REVIEW

OF
SYSTEMS:
HEAD & NECK
JAN MICHAEL G. LARAÑO, RN
STRUCTURE AND
FUNCTION:
Head and neck assessment focuses on the cranium, face,
thyroid gland, and lymph nodes contained within the
head and neck.
HEAD
•CRANIUM
•FACE

NECK
•MUSCLES & CERVICAL VERTEBRAE
•BLOOD VESSELS
•THYROID GLAND

LYMPH NODES OF THE HEAD &NECK

HEAD
The framework of the head is the skull, which can be divided into
two subsections: the cranium and the face
CRANIUM
The cranium houses and protects the brain and major sensory
organs. It consists of eight bones:

• Frontal (1)
• Parietal (2)
• Temporal (2)
• Occipital (1)
• Ethmoid (1)
• Sphenoid (1)

In the adult client, the cranial bones are joined together

by immovable sutures: the sagittal, coronal, squamosal, and
lambdoid sutures.
FACE
Facial bones give shape to the face. The face consists of 14 bones:
• Maxilla (2)
• Zygomatic (cheek) (2)
• Inferior conchae (2)
• Nasal (2)
• Lacrimal (2)
• Palatine (2)
• Vomer (1)
• Mandible (jaw) (1)
All of the facial bones are immovable except for the mandible, which has free
movement (up, down, and sideways) at the temporomandibular joint (TMJ).

• TEMPORAL ARTERY- a major artery is located between the eye.

• PAROTID GLANDS & SUBMANDIBULAR GLANDS – are two
other important structures located in the facial region.
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.

MUSCLES & 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.

•Sternomastoid muscle rotates and flexes the head

•Trapezius muscle extends the head and moves the shoulders

BLOOD VESSELS
The internal jugular veins and carotid arteries are located bilaterally, parallel
and anterior to the sternomastoid muscles.
• It is important to avoid bilaterally compressing the carotid
arteries when assessing the neck, as bilateral compression can
reduce the blood supply to the brain.
THYROID GLAND
The thyroid gland is the largest endocrine gland in the body. It produces thyroid
hormones that increase the metabolic rate of most body cells.
The thyroid gland is surrounded by several structures that are important to palpate for accurate
location of the thyroid gland.
•TRACHEA - through which air enters the lungs, is composed of C-shaped hyaline cartilage rings.

• CRICOID CARTILAGE – the first upper tracheal ring and has small notch in it.

•THYROID CARTILIAGE – AKA ADAM’s APPLE. Is larger and located just above the cricoid
cartilage.

•HYOID BONE – which is attached to the tongue, lies above the thyroid cartilage and under the
mandible
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.
HEALTH ASSESSMENT
I. COLLECTING SUBJECTIVE DATA: THE
NURSING HEALTH HISTORY

II. COLLECTING OBJECTIVE DATA:

PHYSICAL EXAMINATION

III. VALIDATING AND DOCUMENTING

FINDINGS
HEALTH ASSESSMENT
I. COLLECTING SUBJECTIVE DATA: THE
NURSING HEALTH HISTORY
•History of Present Health Concern
 Use of COLDSPA to further explore if there’s a problem
•Past Health History
 History of any Head & Neck trauma, injury, falls)
 History of any Surgery and Treatment
•Family History
 History of any diseases such as Cancer or Migraine Headaches in the
family
•Lifestyle and Health Practices
 History of present and previous activities or even routine activities
HEALTH ASSESSMENT
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
Examining the head allows the nurse to evaluate the overlying protective structures
(cranium and facial bones) before evaluating the underlying special senses (vision,
hearing, smell, and taste) and the functioning of the neurologic system.

Prepare the client for the head and neck examination by instructing him or her
to remove any wig, hat, hair ornaments, pins, rubber bands, jewelry, and head
or neck scarves.
EQUIPMENT:
SMALL CUP OF WATER
STETHOSCOPE
GLOVES*
HEALTH ASSESSMENT
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
INSPECTION
PALPATION
AUSCULTATION
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
HEAD & FACE
INSPECTION & PALPATION
INSPECT THE Head size and shape vary, especially in An abnormally small head is
HEAD. Inspect accord with ethnicity. Usually the head is called microcephaly.
for the size, symmetric, round, erect, and in midline and
shape and appropriately related to body size The skull and facial bones are
configuration (normocephalic). No lesions are visible. larger and thicker in
acromegaly

