth with the number expected for the Gums look pink. person’s age. Ask the person to bite as if chewing something and note alignment of upper and lower jaw.  Physical Examination Techniques And Normal Findings The Mouth Procedure and Rationale Normal Findings Inspect the Mouth Tongue Check for color, surface characteristics and Color is pink and even. moisture. Dorsal surface is normally roughened from the papillae. A thin white coating may be present. Ask patient to touch the tongue to the roof of Ventral surface looks smooth and glistening the mouth. With a glove, hold the tongue with a and shows veins. cotton gauze pad for traction and swing it out No white patches or lesions. and to each side. Inspect for any white patches or lesions;  Physical Examination Techniques And Normal Findings The Mouth Procedure and Rationale Normal Findings Inspect the Mouth Buccal Mucosa Hold the cheek open with a wooden tongue Pink, smooth and moist. blade and check the buccal mucosa for color, nodules or lesions. Palate The more anterior hard palate is white with Shine your light up to the roof of the mouth. irregular transverse rugae. Posterior soft palate is pinker, smooth, and upwardly movable. Throat Color is the same pink as the oral mucosa, and their surface is peppered with With your light, observe the oval, rough- indentations, or crypts. No exudate on surfaced tonsils behind the anterior tonsillar tonsils. pillar. Buccal Mucosa  Physical Examination Techniques And Normal Findings Procedure and Rationale The Neck Normal Findings Inspect And Palpate the Neck Symmetry Head position is centered in the midline, and the accessory neck muscles should be symmetric. The Range of Motion (ROM) head should be held erect Note any limitation of movement during active and still. motion. Ask the person to touch the chin to the When the neck is supple, motion chest, turn the head to the right and left, try to touch is smooth and controlled. each ear to the shoulder (without elevating shoulders, and extend the head backward. Test muscle strength and the status of cranial nerve XI by trying to resist the person’s movements with your hands, as the person shrugs the shoulders and turns the head to each side.  Physical Examination Techniques And Normal Findings The Neck Procedure and Rationale Normal Findings Inspect And Palpate the Neck Lymph Nodes Using a gentle circular motion of your finger pads, palpate the Normal nodes feel movable, discrete, lymph nodes. Begin with the preauricular lymph nodes in front soft, and non tender. of the ear, palpate the 10 groups of lymph nodes in a routine order. Be systematic and thorough in your examination. Use gentle pressure because strong pressure could push the nodes into the neck muscles. If any nodes are palpable, note their location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness.  Physical Examination Techniques And Normal Findings The Neck Procedure and Rationale Normal Findings Inspect And Palpate the Neck Trachea Place your index finger on the trachea in the sternal notch Normally, trachea is midline, palpate for and slip it off to each side. tracheal shift. The space should be symmetric on both sides. Note any deviation from the midline.  Physical Examination Techniques And Normal Findings The Neck Procedure and Rationale Normal Findings Inspect the thyroid gland: Position a standing lamp to shine tangentially across Thyroid tissue moves up with a the neck to highlight any possible swelling. Tilt the swallow and then falls into its head back to stretch the skin against the thyroid. resting position. Supply the person with a glass of water and first inspect the neck as the person takes a sip and swallows. Palpate the thyroid gland: Usually the normal adult thyroid Posterior Approach: Palpate thyroid by standing cannot be palpated. If the person behind the client. Put your hands around his neck has a long thin neck, you with your finger tips on the lower half of the neck sometimes feel the isthmus over over the-trachea. the tracheal rings. The lateral lobes usually are not palpable; palpable lobes feel rubbery but smooth. Physical Examination Techniques And Normal Findings Thyroid Gland  Physical Examination Techniques And Normal Findings The Neck Procedure and Rationale Normal Findings Inspect Externalof Documentation jugular veins assessment Observe findings with patient sitting and Jugular veins should be flat, without sign of distention then lying at 30- 45 angle. Neck Auscultation Carotid bruits are abnormal sounds, such as murmurs, that can be Auscultation of carotid bruits: heard over the carotid arteries in the neck. They can indicate a narrowing or blockage of these arteries (carotid stenosis), which is a risk factor for stroke. To auscultate carotid bruits, you would use a stethoscope to listen for abnormal sounds over the carotid arteries, usually at the level of the Thyroid Auscultation: Adam's apple (thyroid cartilage) on either side of the neck. In some cases, a healthcare provider may auscultate the thyroid gland to assess for bruits or turbulent blood flow, which can be indicative of thyroid disorders or nodules. This is more commonly done by specialists in specific clinical situations.