Head, Neck and Regional Lymph Nodes
Nursing 330
Governors State University
Shirley Comer
Inspection
Inspect head for skull size and symmetry– Normocephalic- normal round, symmetrical skull– Microcephalic- abnormally small– Macrocephalic- abnormally large (Ex. hydrocephalic)
Inspect facial expression and appropriateness– Symmetrical expressions v. drooping, injury, tics, or
malformations– Flat affect=unmoving expression (depression, anger, neuro)
Macro/microcephalic and flat affect
Palpation
Palpate head/scalp Palpate temporal artery Palpate tempro-mandibular joint
– Crepitus-popping or crackling /c movement
Sinus pix
Inspect Sinuses
Frontal and Maxillary Sinuses– Assess for edema, swelling or redness
Trans-illuminate the sinuses– Frontal – shine light under eyebrow: see
above brow– Maxillary – shine light below eye: see on
hard palate
Palpate/Percuss Sinuses
Palpate Sinuses – Tenderness = sinusitis
Percuss– Frontal- above the eyebrows– Maxillary – below eyes
Resonant tone expected Dull = thickening or fullness of sinus
Inspect Nose
– External noseSize, shape, symmetryNote drainageNasal flaringPatency – occlude each side
– Internal nasal mucosa – use penlightNote color, moisture, lesions, septum midlineInspect Turbinates (concha)
– Inferior, medial and superior
Mouth pix
Lips/mouth
Lips– Inspect for Color, condition, lesions, odor– Palpate for consistency and tenderness
Teeth and bite– Ask to smile and open and close mouth– Note number, color and condition of teeth
Oral Mucosa and Gums– Inspect color, condition, bleeding retraction or
hypertrophy
Mouth (Cont)
Inspect hard and soft palate– use penlight – Color and condition
Salivary Glands – Use tongue blade– Inspect
Stensen’s Duct – inner cheek Wharton’s Duct – under tongue
– Palpate Parotid – in front of ears Submandibular and sublingual – under mandible
Mouth (cont)
Tongue – both top and bottom– Inspect color, texture, moisture and mobility– Palpate for consistency and tenderness
Inspect Oropharynx – use tongue blade– Lesions, color, drainage
Inspect Tonsils – (if present)– Note color, size and exudate
Mouth (cont)
Inspect Uvula – Note color, moisture, lesions, midline position– Note movement by having pt say “AH”
Tonsils
Neck
Inspect– in neutral and hyperextended positions– Note lesions, color, trachea position, resp
movement, pulsations, asymmetries
Palpate– Use light palpation to check for masses or
tenderness– Note range of motion
Lymph Nodes
Palpate using a gentle circular motion Palpate all positions
– Pre and post auricular-in front and behind ear– Occipital Juguldigastric-below ear lobe– Superficial cervical-Along upper SCM muscle– Posterior Cervical-base of lateral neck– Supraclavicular-above clavicle– Submandibular-under jaw– Submental-under chin– Deep cervical-jaw line along SCM to clavicle
Cervical Lymph node pix
Lymph nodes cont
Lymphadenopathy– Enlarged lymph glands (cervical nodes often normally felt)– Assess area drained for:
Acute infection– nodes are bilateral, enlarged, warm, tender and firm but moveable
Chronic inflammation– nodes clumped. May be asymmetrical
Cancerous– nodes are hard, unilateral, non-tender and fixed
Thyroid Gland
Inspect – position light across neck – have pt swallow and note thyroid movement
Palpate– Observe from the front – locate isthmus of thyroid– move behind person – pt head sl forward and to right to relax neck– curve fingers on either side of gland and displace sl right – ask pt to swallow – usually not palpable
Auscultate using bell for bruit
Thyroid Pix
Age Specific Considerations- Infant
measure head with tape until age 2 – Sunken fontanels /c dehydration or malnutrition
bulging /c increased ICP anterior
– 2.5 to 5 cm – may see/feel pulse – may bulge if infant crying – closes 9 to 24 months
Posterior– may not be present at birth 1 cm
Infants and children- Head
Adult Age Specific considerations
Pregnant– May normally feel thyroid gland
Older adult– Senile tremors of head are benign– If wears dentures face will appear distorted when
not in mouth– Increased cervical concave curvature of neck
Cranial Nerves
1. Olfactory- smell 2. Optic – vision 3. Oculomotor – sight 4. Trochlear – vision 5. Trigeminal – mouth and jaw 6. Abducens - Vision 7. Facial – facial muscles 8. Acoustic – hearing 9. Glossopharyngeal- speech and soft palate 10. Vagus – palate 11. Spinal – shoulders 12. Hypoglossal - tongue
Testing Cranial Nerves
I - Olfactory- test when pt reports decreased sense of smell– Place aromatic substance under each nostril – Should be able to identify bilaterally
II – Optic – Test visual fields– Use ophthalmoscope to examine retina and observe
optic disk
Testing Cont
III, IV, and VI – Oculomotor, Trochlear and Abducens– Observe pupil size and reactivity (PERRLA)– Assess extraocular movements and cardinal
positions of gaze Nystagmus oscillation of eye abnormal Ptosis – drooping eye lids
Testing Cont
V – Trigeminal– Palpate muscles as pt clenches teeth– Test sensory function by touching cotton wisp to face /c
eyes closed. Pt says “now” when felt– Corneal Reflex for those /c abnormal facial movements
Touch cotton to cornea – should blink bilaterally
VII – Facial – Observe for facial symmetry
Smile, frown Close eyes Lift eyebrows Puff cheeks
Testing Cont
VIII – Acoustic – test hearing acuity with whispered voice, Rinne and Weber tests
IX and X – Glossopharyngeal and Vagus– Watch uvula as pt says “Ahhh”- use tongue blade– Test gag reflex when appropriate – use blade
XI – Spinal Accessory – Shrug shoulders and turn head against your resistance
XII – Hypoglossal – stick out tongue– No tremors or deviations from midline
Practice Exam Question
Your Mother has a sinus infection. Which changes would you expect to find on your head and neck exam?
A. Tender earlobes with enlarged lymph nodes B. Tender maxillary area with enlarged lymph nodes C. Tender neck muscles with enlarged lymph nodes D. Enlarged thyroid gland with enlarged lymph nodes.
Rationale
The correct answer is b. The maxillary sinuses are located here and the lymph nodes would be enlarged r/t increased immune system activity r/t sinus infection
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