10/30/12

Assessing the Head and Neck

Goal: The assessment is completed without the patient experiencing anxiety or discomfort, the findings are documented, and the appropriate referral is made to the other healthcare professionals, as needed, for further evaluation.

1. Perform hand hygiene and put on PPE, if indicated.

2. Identify the patient.

3. Close curtains around bed and close the door to the room, if possible. Explain the purpose of the head and neck examination and what you are going to do. Answer any
questions.

4. Inspect the head and then the face for color, symmetry, lesions, and distribution of facial hair. Note facial expression. Palpate the skull.

5. Inspect the external eye structures (eyelids, eyelashes, eyeball, and eyebrows), cornea, conjunctiva, and sclera. Note color, edema, symmetry, and alignment.

6. Examine the pupils for equality of size, shape, and reaction to light by darkening the room and using a penlight to shine the light on each pupil.

7. To test for pupillary accommodation and convergence, ask the patient to focus on an object as you bring it closer to the nose.

8. Using an ophthalmoscope, check the red reflex.

9. Test the patient’s visual acuity with a Snellen chart. Ask the patient to read the smallest possible line of letters, first with both eyes and then with one eye at a time.

10. With the patient about 2 feet away, ask the patient to focus on your finger and move the patient’s eyes through the six cardinal positions of gaze.

11. Inspect the external ear bilaterally for shape, size, and lesions. Palpate the ear and mastoid process.

12. Perform an otoscopic examination. For an adult, pull the auricle up and back; for a child, pull the auricle down and back. Note cerumen (wax), edema, discharge, or foreign bodies and condition of the tympanic membrane.

13. Use a whispered voice to test hearing. Stand about 1 to 2 feet away from the patient out of the patient’s line of vision. Ask the patient to cover the ear not being tested. Perform test on each ear.

14. Use a tuning fork to perform Weber’s test and Rinne test if the patient reports diminished hearing in either ear.

15. Put on gloves. Inspect and palpate the external nose.

16. Palpate and lightly percuss over the frontal and maxillary sinuses.

17. Occlude one nostril externally with a finger while patient breathes through the other; repeat for the other side.

18. Inspect the internal nostrils using an otoscope with a nasal speculum attachment.

19. Palpate the temporomandibular joint by placing your index finger over the front of each ear as you ask the patient to open and close the mouth.

20. Inspect the lips, oral mucosa, hard and soft palates, gingivae, teeth, and salivary gland openings by asking the patient to open the mouth wide using a tongue blade and penlight.

21. Inspect the tongue. Ask the patient to stick out the tongue. Place a tongue blade at the side of the tongue while patient pushes it to the left and right with the tongue. Inspect the uvula by asking the patient to say “ahh” while sticking out the tongue. Palpate the tongue for muscle tone and tenderness. Remove gloves.

22. Palpate from the forehead to the posterior triangle of the neck for the posterior cervical lymph nodes using the finger pads in a slow, circular motion.

23. Inspect and palpate in front of and behind the ears, under the chin, and in the anterior triangle for the anterior cervical lymph nodes.

24. Inspect and palpate the left and then the right carotid arteries. Only palpate one carotid artery at a time. Use the bell of the stethoscope to auscultate the arteries.

25. Inspect and palpate for the trachea.

26. Palpate the thyroid gland (illustrate the two techniques). Then, if enlarged, auscultate the thyroid gland using the bell of the stethoscope.

27. Inspect and palpate the supraclavicular area.

28. Inspect the ability of the patient to move the neck. Ask the patient to touch chin to chest and to each shoulder, each ear to the corresponding shoulder, and then tip the head back as far as possible.

29. Remove any additional PPE, if used. Perform hand hygiene. Continue with assessments of specific body systems, as appropriate or indicated. Initiate appropriate referral to other healthcare practitioners for further evaluation, as indicated.

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