1. Health Assessment (NUR 230) The Head and Neck Lecture 3

2. Common or Concerning Symptoms
Head
Headache, history of head injury
Eyes
Visual disturbances, use of corrective lenses, pain, redness, excessive tearing, double vision (diplopia)
Ears
Hearing loss, ringing (tinnitus), vertigo, pain, discharge
Nose
Drainage (rhinorrhea), congestion, sneezing, nose bleeds (epistaxis)
Oropharynx
Sore throat, gum bleeding, hoarseness,
Neck
Swollen glands, goiter

3. Head – Inspection and Palpation
Hair distribution, quantity
Skull – size, contour
Face – expression, and symmetry of structure
Skin – color, pigmentation
Hair distribution, lesions
Palpate
Hair texture
Skull – lumps and lesions
Skin – texture, temperature

4. Eye

5. Eyes - Inspection Cornea and lens Iris
Position and alignment of eyes
Eyebrows
Quantity, distribution
Eyelids
Edema, color, lesions
Conjunctiva and sclera
color, vascular pattern
Cornea and lens
Iris
Pupils – size, shape, symmetry, reaction to light

6. Eyes – Techniques of Examination
Visual acuity
Distance/Central vision: Snellen eye chart; position patient 20 feet (6 meters) from the chart
Patients should wear glasses if needed
Test one eye at a time

7. Eyes – Techniques of Examination
Jaeger chart
Rosenbaum chart
Visual acuity
Near vision: use (Jaeger or Rosenbaum chart (hand-held card)
can also use to test visual acuity at the bedside
hold 14 inches (about 30 cm) from patient’s eyes

8. Eyes – Techniques of Examination (cont.)
Visual fields by confrontation
sitting cm from you and at eye level
Test one eye at a time
The client’s peripheral visual fields are compared to that of the examiner.
This test assumes the examiner has normal peripheral vision

9. Eyes – Techniques of Examination (cont.)
Extraocular movements/six cardinal directions of gaze/wagon wheel method
The client must keep the head still while following a pen that you will move in several directions to form a star in front of the client’s eyes.
Always return the pen to the center before changing direction.
Nystagmus: involuntary eye movement

10. Eyes – Techniques of Examination (cont.)
Accommodation
An object held about 10 cm from the client’s nose

11. Ears – Inspection and Palpation
Auricle for redness, lesions
Ear canal
Discharge, foreign bodies, redness, swelling
Tympanic membrane (by Use otoscope )
Color, contour
Palpation
Auricle for lumps, tenderness

12. Straightening the Ear Canal and Inserting the Speculum

13. Ears – Hearing acuity Test one ear at a time Whisper test
Ask the client to occlude the other ear or the ear may be occluded by the nurse.
Cover your mouth so the client cannot see your lips
Standing 30-60cm behind patient, softly say “nine-four,” “baseball”
Ask the client to repeat the phrase.

14. Air and bone conduction (AC and BC)
Ears – Hearing acuity
Rinne
Compare time of air vs. bone conduction
Place the base of the tuning fork on the client’s mastoid process- and note the number of seconds.
Then move the fork in front the external auditory meatus (1-2 cm)
If bone conduction is equal or greater than air conduction, then suspect conductive hearing loss
Air and bone conduction (AC and BC)

15. Air and bone conduction (AC and BC)
Ears – Hearing acuity
Air and bone conduction (AC and BC)
Weber
Lateralization of sound to impaired ear; suspect unilateral conductive hearing loss

16. Ears –
Romberg test:
Ask the patient to remain still and close their eyes (for about 20 seconds).
If the patient loses their balance, the test is positive.

17. Nose – Inspection/Palpation
Size, shape
Symmetry
Lesions/signs of infection
Patency test
Septum (by use nasal speculum)-deviation, inflammation or perforation
Palpate for tenderness, swelling

18. Mouth and Pharynx - Inspection
Lips
Note color, moisture, lumps, ulcers, cracking
Gums and teeth
Note color, presence and position of teeth
Roof of mouth
Note color
Tongue and floor of mouth
Note color and texture, ulcers
uvula, tonsils, pharynx
Note color, symmetry, presence of exudate, swelling, ulceration or tonsillar enlargement

19. The Mouth and Gums

20. Under the Tongue

21. Above and behind the tongue

22. Neck – Inspection and Palpation
Skin color, integrity, shape, and symmetry
Masses, scars, enlarged glands or lymph nodes
Thyroid gland - enlargement
Palpation
Trachea – position (should be midline)
Thyroid gland: consistency, masses, tenderness

23. Midline Structures of the Neck

24. Neck – Thyroid Gland Flex neck slightly forward
Place fingers of both hands with index fingers just below the cricoid cartilage
Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable)
Note the size, shape, and consistency
Identify any nodules or tenderness
If enlarged, listen over lateral lobes to detect a bruit

25. The thyroid can be examined while you stand in front of or behind the patient.