1NU03 2nd Semester A.Y.

2021 – 2022

HEALTH Skull
● Framework of the head divided into 2
ASSESSMENT sections: Cranium (Neurocranium) and
Face (Viscerocranium)
MODULE 5: Assessing Head, Cranial bones
Neck, Breasts and Lymphatic ● Encloses the brain
● Consist of 8 bones:
System o Frontal (1)
o Parietal (2)
Lecturer: Prof. Reggie Mae Jasmin o Temporal (2)
o Occipital (1)
o Ethmoid (1)
TOPIC OUTLINE o Sphenoid (1)
A. Anatomy and Physiology of Head and
Neck
i. Skull
ii. Cranial Bones
iii. Facial Bones
iv. Neck
v. Cervical Vertebrae
vi. Thyroid Gland
vii. Cervical Lymph Nodes
B. Nursing Health History
i. Traumatic Brain Injury
ii. Infant and toddler Risk Factors
iii. Children and Teens Risk Factors
iv. Adults and Older Adult Risk Factors Figure 1.1 Cranial Bones
v. Risk Reductions
● Fused by immovable sutures:
C. Physical Examinations
o Sagittal
i. Equipments o Coronal
ii. Techniques o Squamosal
iii. Physical Assessment o Lambdoid
iv. Inspection
v. Auscultation
vi. Geriatric Considerations
D. Breast
i. Anatomy of the Breast
ii. Breast Cancer Signs and Symptoms
iii. Nursing Health History
iv. Peau d’ Orange
v. Supernumerary Nipples
vi. Gynecomastia
vii. Paget’s Disease
viii. Retracted Nipples
ix. Palpation
x. Geriatric Considerations
Figure 1.2 Facial Bones
xi. Clinical Correlations
Facial Bones (Viscerocranium)
● Consist of 14 bones:
ANATOMY AND PHYSIOLOGY OF o Maxilla (2)
HEAD AND NECK o Palatine Bones (2)
o Zygomatic Bones (2)
o Lacrimal Bones (2)

ANTIQUIN BUGNOT CUARTERO DANCEL ROSALES SUPNET VILLAMAYOR VILLEGAS

 o Inferior Nasal Conchae (2)
o Mandible (1)
Cervical Vertebrae
o Vomer (1)
● Consists of several muscles for facial
movement and expression.
● Contain salivary glands
- Exocrine glands that produce saliva
through a system of ducts
o Parotid Glands
- Located anterior and inferior to
the ears
o Submandibular Glands
- Located inferior to the mandible
Figure 1.3 Anterior Muscles of the Neck
● Paranasal Sinuses
- Air-filled extension of nasal cavities
- Each sinus is lined by ciliated
pseudostratified epithelium, interspersed
with mucus-secreting goblets.
o Frontal
o Sphenoidal
o Ethmoidal
o Maxillary

Note:
● all the facial bones are immovable
Figure 1.4 Cervical Vertebrae
EXCEPT for the mandible which has free
movement.
Thyroid Gland
Neck
● Contains muscles, the hyoid bone, carotid
arteries, jugular veins, larynx, trachea,
thyroid gland, and cervical vertebrae.
o Sternocleidomastoid Muscle
- Neck rotation and flexion
o Trapezius Muscle
- Neck extension and shoulder
movement
● Neck Triangles
o Anterior Neck Triangle
- Located under the mandible,
anterior to the sternomastoid
muscle.
o Posterior Neck Triangle
Cervical Lymph Nodes
- Located between the
trapezius and sternomastoid
muscles
● C7 – Vertebra Prominens
● Largest endocrine gland in the body
● Contain 4 parathyroid glands
● Produces thyroid hormones (FT3, FT4)
that increase the metabolic rate of cells
● Isthmus
- Connect the 2 lobes
- Located on 2nd and 3rd tracheal rings
- Contains 4 parathyroid glands posteriorly
● Thyroid Cartilage
- Adam’s Apple
- Located below the hyoid bones, posterior
to the thyroid gland
● Cricoid Cartilage
- Located below the thyroid cartilage
● Part of the immune system which produces
lymphocytes against several pathogens.
● Filter lymph, remove bacteria and tumor
cells from the lymph.
● Size and shape vary, usually, 1 cm
appearing in clusters
● Lymph Nodes
o Normal: Not palpable Very small
beads

