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At the end of the session, the students will be able to:

1 review basic anatomy and physiology of the head

and neck.
2 identify the purpose of assessing the head and neck

3 identify methods of data collection during the

Cory Manuel-Balganion, MSN assessment of head and neck

4 describe important aspect in assessing the head and

neck

NCM 101 - Health Assessment

First Semester, AY 2020-2021

HEAD and NECK ASSESSMENT

HEAD and NECK ASSESSMENT

•HEAD • NECK
• Cranium • Muscles and cervical
• Face vertebrae
• Blood vessels
• Thyroid gland
• Lymph nodes

Weber et. al, 2014

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Node Center Node Center

Location Area Drained (Floor of mouth) Location Area Drained
(Head)
Occipital Posterior base of skull Occipital region of scalp Submandibular Along the medial Chin, upper lip,
and deep structures of (submaxillary) border of the lower cheek, nose, teeth,
back of neck jaw, halfway between eyelids, part of the
the angle of the jaw tongue and floor of
and the chin the mouth
Post-auricular Behind the auricle of the Parietal region of the
ear, in front of mastoid head and part of the ear Submental Behind the tip of the Anterior third of
process
mandible, in the tongue, gums and
Pre-auricular In front of the tragus of the Forehead and upper midline, under the floor of mouth
ear face chin

Node Center
(Neck) Location Area Drained HEAD and NECK ASSESSMENT
Superficial (anterior) Along the anterior of the Skin and neck
• Subjective Data – reports of patient
cervical chain sternocleidomastoid muscle
• Headache
Posterior cervical chain posterior of the Posterior and lateral • Head injury
sternocleidomastoid and regions of the neck, • Dizziness
along the anterior aspect of occiput, mastoid • Neck pain
the trapezius muscle • Limitation of motion
• Lumps or swelling
Deep cervical chain deeply within the Larynx, thyroid gland,
sternocleidomastoid muscle trachea, upper part of
• Objective Data – nurse’s observations, physical
esophagus assessment
Supraclavicular Above the clavicle, angle bet. Lateral regions of neck
Clavicle and SCM muscle and lungs

THE HEAD THE HEAD

STEP
1. Inspect head for size,
shape and configuration
2. Inspect for involuntary
movement
NORMAL ABNORMAL STEP NORMAL ABNORMAL
- symmetric, round, erect - skull and facial bones are
3. Palpate the skull - symmetric and smooth - lumps
and in midline large and thick
- protruded on the forehead, - depressions
- no lesions (acromegaly)
lateral edge of parietal and - abnormal protrusions
- microcephaly occipital bones and the mastoid - tenderness
- macrocephaly process
- no tenderness
- head is still and upright - tremors, jerking
- nodding movement
-“senile tremors” and head - head tilted to one side
nodding are normal for old
people

