Chapter 15

Assessing Head and Neck

Learning Objectives
 Describe the structure and functions of the head and
neck.
 Discuss rick factors associated with head and neck
disorders across the cultures.
 Use the headache impact test to determine how
headaches affect the client’s activities of daily living.
 Differentiate between normal and abnormal objectives
and subjectives finding related to the head and neck.
 Analyze head and neck data obtained from the interview
and physical assessment to make valid clinical
judgements.

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The Head
 The framework of the head is the skull, which can be
divided into two subsections: the cranium and the face
o Cranium
 The cranium houses and protects the brain and
major sensory organs.
o Face
 Facial bones give shape to the face.

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Structure and Function #1

 The Head
o Cranium—8 bones
 Frontal (1)
 Parietal (2)
 Temporal (2)
 Occipital (1)
 Ethmoid (1)
 Sphenoid (1)

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Structure and Function #2
 The Head
o Face—14 bones
 Maxilla (2)
 Zygomatic (2)
 Inferior conchae (2)
 Nasal (2)
 Lacrimal (2)
 Palatine (2)
 Vomer (1)
 Mandible (1)

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The Skull

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The Neck
 the structure of the neck is composed of muscles,
ligaments, and the cervical vertebrae. Contained
within the neck are the hyoid bone, several major blood
vessels, the larynx, trachea, and the thyroid gland,
which is in the anterior triangle of the neck

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Structure and Function #3

 The Neck
o Hyoid bone
o Several major blood vessels
o Larynx
o Trachea
o Thyroid gland

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Structures of the Neck

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Muscles and Cervical Vertebrae
 The sternomastoid (sternocleidomastoid) and
trapezius muscles are two of the paired muscles that
allow movement and provide support to the head and
neck The sterno-mastoid muscle rotates and flexes the
head, whereas the trapezius muscle extends the head
and moves the shoulders.
 The eleventh cranial nerve is responsible for muscle
movement that permits shrugging of the shoulders by
the trapezius muscles and turning the head against
resistance by the sternomastoid muscles.

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Cervical Vertebrae

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Blood Vessels and Thyroid Gland
 Blood Vesseld: The internal jugular veins and carotid
arteries are located bilaterally, parallel and anterior to
the sternomastoid muscles. The external jugular vein lies
diagonally over the surface of these muscles. The
purpose and assessment of these major blood vessels
are discussed in Chapter 21.
 Thyroid Gland: The thyroid gland is the largest endocrine
gland in the body. The thyroid cartilage ("Adam's apple"
Kis larger and located just above the cricoid cartilage.

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Lymph Nodes of the Head and Neck
 Lymph nodes filter lymph, a clear substance composed
mostly of excess tissue fluid,
 after the lymphatic vessels collect it but before it returns
to the vascular system.

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Lymph Nodes

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Traumatic Brain Injury
 Presence of transportation accidents involving
automobiles, motorcycles, bicycles, and pedestrians
 Presence of violence, such as firearm assaults and child
abuse or self-inflicted wounds
 Falling
 Excessive alcohol ingestion
 Infants and elderly being cared for by caregivers

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Infant and Toddlers Risk Factors
 Environmental risks (for falls)
 Lack of parental knowledge of shaken baby syndrome
 Caregivers risk of shaken baby syndrome

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Children and Teens Risk Factors
 Knowledge and use of protective equipment in sports
and bicycle use
 Knowledge and use of safety practices when driving

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Adults and Older Adults Risk Factors
 Knowledge and use of safety practices when driving
 Impairment of physical or mental stability
 Potential for maltreatment or domestic violence

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Risk Reduction #1
 Buckling your child in the car using a child safety seat,
booster seat, or seat belt (according to the child’s height,
weight, and age). Know the stages:
o Birth through age 2
o Between ages 2 and 4/until 40 lb
o Between ages 4 and 8 or until 4’ 9” tall
o After age 8 and/or 4’ 9” tall
 Wearing a seat belt every time you drive or ride in a
motor vehicle

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Risk Reduction #2

 Never driving while under the influence of alcohol or drugs

 Wearing a helmet and making sure your children wear helmets
when:
o Riding a bike, motorcycle, snowmobile, scooter, or all-
terrain vehicle
o Playing a contact sport, such as football, ice hockey, or
boxing
o Using in-line skates or riding a skateboard
o Batting and running bases in baseball or softball
o Riding a horse
o Skiing or snowboarding

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Risk Reduction #3
 Making living areas safer for seniors, by:
o Removing tripping hazards such as throw rugs and
clutter in walkways
o Using nonslip mats in the bathtub and on shower
floors
o Installing grab bars next to the toilet and in the tub
or shower
o Installing handrails on both sides of stairways
o Improving lighting throughout the home

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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:
o Installing window guards to keep young children from
falling out of open windows
o Using safety gates at the top and bottom of stairs
when young children are around
o Making sure that the surface on your child’s
playground is made of shock-absorbing material,
such as hardwood mulch or sand.

