ASSESSING THE NECK
ASSESSING THE NECK
Assessment techniques used: Areas to be examined:
a. Inspection 1. The muscles
b. Palpation a. Sternocleidomastoid muscle
c. Auscultation b. Trapezius muscle
2. Lymph nodes
3. Trachea
4. Thyroid gland
5. Carotid arteries
6. Jugular veins
AREAS OF THE NECK
1. The muscles
Sternocleidomastoid muscles
Divides each side of the neck into 2
triangles.
a. Anterior triangle
Trachea
Thyroid gland
Anterior cervical nodes
Carotid artery
b. Posterior angle
Posterior lymph nodes
AREAS OF THE NECK
• Anterior angle of the neck • Posterior angle of the neck
Each sternocleidomastoid muscle extends from the upper sternum
and the medial third of the clavicle to the mastoid process of the
temporal bone behind the ear.
These muscles turn and laterally flex the head.
TRAPEZIUS MUSCLE
Each extends from the occipital
bone of the skull to the lateral
third of the clavicle.
Functions:
a. Draw the head to the side and
back,
b. Elevate the chin
c. Elevate the shoulders to shrug
them
3. LYMPH NODES IN THE NECK
A. Head
1. Occipital
located at posterior base of the skull.
2. Post auricular (mastoid)
behind the auricle of the ear or in front of the mastoid
process.
3. Preauricular :
in front of the tragus
B. Floor of the mouth
1. Submandibular ( submaxillary)
along the medial border of the lower jaw, halfway
between the angle of the jaw and the chin.
2. Submental : behind the tip of the mandible in the
C. Neck
1. Superficial (anterior) cervical chain
along the anterior to the
sternocleidomastoid muscle
2. Posterior cervical chain
along the anterior aspect of the
trapezius mastoid muscle.
3. Deep cervical
under the sternocleidomastoid muscle
4. Supraclavicular
Above the clavicles in the angle
between
the sternocleidomastoid muscle.
PROCEDURE : ASSESSING THE NECK
Procedure :
2. Observe appropriate infection control
1. Explain to the client what you are going procedures.
do, why is it necessary, and how he or
can cooperate.
3. Provide for client privacy.
Assessment Normal findings:
4. Inspect the neck muscles • Muscles equal in size:
(sternocleidomastoid and trapezius) for
abnormal swellings or masses. Ask the client • Head centered.
to hold head erect.
Deviations from normal:
• Unilateral neck swelling
• Head tilted to one side(indicate
presence of masses, Injury,
muscle weakness, shortening of
sternocleidomastoid muscle,
scars)
5. Observe head movement.
Normally there is coordinated, smooth movement with
no discomfort.
Deviations from normal :
Muscle tremor, spasm or stiffness.
Ask client to;
• Move the chin to the chest
( determines function of the sternocleidomastoid
muscle)
Normal findings:
Head flexes 45 degrees
• Deviations from normal :
Limited ROM, painful movements; involuntary
movements (e.g, up and down nodding
movements associated with Parkinson’s disease.)
6. Move head back so that the chin
points upward. (Determines function
of the trapezius muscle.)
Normal findings :
• Head hyperextends 60 degrees.
Deviations from normal:
• Head hyperextends less than 60
degrees
• Move head so that the ear is moved Turn head to the right and to the
toward the shoulder on each side. left. (Determines function of the
(Determines function of the sternocleidomastoid muscle.)
sternocleidomastoid muscle.)
7. Assess muscle strength. • Shrug shoulders against
• Ask the client to: the resistance of your
• Turn head to one side against hands.
the resistance of your hand.
Repeat with the other side
Lymph Nodes
8. Palpate the entire neck for
enlarged lymph nodes.
Trachea
9. Palpate the trachea for lateral
deviation.
• Place your fingertip or thumb on the
trachea in the suprasternal notch,
then move your finger laterally to the
left and the right in spaces bordered
by the clavicle, the anterior aspect of
the sternocleidomastoid muscle, and
the trachea
Thyroid Gland
10. Inspect the thyroid gland.
• Stand in front of the client.
• Observe the lower half of the neck
overlying the thyroid gland for
symmetry and visible masses.
• Ask the client to hyperextend head 11. Palpate the thyroid gland for
and swallow. If necessary, offer a
glass of water to make it easier for the smoothness.
client to swallow. • Note any areas of enlargement,
masses, or nodules.
12. If enlargement of the gland is suspected:
• Auscultate over the thyroid area for a bruit 13. Document findings in the
(vascular murmur) client
• Use the bell-shaped diaphragm of the record.
stethoscope. • Neck symmetric with centered
• A thyroid bruit is described as a continuous head position and no bulging
masses. Has smooth,
sound that is heard over the thyroid mass controlled, full range of
• thyroid bruit is seen in Grave's disease motion on the neck. Thyroid
gland non-visible but palpable
when swallowing. Trachea is
midline. Lymph nodes
nonpalpable.