Acorn-shaped, enlarged skull

bones are seen in Paget’s
disease of the bone.
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
HEAD & FACE
INSPECTION & PALPATION
INSPECT THE The head is normally hard and smooth, Asymmetry in front of the
FACE, inspect without lesions. earlobes occurs
for symmetry, with parotid gland enlargement
features, from an
movement, abscess or tumor.
expression and
skin condition The face is symmetric with a round, Drooping, weakness, or
oval, elongated, or square appearance. paralysis on one side
No abnormal movements noted. of the face may result from a
stroke (cerebrovascular
accident, CVA)
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
HEAD & FACE
INSPECTION & PALPATION
PALPATE The temporal artery is elastic and not The temporal artery is hard,
THE tender. thick, and tender
TEMPORAL with inflammation, as seen
ARTERY,
with temporal
which is located
between the top arteritis (inflammation of
of the eat and the temporal arteries
eye that may lead to blindness).
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
HEAD & FACE
INSPECTION & PALPATION
PALPATE Normally there is no swelling, Limited range of motion,
THE tenderness, or crepitation with swelling, tenderness,
TEMPOROMA movement. Mouth opens and closes or crepitation may indicate
NDIBULAR
fully (3 to 6 cm between upper and TMJ syndrome.
JOINT
(TMJ). To lower teeth). Lower jaw moves laterally
assess the TMJ, 1 to 2 cm in each direction.
place your index
finger over the
front of each ear
as you ask
the client to open
the mouth
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
INSPECTION
Inspect the neck. Neck is symmetric, with head centered Swelling, enlarged masses—or
Observe the client’s and without bulging masses. nodules—
slightly extended may indicate an enlarged
neck for position, thyroid gland, inflammation of
symmetry, and lymph nodes, or a tumor.
lumps or masses.
Shine a light from
the side of the neck
across to highlight
any swelling.
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
INSPECTION
Inspect movement The thyroid cartilage, cricoid cartilage Asymmetric movement or
of the neck move upward symmetrically as the client generalized
structures. swallows. enlargement of the thyroid
Ask the client to gland is considered
swallow a small abnormal.
sip of water.
Observe the
movement of the
thyroid cartilage,
thyroid gland
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
INSPECTION
Inspect the C7 (vertebrae prominens) is usually Prominence or swelling
cervical visible and palpable. other than the C7 vertebrae
vertebrae. Ask may be abnormal
the client to flex
the neck (chin to
chest).
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
INSPECTION
Inspect range of Normally neck movement should be Muscle spasms, inflammation,
motion. Ask the smooth and controlled with 45-degree or cervical
client flexion, 55-degree extension, 40-degree arthritis may cause stiffness,
to turn the head to lateral abduction, and 70-degree rotation. rigidity, and limited
the right and to the mobility of the neck, which
left may affect
(chin to shoulder), daily functioning.
touch each ear to the A stiff neck is often a late
shoulder, touch chin symptom seen in
to chest, and lift the meningitis (Knight and
chin to the ceiling. Glennie, 2010).
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
PALPATION
Palpate the Trachea is midline. The trachea may be pulled
trachea. Place to the affected
your finger in side in cases of large
the sternal notch. atelectasis, fibrosis
Feel each side of or pleural adhesions. The
the notch trachea is pushed
and palpate the to the unaffected side in
tracheal rings cases of a tumor,
enlarged thyroid lobe,
pneumothorax, or
with an aortic aneurysm.
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
PALPATION
Palpate the Landmarks are positioned midline. Landmarks deviate from
thyroid gland. midline or are
Locate key obscured because of masses
landmarks with or abnormal
your index finger growths.
and thumb:
II. COLLECTING OBJECTIVE DATA:
PHYSICAL EXAMINATION
ASSESSMENT NORMAL FINDINGS ABNORMAL FINDINGS
PROCEDURE
NECK
AUSCULTATION
Auscultate the No bruits are auscultated. A soft, blowing, swishing
thyroid only if you sound auscultated
find over the thyroid lobes is
an enlarged
often heard in
thyroid gland
during inspection hyperthyroidism because of
or palpation. Place an increase in
the bell of the blood flow through the
stethoscope over the thyroid arteries.
lateral lobes of the
thyroid
gland
HEALTH ASSESSMENT
III. VALIDATING AND DOCUMENTING
FINDINGS
Validate the head and neck assessment data that you have
collected. This is necessary to verify that the data are reliable and
accurate. Document the assessment data following the health care
facility or agency policy.
ANALYSIS OF DATA:
DIAGNOSTIC REASONING
MEDICAL PROBLEMS:

ACROMEGALY - Acromegaly is characterized by enlargement of the

facial features (nose, ears) and the hands and feet. It occurs in about 6 of every 100,000
adults and is caused by increased production of growth hormone after the skeleton and
other organs finish growing.

CUSHING’S SYNDROME - Cushing’s syndrome may

present with a moon-shaped face with reddened cheeks and increased facial hair.
ANALYSIS OF DATA:
DIAGNOSTIC REASONING
MEDICAL PROBLEMS:

SCLERODERMA - A tightened-hard face with thinning facial skin is

seen in scleroderma.

HYPERTHYROIDISM - Exophthalmos is seen in

hyperthyroidism.

BELL’S PALSY - Bell’s palsy usually begins suddenly and reaches a peak
within 48 hours. Symptoms may include twitching, weakness,
paralysis, drooping eyelid or corner of the mouth, drooling, dry eye, dry mouth, decreased ability to
taste, eye tearing, facial distortion.
 REVIEW
OF
SYSTEMS:
HEAD & NECK
JAN MICHAEL G. LARAÑO, RN