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THE HEAD
STEP
4. Inspect the face for
symmetry, features,
movement, expression, and
skin condition.
5. Palpate the temporal artery
THE NECK
STEP
A. Inspect the neck.
1. Ask client to slightly
extend neck.
2. Observe for position,
symmetry, lumps and
masses.
THE NECK
STEP
C. Inspect the cervical
vertebrae
(RANGE of MOTION)
1. Ask the client to :
a) flex the neck to chin
b) flex the ear to shoulder
c) twist neck right to left &
vice versa
d) flex neck forward and
backward
NORMAL
- Face is symmetric (round, oval,
elongated or square
appearance)
- no abanormal movemens
noted
- elastic
- not tender
NORMAL
-symmetric with head
-no bulging masses
NORMAL
- C7 (vertebrae prominens)
is visible and palpable
-neck movement is
smooth and controlled
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THE HEAD
ABNORMAL STEP NORMAL ABNORMAL
- unusual or assymetric 5. Palpate the temporo- - no swelling, tenderness or - limited range of motion
orofacial movement mandibular joint crepitation with movement
- drooping l Place index finger over - mouth opens and closes fully
- swelling
- mask-like the front of each ear - lower jaw moves laterally 1-2 cm
in each direction
- tenderness
lAsk patient to open her
mouth.
- the artery is hard, thick and - crepitation
tender
lAsk patient to move jaws
laterally
THE NECK
ABNORMAL STEP NORMAL ABNORMAL
-swelling B. Inspect movement of - the thyroid cartilage, - asymmetric movement and
neck structures cricoid cartilage and thyroid generalized enlargement of
-enlarged masses or gland move upward the thyroid gland
1. Ask the client to swallow
nodules a small sip of water. symmetrically
-head tilt
2. Observe the movement of
the thyroid and cricoid
cartilages, and thyroid
gland.
Lymph nodes of the Head and Neck
ABNORMAL
STEP NORMAL ABNORMAL
- prominence other than C7 D. Palpate the lymph nodes
- pre-aurical nodes
- post-aurical nodes
- rigidity - occipital nodes -no enlargement or - enlarged or tender,
- limited mobility of the neck
- tonsillar nodes
tenderness swollen, hardened and
- submandibular nodes immobile
- pain - submental nodes
-superficial cervical nodes
- posterior cervical nodes
- deep cervical chain nodes
- superclavicular nodes
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THE NECK
STEP
E. Palpate the trachea
- positioned midline
1. Place your finger in the
sternal notch.
2. Feel each side of the
notch and palpate the
tracheal rings
The first upper ring above
te sooth tracheal rings is
the cricoid cartilage.
NORMAL ABNORMAL
- trachea is pulled to the
affected side (large
atelectatsis, fribrosis or
leural adhesions
- trachea is pushed to the
unaffected side (tumor,
enlarged thyroid lobe,
pneumothorax, or aortic
aneurysm)

THE NECK THE NECK

STEP NORMAL ABNORMAL STEP NORMAL ABNORMAL
(continued…)
F. Palpate the thyroid 2. Stand behind the client.
gland - landmarks are positioned - landmarks deviate from
1. Locate key landmarks midline midline or are obscured 3. Ask him/her to lower the chin
with your index finger and because of masses or to the chest and turn the neck
thumb. abnormal growths slightly to the right.
- hyoid bone
4. Place thumbs on the nape of - the thyroid gland in an adult is - enlarged lobes that are easily
- thyroid cartilage the client’s neck with the
(Adam’s apple) not palpable palpated before swallowing
fingers of left hand to push the
- tenderness
- cricoid cartilage trachea slightly to the right.
- palpable during pregnancy - presence of nodules or lumps

THE NECK THE NECK

STEP NORMAL ABNORMAL STEP NORMAL ABNORMAL
F. Palpate the thyroid -the thyroid moves up under
gland. (cont…) the fingers with the trachea
-enlarged lobes that Auscultate the -- no bruits - soft, swishing sound
and larynx as the patient
5. Curve right fingers swallows are easily palpated thyroid only if you find (hyperthyroidism)
between the trachea and before swallowing an enlarged thyroid
sternocleidomastoid lobes feel smooth, rubbery
-
gland during
muscle. and free of nodules
- tenderness inspection or
6. Retract it slightly.
palpation.
7. Ask the patient to take
a sip of water and - presence of nodules or
swallow. lumps
8. Reverse the procedure
for the left side.

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References:

• Jarvis, Carolyn. (2004). Pocket Companion for Physical Examination and Health
Assessment. 4th Ed. St. Louis, Missouri, Saunders (Read pp. 57-64)

• Weber, J. et al. (2007). Health Assessment in Nursing. 3rd. Ed. Philadelphia,

Lippincott

• Weber, J. et al. (2014). Health Assessment in Nursing. 5th. Ed. Philadelphia,

Lippincott

• https://www.sciencedirect.com/topics/medicine-and-dentistry/seventh-cervical-
vertebra