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
 ▪ Postauricular
▪ Tonsillar
● Presence of transportation accidents involving
▪ Occipital automobiles, motorcycles, and pedestrians
▪ Submandibular ● Presence of violence, such as firearm assaults and
▪ Submental child abuse or self-inflicted wounds
▪ Superficial cervical ● Falling
● Excessive alcohol ingestion
▪ Posterior cervical ● Infants and elderly being cared for by caregivers
▪ Deep cervical
▪ Supraclavicular INFANT AND TODDLERS RISK
FACTORS
● Environmental risks
(for falls)
● Lack of parental knowledge of shaken baby
syndrome
● Caregivers risks of shaken baby syndrome

Figure 1.5 Lymph Nodes

NURSING HISTORY
● Chief complaint
● History of present illness
- COLDSPA (Character, Onset, Location, Figure 1.6 Environmental Risk (Fall)
Duration, Severity, Pattern, Associated
Factors)
● Past health history
● Family History
● Social history (lifestyle and health practices)
● Instruct the patient to remove any wig, hat,
hair ornaments, pins, rubber bands, jewelry,
and head or neck scarves.
● Consider cultural norms for touch when
assessing the head.
● Ask patient to sit upright, back and
shoulder-held back and straight
● Keep in mind that normal facial structures and
features tend to vary widely among individuals
and cultures
● Wear gloves (and other PPEs) and prepare
stethoscope Figure 1.7 Shaken baby syndrome

TRAUMATIC BRAIN INJURY

CHILD AND TEENS RISK
FACTORS
● Knowledge and use of protective equipment in
sports and bicycle use
● Knowledge and use of safety practices when
driving

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS

Figure 1.8 Use of Protective Equipment in Sports
ADULTS AND OLDER ADULTS
RISK FACTORS
Figure 1.9 Safety Practices in Driving
● Knowledge and use of safety practices
when driving
● Impairment of physical or mental stability
● Potential for maltreatment or domestic
violence
RISK REDUCTION
Risk Reduction #1
● Buckling your child in the car using a child
safety seat, booster seat, or seat belt.
● Wearing a seat belt every time you drive or
ride in a motor vehicle.
Risk Reduction #2
● Never driving while under the influence of
alcohol or drugs
● Wearing a helmet and making sure your
children wear helmets when:
● Riding a bike, motorcycle, snowmobile,
scooter, or all-terrain vehicle
● Playing a contact sport, such as football,
ice hockey, or boxing
ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR
VILLEGAS
● Using in-line skates or riding a skateboard
● Batting and running bases in baseball or
softball
● Riding a horse
● Skiing or snowboarding
Risk Reduction #3
● Making living areas safer for seniors, by:
● Removing tripping hazards such as throw
rugs and clutter in walkways
● Using non slip mats in the bathtub and on
shower floors
● Installing grab bars next to the toilet and in
the tub or shower
● Installing handrails on both sides of
stairways
● Improving lighting throughout the home
Risk Reduction #4
● Maintaining a regular physical activity
program, if your doctor agrees, to improve
lower body strength and balance
● Making living areas safer for children, by:
- Installing window guards to keep young
children from falling out of open windows.
- Use safety gates at the top and bottom of
stairs when young children are around.
- Make sure that the surface on your child’s
playground is made of shock-absorbing
material, such as hardwood mulch or sand.
PHYSICAL EXAMINATIONS
I. Equipment for Head and Neck
Assessment
● Gloves
● Penlight or flashlight
● Small glass of water
● Stethoscope
II. Physical Examination Considerations
● Instruct the patient to remove any wig,
hate, hair ornaments, rubber bands,
jewelry, and head or neck scarves.
● Take care to consider cultural norms for
touch when assessing the head. Some
cultures (e.g., Southeast Asian) prohibit
touching the feet before touching the head
(Purnell & Paulanka, 2008) – Buddhist,
Thai, and Laos cultures; male healthcare
providers may be prohibited from touching
or examining certain parts of the female
body and vice versa.
● Ask the patient to sit upright, back and
shoulders held back and straight.
● Keep in mind that normal facial
structures and features tend to vary
widely among individuals and cultures.
Variations occur in the shape and size of
 the orbital regions, nose heights and
widths, nasio-labial and ear dimensions
(Farkas, et al., 2005; McKnight, Momoh, &
Bullocks, 2009)
● Wear gloves and prepare a stethoscope.
- Nuchal rigidity indicative of meningitis
● Buffalo’s Hump
● A collection of excess fat behind the neck
that causes the shoulders to develop a
hump-like shape.

