1. Weber Health Assessment in Nursing
Chapter 15: Assessing Head and Neck

2. Structure and Function
The Head
Cranium
Frontal; Parietal
Temporal; Occipital
Ethmoid; Sphenoid

3. Question
Is the following statement true or false?
The skull, which is the framework of a head, has two subsections – the cranium and cervical vertebrae.

4. Answer
False.
The skull has two subsections – the cranium and the face.

5. Structure and Function
The Head
Face
Maxilla; Zygomatic
Inferior conchae; Nasal
Lacrimal; Palatine; Vomer
Mandible

6. The Skull

7. Question
Which bone belongs to the face?
a. Parietal
b. Temporal
c. Palatine
d. Mandible

8. Answer
c. Palatine
Rationale: Palatine is a facial bone that gives shape to the face. Parietal, temporal, and sphenoid are bones of the cranium.

9. Structure and Function
The Neck
Hyoid bone
Several major blood vessels
Larynx
Trachea
Thyroid gland

10. Structures of the Neck

11. Cervical Vertebrae

12. Question
Tell whether the following statement is True or False.
The axis is the first of the seven cervical vertebrae.

13. Answer
False.
The axis is the second of the seven cervical vertebrae.

14. Lymph Nodes

15. 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

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

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

18. 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

19. Risk Reduction
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
Birth Through Age 2
Between Ages 2-4/Until 40 lbs
Between Ages 4-8 or Until 4'9" Tall
After Age 8 and/or 4'9" Tall
Wearing a seat belt every time you drive or ride in a motor vehicle.

20. Risk Reduction (cont.)
Never driving while under the influence of alcohol or drugs.
Wearing a helmet and making sure your children wear helmets when:
Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
Playing a contact sport, such as football, ice hockey, or boxing;
Using in-line skates or riding a skateboard;
Batting and running bases in baseball or softball;
Riding a horse; or skiing or snowboarding.

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

22. Risk Reduction (cont.)
Maintaining a regular physical activity program, if your doctor agrees, to improve lower body strength and balance.
Making living areas safer for children, by:
Installing window guards to keep young children from falling out of open windows; and
Using safety gates at the top and bottom of stairs when young children are around.
Making sure the surface on your child's playground is made of shock absorbing material, such as hardwood mulch or sand.

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

24. Headaches
Character: Describe how the headache feels (sharp, throbbing, dull)?
Onset: When did it first begin?
Does it tend to occur with other factors (i.e., Menstrual cycle, emotional or physical stress, ingestion of alcohol or other certain foods like cheese or chocolate)?
Locations: Where does your headache begin? (Ask client to point to area in head if possible). Does it radiate or spread to other areas?

25. Headaches (cont.)
Duration: How long does it last? How often does it recur? Has there been any change in the duration of your headaches? Explain.
Severity: How severe is the headache? Rate it on a scale of 1-10 (10 being most severe). Does the headache keep you from doing your usual activities of daily living? Explain.
Pattern: What aggravates it? What makes the pain go away? What pain relievers work best for you?
Associated Factors: Do you have other symptoms with the headache such as nausea, visual changes, dizziness, or sensitivity to noise or light?

26. Equipment
Gloves
Penlight or flashlight
Small glass of water
Stethoscope

27. Physical Assessment: Head
Inspect the size, shape, configuration
Consistency
Involuntary movement
Palpate the head

28. Physical Assessment: Face
Inspect the face
Symmetry
Features
Movement
Expression
Skin condition

29. Physical Assessment: Face
Palpate
Temporal artery: tenderness and elasticity
Temporomandibular joint (TMJ): range of motion, swelling, tenderness, crepitation

30. Physical Assessment: Neck
Inspect movement of neck structures
Cervical vertebrae
Neck range of motion (ROM)

31. Physical Assessment: Neck
Palpate
Trachea
Thyroid gland
Thyroid cartilage
Cricoid cartilage
Auscultate an enlarged thyroid gland

32. Physical Assessment: Neck
Palpate lymph nodes of head and neck
Preauricular
Postauricular
Occipital
Tonsillar
Submandibular

33. Physical Assessment: Neck
Palpate lymph nodes of head and neck
Submental
Superficial cervical
Posterior cervical
Deep cervical
Supraclavicular

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

35. 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.

36. Hyperthyroidism Increased appetite
Sudden weight loss, without changes in appetite and diet
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

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

38. Headaches
Sinus
Cluster
Tension
Migraine
Tumor related

39. Abnormal Findings Acromegly Cushing’s Syndrome Scledodema
Hypothryoidism
Bell’s Palsy

40. Older Adults
Older clients who have arthritis or osteoporosis may experience neck pain and a decreased range of motion
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.

41. Older Adults (cont.)
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.

42. Validating and Documenting Findings
Health promotion diagnoses
Risk diagnoses
Actual diagnoses
Collaborative problems
Medical problems