King Saud University College of Nursing Health Assessment (NUR 224) The Head, Neck, Lymph Nodes 1

Objectives After completion of this presentation, the nurse will be able to:  Conduct a basic adult head, neck, and lymph nodes assessment.  Distinguish normal from abnormal findings

Technique Inspection Auscultation Palpation

4 Anatomy and Physiology The skull is made up of the bones of the cranium and the face. The cranium includes frontal, parietal, temporal, and occipital bones. The muscles of the face play a role in expression of emotions and assist in neck movement. Movement of the facial muscles is controlled by cranial nerves V and VII. The carotid arteries provide the blood supply to the head; the temporal artery supplies blood to much of the face. The neck is supported and made mobile by vertebral processes and the sternocleidomastoid and trapezius muscles.

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6 Health History Determine presence/absence of age- and gender-specific diseases of the head and neck Common chief complaints Neck pain or stiff neck Hoarseness Neck mass Headache Head injury

7 Evaluating Chief Complaint Determine the following characteristics Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing

8 Past Health History Medical conditions Surgeries Medications Injuries or accidents

9 Family Health History Determine if family history of Thyroid disease Headache

10 General Approach to Head and Neck Assessment Greet patient, explain assessment techniques Environment Quiet Warm Private Adequate lighting Upright sitting position Compare right and left sides Systematic approach EQUIPMENT Tape measure ◆ Stethoscope ◆ Cup of water (for evaluation of thyroid gland)

11 Assessment of the Head Inspection Shape Symmetry Palpation Masses Depression Tenderness

12 Inspection and Palpation of the Scalp Inspect Lesions or masses Normal findings Scalp is shiny, intact, without lesions or masses Abnormal findings Bleeding, lesions, masses, hematomas

13 Assessment of the Face Inspection Shape Symmetry Normal findings Symmetrical features Palpebral fissures equal Shape can be oval, round, or slightly square

14 Assessment of the Face Abnormal findings Deformed or absent structures Asymmetry More or less pronounced facial features Diseases which may alter facial features: Bell’s palsy, A temporary disorder affecting cranial nerve VII and producing a unilateral facial paralysis

15 Acromegaly: An enlargement of the skull and cranial bones due to increased growth hormone Hydrocephalus: The enlargement of the head caused by inadequate drainage of cerebrospinal fluid, resulting in abnormal growth of the skull

16 Cushing syndrome Facies include a rounded or “moon-shaped” face with thin, erythematous skin

17 Down syndrome Note depressed nasal bridge, epicanthal folds, mongoloid slant of eyes, low-set ears, and large tongue

18 Hydrocephalus Hydrocephalus, with characteristic enlarged head, bulging fontanel, dilated scalp veins,

19 Left facial palsy Left facial palsy. Facies include asymmetry of one side of the face, eyelid not closing completely, drooping lower eyelid and corner of mouth, and loss of nasolabial fold. arches

20 Mandible Palpate and auscultate the temporo-mandibular joint when the client opens and closes the mouth Normal findings No discomfort, joint articulates smoothly without clicking or crepitus Abnormal findings Pain, tenderness, crepitus

21 Neck Inspection Palpation Normal findings Full ROM, pain free, symmetrical muscles, no masses Abnormal findings Limited ROM, pain, asymmetrical muscles, masses

Salivary glands Parotid glands In the cheeks over mandible Largest of salivary glands Submandibular Beneath mandible Sublingual Lies in the floor of the mouth Temporal artery Lies superior to temporalis muscle

Salivary Glands and Neck Vessels

24 Trachea Trachea is midline. Palpate for tracheal shift. To palpate trachea:  Place your index finger on the trachea in the sternal notch, then,  Slip it off to each side  Note for symmetric on both sides.

25 Position of the thumbs to evaluate the midline position of the trachea

26 Thyroid Gland  The thyroid gland is in the middle of the neck anterior to the trachea.  The isthmus is the center, and the two lobes lie on either side of the trachea. Normal findings Symmetrical movement with swallowing Adam’s apple more pronounced in males No masses, tenderness, or enlargement Absent bruit Abnormal findings Mass Enlarged gland Goiter Asymmetrical enlargement Presence of a nodule or bruit

27 Hyperthyroidism: The excessive production of thyroid hormones, resulting in enlargement of the gland, exophthalmos (bulging eyes), fine hair, weight loss, diarrhea, and other alterations. Hypothyroidism: Metabolic disorder causing enlarged thyroid due to iodine deficiency.

Palpate Thyroid: Posterior Approach  Move behind the person.  Ask to sit up very right, then bend the head slightly forward and then right (to relax the neck muscle).  Use fingers of your left hand to push the trachea slightly to the right,  Then, curve your right fingers between the trachea and the sternomastoid muscle, and ask the person to swallow,  You should feel the thyroid moves up under your fingers.

Palpate Thyroid: Anterior Approach  Needs an expert to do.  Stand facing the person, ask the person to tip head forward and then to the examiner’s right,  Use right thumb to displace the trachea slightly to the person’s right,  Then, hook your right thumb and fingers around the sternomastoid muscle, and feel for lob enlargement as the person swallow.

Lymph Nodes  Located in head and neck  Drain the head and neck.  Extensive vessel system  Separate from cardiovascular  Major part of immune system  Detect and eliminate foreign bodies

31 Lymph Nodes  Inspection  Palpation  Locations

32 Lymph Nodes  It is more efficient to palpate with both hands to compare both sides for symmetrically,  However, it is easier to palpate the sublingual gland under the chine with one hand.  Using a gentle circular motion of finger pad.  Begin with preauricular and continue in a routine order.

33 Lymph Nodes Normal findings Unable to palpate or see nodes Abnormal findings Enlarged nodes Able to palpate or see nodes Tenderness Firm, hard nodes

34 Question?