III. Inspection IV. Palpation

A. Inspect the Head 1. Note the consistency of the head (hard
● Size, shape and configuration and smooth without lesions)
● Normal result: Normocephalic 2. Palpate the temporal artery
(Symmetric, round, erect, in the midline Temporal arteritis: Inflammation of the
with no visible lesions) temporal artery that may lead to blindness
3. Palpate the temporomandibular joint
ABNORMAL o No swelling, tenderness, or crepitation
Microcephaly Abnormal small head for with movement
age o Mouth opens and closes fully (3 to 6
cm between upper and lower teeth)
Anencephaly Serious birth defect in
o Lower jaw moves laterally (1 to 2 cm
which a baby is born
in each direction)
without parts of the brain
4. Palpate the trachea
and skull
Acromegaly Skull and facial bones are
larger and thicker
Paget’s Disease Acorn-shaped enlarged
skull
Head bobbing or Involuntary movement may
Nodding signify neurologic or aortic
insufficiency

B. Inspect the Face

● Inspect for symmetry, features, movement,
expression, and skin condition.
● The nasolabial folds and palpebral fissures
are ideal places to check facial features for Figure 1.10 Buffalo Hump Reduction
symmetry.
o Normal: Trachea is midline
ABNORMAL o Towards the affected side:
Stroke (CVA) Facial asymmetry, drooping Atelectasis, Fibrosis or Pleural
of eyelid or nasolabial folds adhesions
+ one-sided body o Towards the unaffected side:
weakness Tumor, Pneumothorax, Thyroid Mass
Bell’s Palsy Drooping, weakness or or Aortic aneurysm
paralysis on one side of the 5. Palpate the thyroid gland
face o Use a posterior approach. Stand
Parkinson’s Mask-like face, hollow behind the client and ask the client to
Disease cheeks lower the chin to the chest and turn
Cushing Moon-shaped face with the neck slightly to the right. This will
Syndrome reddened cheeks and relax the client’s neck muscles.
increased hair may indicate o place your hands on the nape of the
client’s neck with your other fingers on
C. Inspect the Neck either side of the trachea below the
● Position, symmetry, lumps or masses cricoid cartilage. Use your left fingers
● Note for any palpable lymph nodes or to push the trachea to the right. Then
thyroid gland use your right fingers to feel deeply in
● Ask to swallow, observe for movement of front of the sternocleidomastoid
thyroid cartilage muscle.
● Ask to flex the neck. Inspect C7 (Vertebra o Ask the client to swallow as you
Prominens) palpate the right side of the gland.
● Assess the range of motion of the neck. Reverse the technique to palpate the
Muscle spasms, inflammation, or cervical left lobe of the thyroid.
arthritis may cause stiffness, rigidity, and o Normal: Lobes are smooth, rubbery,
limited mobility of the neck, which may and free of nodules)
affect daily functioning. 6. Palpate the lymph nodes of head and
● (+) Brudzinski sign neck

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
 Preauricular → Postauricular → Types of Headache
Occipital → Tonsillar → ● Can also be tumor-related
Submandibular → Submental →
Superficial Cervical → Posterior
Cervical → Deep Cervical →
Supraclavicular Nodes

Figure 1.13 Types of Headache

VI. Geriatric Considerations

Figure 1.11 Lymph Nodes Location ● Facial wrinkles are prominent in older
clients because subcutaneous fat
V. Auscultation decreases with age.
● Auscultate the thyroid only if you find an ● The lower face may shrink and the mouth
enlarged thyroid gland during inspection or may be drawn inward as a result of
palpation. Place the bell of the stethoscope resorption of mandibular bone (also an
over the lateral lobes of the thyroid gland. age-related process)
Ask the client to hold his breath (to
obscure any tracheal breath sounds while
you auscultate)

