Transcript The Head, Neck, Lymph Nodes

King Saud University
College of Nursing
Health Assessment (NUR 224)
The Head, Neck, Lymph Nodes
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Objectives
After completion of this presentation, the nurse will be able to:
 Conduct a basic adult head, neck, and lymph nodes
assessment.
 Distinguish normal from abnormal findings
Technique
 Inspection
 Auscultation

Palpation
Anatomy and Physiology
 The skull is made up of the bones of the cranium and the face .
 The cranium includes frontal, parietal, temporal, and occipital bones .
 The muscles of the face play a role in expression of emotions and assist in
neck movement .
 Movement of the facial muscles is controlled by cranial nerves V and VII .
 The carotid arteries provide the blood supply to the head; the temporal
artery supplies blood to much of the face .
 The neck is supported and made mobile by vertebral processes and the
sternocleidomastoid and trapezius muscles.
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Health History
 Determine presence/absence of age- and gender-specific
diseases of the head and neck
 Common chief complaints
 Neck pain or stiff neck
 Hoarseness
 Neck mass
 Headache
 Head injury
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Evaluating Chief Complaint
 Determine the following characteristics
 Quality
 Associated manifestations
 Aggravating factors
 Alleviating factors
 Setting
 Timing
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Past Health History
 Medical conditions
 Surgeries
 Medications
 Injuries or accidents
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Family Health History
 Determine if family history of
 Thyroid disease
 Headache
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General Approach to Head and Neck
Assessment
 Greet patient, explain assessment techniques
 Environment
 Quiet
 Warm
 Private
 Adequate lighting
 Upright sitting position
 Compare right and left sides
 Systematic approach
 EQUIPMENT
 Tape measure ◆ Stethoscope ◆
evaluation of thyroid gland)
Cup of water (for
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Assessment of the Head
 Inspection
 Shape
 Symmetry
 Palpation
 Masses
 Depression
 Tenderness
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Inspection and Palpation
of the Scalp
 Inspect
 Lesions or masses
 Normal findings
 Scalp is shiny, intact, without lesions or masses
 Abnormal findings
 Bleeding, lesions, masses, hematomas
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Assessment of the Face
 Inspection
 Shape
 Symmetry
 Normal findings
 Symmetrical features
 Palpebral fissures equal
 Shape can be oval, round, or slightly square
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Assessment of the Face
 Abnormal findings
 Deformed or absent structures
 Asymmetry
 More or less pronounced facial features
 Diseases which may alter facial features:
 Bell’s palsy, A temporary disorder affecting cranial nerve
VII and producing a unilateral facial paralysis
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 Acromegaly: An enlargement of the skull and cranial bones
due to increased growth hormone
 Hydrocephalus: The enlargement of the head caused by
inadequate drainage of cerebrospinal fluid, resulting in
abnormal growth of the skull
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Cushing syndrome
 Facies include a rounded or “moon-shaped” face with
thin, erythematous skin
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Down syndrome
 Note depressed nasal bridge, epicanthal folds,
mongoloid slant of eyes, low-set ears, and large
tongue
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Hydrocephalus
 Hydrocephalus, with characteristic enlarged head,
bulging fontanel, dilated scalp veins,
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Left facial palsy
 Left facial palsy. Facies include asymmetry of one
side of the face, eyelid not closing completely,
drooping lower eyelid and corner of mouth, and loss
of nasolabial fold. arches
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Mandible
 Palpate and auscultate the temporo-mandibular joint when
the client opens and closes the mouth
 Normal findings
 No discomfort, joint articulates smoothly without clicking
or crepitus
 Abnormal findings
 Pain, tenderness, crepitus
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Neck
 Inspection
 Palpation
 Normal findings
 Full ROM, pain free, symmetrical muscles, no masses
 Abnormal findings
 Limited ROM, pain, asymmetrical muscles, masses
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Salivary glands
 Parotid glands
 In the cheeks over mandible
 Largest of salivary glands
 Submandibular
 Beneath mandible
 Sublingual
 Lies in the floor of the mouth
 Temporal artery
 Lies superior to temporalis muscle
Salivary Glands and Neck Vessels
Trachea
 Trachea is midline.
 Palpate for tracheal shift.
 To palpate trachea:
 Place your index finger on the trachea in the sternal notch,
then,
 Slip it off to each side
 Note for symmetric on both sides.
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Position of the thumbs to evaluate the midline position of the trachea
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Thyroid Gland
 The thyroid gland is in the middle of the neck anterior to the
trachea .
 The isthmus is the center, and the two lobes lie on either side of
the trachea .
Normal findings
Symmetrical movement with
swallowing
Adam’s apple more pronounced
in males
No masses, tenderness, or
enlargement
Absent bruit
Abnormal findings
Mass
Enlarged gland
Goiter
Asymmetrical
enlargement
Presence of a nodule or
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bruit
Hyperthyroidism: The excessive production of thyroid
hormones, resulting in enlargement of the gland, exophthalmos
(bulging eyes), fine hair, weight loss, diarrhea, and other
alterations.
Hypothyroidism: Metabolic disorder causing enlarged thyroid
due to iodine deficiency.
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Palpate Thyroid:
Posterior Approach
 Move behind the person.
 Ask to sit up very right, then bend the head slightly forward
and then right (to relax the neck muscle).
 Use fingers of your left hand to push the trachea slightly to
the right,
 Then, curve your right fingers between the trachea and the
sternomastoid muscle, and ask the person to swallow,
 You should feel the thyroid moves up under your fingers.
Palpate Thyroid:
Anterior Approach
 Needs an expert to do.
 Stand facing the person, ask the person to tip head forward
and then to the examiner’s right,
 Use right thumb to displace the trachea slightly to the
person’s right,
 Then, hook your right thumb and fingers around the
sternomastoid muscle, and feel for lob enlargement as the
person swallow.
Lymph Nodes
 Located in head and neck
 Drain the head and neck.
 Extensive vessel system
 Separate from cardiovascular
 Major part of immune system
 Detect and eliminate foreign bodies
Lymph Nodes
 Inspection
 Palpation
 Locations
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Lymph Nodes
 It is more efficient to palpate with both hands to compare both
sides for symmetrically,
 However, it is easier to palpate the sublingual gland under the
chine with one hand.
 Using a gentle circular motion of finger pad.
 Begin with preauricular and continue in a routine order.
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Lymph Nodes
 Normal findings
 Unable to palpate or see nodes
 Abnormal findings
 Enlarged nodes
 Able to palpate or see nodes
 Tenderness
 Firm, hard nodes
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Question?
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