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Health Assessment: Subjective Data
 Interview Approach (COLDSPA)
o History of current health problem, past health, family
o Lifestyle and health practices

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Headache Impact Test #1

 When you have headaches, how often is the pain

severe?
 How often do headaches limit your ability to do usual
daily activities including household work, work, school,
or social activities?
 When you have a headache, how often do you wish you
could lie down?
 In the past 4 weeks, how often have you felt too tired
to do work or daily activities because of your
headaches?

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Headache Impact Test #2

 In the past 4 weeks, how often have you felt fed up or

irritated because of your headaches?
 In the past 4 weeks, how often did headaches limit
your ability to concentrate on work or daily activities?

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Equipment for Head and Neck
Examination

 Gloves
 Penlight or flashlight
 Small glass of water
 Stethoscope

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Physical Assessment: Head

 Inspect the size, shape, configuration

 Consistency
 Involuntary movement
 Palpate the head

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Physical Assessment: Face #1
 Inspect the face
o Symmetry
o Features
o Movement
o Expression
o Skin condition

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Physical Assessment: Face #2

 Palpate
o Temporal artery: tenderness and elasticity
o Temporomandibular joint (TMJ): range of motion
(ROM), swelling, tenderness, crepitation

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Physical Assessment: Neck #1
 Inspect movement of neck structures
o Cervical vertebrae
o Neck ROM

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Physical Assessment: Neck #2

 Palpate
o Trachea
o Thyroid gland
 Thyroid cartilage
 Cricoid cartilage
 Auscultate an enlarged thyroid gland

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Physical Assessment: Neck #3

 Palpate lymph nodes of head and neck

o Preauricular
o Postauricular
o Occipital
o Tonsillar
o Submandibular

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Physical Assessment: Neck #4

 Palpate lymph nodes of head and neck (cont.)

o Submental
o Superficial cervical
o Posterior cervical
o Deep cervical
o Supraclavicular

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Normal and Abnormal Findings
 Review and discuss findings of assessment of client’s
head and neck with peers.

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Altered Thyroid Function
 Increased sensitivity to cold
 Constipation
 Depression
 Fatigue
 Heavier menstrual periods
 Pale, dry skin
 Thin, brittle hair or nails
 Weakness
 Unintentional weight gain

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Hyperthyroidism #1
 Sudden weight loss, without changes in appetite and diet
 Increased appetite
 Rapid heartbeat (tachycardia) greater than 100 beats a
minute, irregular heartbeat (arrhythmia), or palpitations
 Nervousness, anxiety, and irritability
 Tremor in the hands and fingers
 Sweating

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Hyperthyroidism #2
 Changes in menstrual patterns
 Increased sensitivity to heat
 Changes in bowel patterns, more frequent bowel
movements
 Enlarged thyroid gland (goiter)
 Fatigue, insomnia
 Muscle weakness

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Types of Headaches (pg298)
 Sinus
 Cluster
 Tension
 Migraine
 Tumor related

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Abnormal Findings of the Head and Neck #1
 Acromegaly
 Cushing syndrome
 Scleroderma
 Hypothyroidism
 Bell palsy

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Abnormal Findings of the Head and Neck #2
 Hyperthyroidism
 Simple Goiter
 Cerebrovascular Accident
 Parkinson Disease

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Findings in Older Adults #1
 Older clients who have arthritis or osteoporosis may
experience neck pain and a decreased ROM.
 In older clients, facial wrinkles are prominent because
subcutaneous fat decreases with age. In addition, the
lower face may shrink and the mouth may be drawn
inward as a result of resorption of mandibular bone, also
an age-related process.
 The strength of the pulsation of the temporal artery may
be decreased in the older client.

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Findings in Older Adults #2

 In older clients, cervical curvature may increase because

of kyphosis of the spine. Moreover, fat may accumulate
around the cervical vertebrae (especially in women). This
is sometimes called a “dowager’s hump.”
 Older clients usually have somewhat decreased flexion,
extension, lateral bending, and rotation of the neck. This
is usually due to arthritis.
 If palpable, the older client’s thyroid may feel more
nodular or irregular because of fibrotic changes that
occur with aging; the thyroid may also be felt lower in
the neck because of age-related structural changes.

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Validating and Documenting Findings

 Health promotion diagnoses

 Risk diagnoses
 Actual diagnoses
 Collaborative problems
 Medical problems

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