● Hyperthyroidism = (+) bruits; soft,

blowing, a swishing sound heard over the
lobes of increased blood flow through
thyroid arteries.
o Sudden weight loss, without changes
in appetite and diet, increases appetite, rapid
heartbeat (tachycardia), irregular heartbeat
(arrhythmia), or palpitations, nervousness,
anxiety, irritability, tremor in the hands and
fingers, sweating.
o Changes in menstrual pattern,
increased sensitivity to heat, changes in bowel
patterns, more frequent bowel movements,
enlarged thyroid gland (goiter), fatigue, Figure 1.14 Shrinking of mouth and lower face
insomnia, muscle weakness.
● Cervical curvature may increase because
of kyphosis.
● Fat may accumulate around the cervical
vertebrae (especially in women) and is
sometimes called “Dowager’s Hump”

Figure 1.12 Hyperthyroidism

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
 - Center of the breast composed mostly
of smooth muscle fiber
● Areolae
- Pigmented area of skin surrounding the
nipple
o Sebaceous Glands within Areolae:
- Enlarge during pregnancy
- Secrete an oily substance the act as a
protective lubricant for the nipple

SEBACEOUS GLANDS WITHIN AREOLAE

Mammary Glands ● The mammary
(Montgomery Gland) glands are
modified sweat
glands.
Figure 1.15 Scoliosis and Lordosis ● Consist of a series
of ducts and
● If palpable, the older client’s thyroid may secretory lobules
feel more nodular or irregular because of
fibrotic changes that occur with aging.; the (15-20)
thyroid may also be felt lower in the neck ● Each lobule
because of age-related structural changes. consists of many
alveoli drained by
BREAST a single lactiferous
duct
● Located on the anterior thoracic wall ● These ducts
● Lies superficially to the pectoralis major converge at the
and serratus anterior muscles. nipple like spokes
● Horizontally, it extends from the lateral of a wheel
border of the sternum to the mid-axillary Connective Tissue ● Supporting
line. Stroma structure which
● Vertically, it spans between the 2nd and surrounds the
6th coastal cartilages. mammary glands.
● It has a fibrous
and fatty
component.
● The fibrous
stroma condenses
to form
suspensory
ligaments (of
cooper)
● These ligaments
have two main
functions:
o Attach and
Figure 1.16 Breast Anatomy secure the
breast to the
Anatomy and Physiology dermis and
● 2 Regions of Breast underlying
o Circular Body - Largest most prominent o pectoral
part of the breast fascia
o Axillary Tail - Smaller part, runs along the o Separate the
inferior lateral edge of the pectoralis major secretory
towards the axillary fossa lobules of the
● Nipple breast

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
 - Parasternal nodes (20%)
● Pectoral Fascia - Posterior intercostal nodes (5%)
- Where the base of the breast lies a flat o Skin of the breast receiving lymphatic
sheet of connective tissue associated drainage:
with the pectoralis major muscle ▪ Skin – drains to the axillary, inferior
- It acts as an attachment point for the deep cervical and infraclavicular
suspensory ligaments nodes
o Retromammary Space ▪ Nipple and Areola – drain to the
- Layer of loose connective tissue subareolar lymphatic plexus
between the breast and pectoral ● Innervation
fascia - The breast is innervated by the
- A potential space, often used in anterior and lateral cutaneous
reconstructive plastic surgery branches of the 4th to 6th intercostal
● Vasculature nerves.
- Arterial supply to the medial aspect of - These nerves contain both sensory
the breast is via the internal thoracic and autonomic nerve fibers (the
(also known as an internal mammary autonomic fibers regulate smooth
artery)
muscle and blood vessel tone).
o A branch of the subclavian artery
- It should be noted that these nerves
- The veins of the breast corresponded
do not control the production and
with the arteries, draining into the
axillary and internal thoracic veins secretion of milk.
THE LATERAL PART OF THE BREAST - This is regulated by the hormone’s
RECEIVES BLOOD FROM 4 VESSELS: prolactin and oxytocin, which are
secreted from the pituitary gland.
Lateral thoracic ● Originates
and from the
Thoracoacromial axillary artery. Nursing Health History
branches ● Chief complaint
Lateral mammary ● Originate from ● History of present illness
branches the posterior ● COLDSPA (Character, Onset, Location,
intercostal Duration, Severity, Pattern, Associated
arteries Factors)
(derived from ● Past Health History
the aorta). ● Family History
They supply ● Social History (lifestyle & health practices)
the lateral BREAST BREAS
aspect of the PHYSICAL EXAMINATION
breast in the
2nd, 3rd and ● Explain in detail what is happening throughout
4th intercostal the assessment and answer any questions the
spaces. client might have
● Provide privacy.
Mammary branch ● Originates ● Have the patient sit upright
● Explain that it will be necessary to expose both
from the breasts to compare for symmetry during the
anterior inspection. One breast to compare for
intercostal symmetry during the inspection. One breast
artery may be draped while the other breasts are
palpated.

