1. Assessment of Head, Neck, Nose, Throat NUR123 Spring 2009 K. Burger, MSEd, MSN, RN, CNE PPP by: Victoria Siegel RN, CNS, MSN Sharon Niggemeier RN, MSN Revised by: Kathleen Burger

2. Subjective Data-Head Headache (HA) Injury Dizziness/Syncope/Vertigo Neck Pain Limited ROM Lumps or Swelling Hx. Head or Neck Surgery

3. Objective Data-Head SKULL and FACE Normocephalic Cranium (Skull): Inspect and palpate Temporal area:Inspect & palpate temporal arteries temporomandibular joint Face: Inspect and palpate, note symmetry, involuntary movement, color, texture, masses, lesions

4. Subjective Data-Neck History of problems Neck pain Lumps Swelling Surgery

5. Objective Data – Lymph Nodes Palpate all 10 nodal areas beginning with the: Preauricular nodes and ending with the Supraclavicular nodes. Use gentle pressure and slight circular motion. Palpate both sides simultaneously Note enlargements ( bi or unilateral ) by location, size, mobility, tenderness If nodal enlargement – check the area they drain for S/S of inflammation, neoplasm

6. Objective Data-Neck Inspect- symmetry, midline, erect Palpate- carotid pulse Any abnormal pulsations? Note enlargement of lymph nodes Test for ROM, naturally decreases with age. Auscultate carotid arteries.

7. Objective Data-Neck Inspect & palpate Masses Swelling Bruises Use of accessory muscles. Alignment Symmetry

8. Subjective Data- Trachea History trachea problems? Tracheotomy Tracheostomy

9. Objective Data-Trachea Palpate trachea for: Deviations Tenderness Masses Masses push trachea away from affected area, whereas atelectasis causes pull toward affected area.

10. Subjective Data- Thyroid History thyroid problems Thyroid levels Thyroid medication

11. Objective Data- Thyroid Inspect: note deviations or bulges As person extends neck slightly and swallows water, note upward, symmetrical movement of trachea and other cartilage

12. Palpating Thyroid Ask person to tilt head slightly to side and palpate lobes. Use fingers on opposite side to displace gland in lateral direction, ask person to swallow: isthmus rises

13. Palpating Thyroid Anterior approach Rest fingers around sternomastoid muscle place thumbs on side of trachea. Displace gland & palpate isthmus as person swallows, thyroid rises

14. Palpating Thyroid Posterior approach Rest thumbs on back of person’s neck, place fingers on cricoid cartilage. Displace gland & palpate isthmus as person swallows, thyroid rises

15. Thyroid Auscultate thyroid if enlarged Normal thyroid documented as: Thyroid palpated as symmetric, without enlargement. Texture consistent, with no masses, nodules or tenderness.

16. Subjective Data- Nose Discharge Frequent upper respiratory infections Sinus pain Trauma Epistaxis Allergies Sense of smell

17. Objective Data- Nose Inspect external nose: symmetry, deformity, lesions Palpate sinuses, note tenderness Test patency of each nostril Inspect using nasal speculum: –Color and integrity of nasal mucosa –Septum- note any deviation,perforation, bleeding –Turbinates- Note color, exudate, swelling

18. Subjective Data- Oral cavity Sores/lesions Sore throat Bleeding gums Toothache Dysphagia Altered taste Tobacco Self-care behaviors

19. Objective Data- Oral Cavity Exam Inspect and palpate: Note condition gums, mucosa, teeth (caries? # of teeth malocclusion) Lips: (lumps, lesion, cracking,color) Tongue: color, moisture, surface characteristics. Check for white patches Wharton’s Duct: opening of submandibular glands Stensen’s Duct: opening of parotid salivary glands Remember proper PPE

20. Objective Data- Oral Cavity Exam With tongue blade inspect cheeks and underside lips With gloves and gauze- pull tongue L and R

21. Objective Data- Throat Inspect uvula, palate, tonsils Uvula looks like hanging pendant (if split in two= bifid) Palate:anterior hard palate=whitish posterior soft palate = pinkish Tonsils- graded by enlargement: 1+ visible 2+ near uvula 3+ touching uvula 4+ touching together

22. Summary: Assessment of Head & Neck Includes: Head Neck & Lymph nodes Trachea Thyroid Nose Oral cavity Throat