Head, Eyes, Ears, Nose, and Throat assessment

Cranium

The head

-22 bones supporting the soft tissue structures of the head

Blood supply to the head

-Carotid and temporal arteries

-Internal and external jugular veins

Nerve supply to the head

Cranial Nerve V

-Facial nerve

Salivary glands of the head

Parotid, submandibular, and sublingual

Priority urgent assessment-stabilization

Stabilization of the head and neck is essential to avoid further neurological injury

-History of trauma to the head and or neck warrants a careful assessment for bleeding, swelling, loss of mobility, and pain

-KEEP SPINE IMMOBILIZED TO PREVENT SPINAL CORD INJURY AND DON’T REMOVE UNTIL CLEARED BY A PROVIDER

Priority urgent assessment-Jaw pain

Especially if associated with shoulder or arm pain, could indicate cardiac involvement. This is a medical emergency and requires immediate evaluation and treatment

Priority urgent assessment-changes in vision

May be associated with ischemic attacks in the brain or stroke. Be aware of sudden onset of blurred vision that can also be symptom of increasing intracranial pressure 

Older adult considerations

-Facial skin becomes less elastic

-Bony structures are more pronounced

-Hair thins

-Hypothyroidism more common

-Smell and taste diminish

-Decreased enamel on teeth

-Thinning of soft tissue in oral cavity-increased infection, oral cancers

Cultural variations and health disparities

-Shape and size of facial features based on genetics

-Females at higher risk for hyper/hypothyroidism

-Oral diseases higher in lower socioeconomic communities

Head and neck assessment

-Acute injury (c-sine collar for stability, assess for neurological changes) 

-Check for hair (lice, alopecia) 

-Palpate head for pain, swelling 

-Inspect for skin changes 

-Palpate sinuses for pain, also percuss

-Palpate for TMJ

Neck assessment

Palpate for tenderness, masses, and pulse (NEVER BOTH CAROTID AT ONCE)

-Check for JVD

-Lymph node assessment

-Tracheal placement

-Thyroid assessment

Lymph nodes should be less than -, mobile, and non-tender. Enlarged lymph nodes may be a - - -, an - lymph node, or - -

1 cm (pea sized), response to infection, infected, benign/cancerous mass

Eye inspection

-Erythema of lens or conjunctiva, sclera

-Ptosis (drooping)

-Discharge from eye

PERRLA

Pupils are Equal Round & Reactive to Light and Accommodation

Ears

Inspect for erythema and or swelling

-Palpate for external pinna tenderness

-Whisper test

Teaching 

-No tobacco or recreational drug use 

-Sleep disorders (apnea) 

-Signs of cancer 

-Oral health 

-Hereditary issues 

-Chronic headaches or pain 

-ROM 

-Thyroid concerns

Lab and diagnostic testing

-Sinus, throat cultures

-Biopsies

-Lab values: CBC, thyroid levels

-RAST for allergies

-X-rays

-CT scans

-MRI

-Sleep studies

Prioritizing and taking XII on

-Urgent situation= ABC’s and Spine or Neck injury

-Related to cardiac or neurological situation?

-Difficulty swallowing?

Step 1 of inspection

Head

Step 2 of inspection

Neck

Step 3 of inspection

Eyes

Step 4 of inspection

Ears

Step 5 of inspection

Nose

Step 6 of inspection 

Mouth

Step 7 of inspection

Throat