Lymphatics INSPECTION
● The lymphatic drainage of the breast is of great
● Observe and inspect breast skin, areolas, and
clinical importance due to its role in the
nipples for size, color, shapes, rashes, dimpling,
metastasis of breast cancer cells swelling, discoloration, retraction, asymmetry, and
o 3 groups of lymph nodes that receive other unusual findings.
lymph from breast tissue:
- Axillary nodes (75%)

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
 Gynecomastia
● Enlargement of breast
● Tissues may be due to puberty
● Hormonal imbalance, drug abuse, cirrhosis,
leukemia, and thyrotoxicosis

Figure 1.17 Breast inspection

Peau d’ Orange
● The orange-peel texture of the breast. Figure 1.20 Gynecomastia

Paget’s Disease
● Redness, mild, scaling and flaking of the
nipple

Figure 1.18 Peau d’ Orange

Supernumerary Nipples
● Milk line
● Common, minor birth defects that consist of an Figure
extra nipple. 1.21 Gynecomastia Redness, mild, scaling, and
flaking of the nipple.

Retracted Nipples
● Suggest malignancy

Figure 1.19 Milk lines

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
Figure 1.22 Retracted Nipple ● Glandular tissue decreases whereas fatty
tissue increases. A well-fitting bra can
PALPATION reduce breast discomfort related to
● Palpate breasts and axillary lymph nodes for sagging breasts.
swelling, lumps, masses, warmth or inflammation, ● The older client often has more pendulous,
tenderness, and other abnormalities less form, and saggy breasts.
● Ask the client to lie down and to place overhead the ● The older client’s breasts may feel more
arm on the same side as the breast being palpated. granular, and the inframammary ridge may
Place a small pillow or rolled towel under the breast be more easily palpated as it thickens.
being palpated.
● Use the flat pads of three fingers to palpate the Clinical Correlations
client’s breast.
● Palpate the breasts using one of three different Fibrocystic Breast Disease
patterns (circular, wedged, or vertical strip)
● Be sure to palpate every square inch of the breast, ● Benign cystic lesion, round, elastic,
from the nipple and areola to the periphery of the defined, tender and common mobile
breast tissue and up into the tail of Spence ● Common to age 30 to menopause
● Light – superficial
● Medium – mid-level tissue
● Firm – to the ribs
● Use the bimanual technique if the client has
large breasts. Support the breasts with your
non-dominant hand, and use your dominant
hand to palpate

Figure 1.25 Normal Vs. Fibrocystic Breast

Fibroadenoma
● Benign tumor, lesions are lobular, ovoid or
round, firm, well-defined, singular and
mobile
● Occur commonly between puberty and
menopause
FIGURE 1.23 Palpation

Figure 1.26 Fibroadenoma

Figure 1. 24 Bimanual Technique

Geriatric Considerations
● The older client may notice a decrease in Milk cysts
the size and firmness of the breast as she
ages because of a decrease in estrogen Mastitis
levels.

Lipoma

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS
Breast cancer
● Malignant tumors are mostly found in the
upper outer quadrant of the breast.
● Dimpling or retraction of the breasts is
usually caused by a malignant tumor
● They are usually unilateral, with irregular,
poor delineated borders. They are hard,
non-tender, and fixed to underlying tissues.
- Expected changes in female
breasts:
o Decrease in size
o Decrease in firmness
o Glandular tissue decreases
o Fatty tissues increase

Figure 1.27 Breast Cancer

Figure 1.28 Breast Cancer Signs and Symptoms

Breast Cancer Signs and Symptoms

● Most common cancer among women
● Risk factors
● Ways to reduce risk factors
● Cultural consideration

ANTIQUIN BUGNOT CUARTERO DANCEL MANLANGIT ROSALES SUPNET VILLAMAYOR

VILLEGAS