HEENOT and Neck Checkoff

What is the correct general approach to a HEENOT and neck assessment?

Perform hand hygiene, introduce yourself and your role, explain the examination in understandable language, provide instructions throughout, and assess each area systematically and professionally.

What does HEENOT stand for in this assessment?

Head, eyes, ears, nose, oral cavity/throat, and neck.

What should you do before beginning the HEENOT and neck assessment?

Perform hand hygiene using alcohol-based gel or soap and water.

How should you introduce yourself to the patient?

State your name and role, and explain that you will be performing an assessment of the head, eyes, ears, nose, mouth, throat, and neck.

How should you explain the assessment to the patient?

Explain that you will inspect and gently examine the head and neck, assess vision and eye movements, check hearing and balance, examine the nose and sinuses, and inspect the mouth and throat. Explain each procedure before performing it.

Why should you explain each procedure before performing it?

It helps the patient understand what to expect, follow instructions, feel more comfortable, and participate in the assessment.

What does it mean to perform an assessment systematically?

Follow an organized sequence, assess all required structures, use appropriate techniques, and avoid skipping assessment components.

What should you assess when inspecting the head?

Observe the size and shape of the skull, skin condition and color, and symmetry of structures.

How do you assess the size and shape of the skull?

Visually inspect the head and observe its overall size, shape, and symmetry.

What skin characteristics should you observe when assessing the head?

Observe skin condition, color, and symmetry of the structures.

What should you assess during neck range-of-motion testing?

Assess the patient's ability to move the neck safely through the requested movements.

How should you instruct a patient during neck range-of-motion testing?

Ask the patient to move the neck slowly and comfortably as directed, stopping if significant pain or dizziness occurs.

What neck movements are commonly assessed during range-of-motion testing?

Flexion, extension, lateral flexion to each side, and rotation to each side.

What does neck flexion mean?

Moving the chin toward the chest.

What does neck extension mean?

Moving the head backward.

What does lateral neck flexion mean?

Tilting the head toward one shoulder and then the other.

What does neck rotation mean?

Turning the head to the right and left.

What structures should you palpate in the neck according to the check-off sheet?

The trachea and cervical vertebrae.

How do you assess the trachea?

Gently palpate the trachea and assess its position, noting whether it appears centered.

What are the cervical vertebrae?

The bones of the neck that form the cervical portion of the vertebral column.

How many lymph node groups does the check-off sheet require you to palpate?

Nine lymph node groups of the head and neck.

What are the nine lymph node groups you must assess?

Preauricular, postauricular, occipital, retropharyngeal or tonsillar, submandibular or submaxillary, submental, superficial cervical, posterior or deep cervical, and supraclavicular.

How should you palpate the lymph nodes of the head and neck?

Using the pads of your fingers, gently palpate the required lymph node areas in a systematic sequence, comparing sides when appropriate and noting tenderness, enlargement, or other abnormalities.

What should you assess when palpating lymph nodes?

Assess for enlargement, tenderness, and other abnormal characteristics, noting the location and findings.

Where are the preauricular lymph nodes located?

In front of the ears.

Where are the postauricular lymph nodes located?

Behind the ears.

Where are the occipital lymph nodes located?

At the back of the head near the base of the skull.

Where are the retropharyngeal or tonsillar lymph nodes assessed?

In the upper neck region near the angle of the mandible and below the ears.

Where are the submandibular lymph nodes located?

Under the mandible, or lower jaw.

Where are the submental lymph nodes located?

Under the chin.

Where are the superficial cervical lymph nodes located?

Along the superficial cervical region of the neck.

Where are the posterior or deep cervical lymph nodes located?

Along the posterior or deeper cervical chain of the neck.

Where are the supraclavicular lymph nodes located?

Above the clavicles, or collarbones.

What eye structures should you inspect?

Eyebrows, eyelids, eyelashes, conjunctiva, sclera, cornea, and iris.

What should you observe when inspecting the eyebrows and eyelashes?

Observe their appearance, distribution, symmetry, and overall condition.

What should you assess when inspecting the eyelids?

Observe their position, symmetry, and condition.

What is the conjunctiva?

The thin membrane lining the inner surface of the eyelids and covering the visible anterior portion of the eye.

What is the sclera?

The white outer portion of the eyeball.

What is the cornea?

The transparent front surface of the eye that covers the iris and pupil.

What is the iris?

The colored portion of the eye surrounding the pupil.

What should you palpate during the eye assessment according to the check-off sheet?

The lacrimal apparatus or sacs and the eyelids.

What is the lacrimal apparatus?

The structures responsible for producing and draining tears.

What is the purpose of palpating the lacrimal sacs?

To assess for tenderness, swelling, or other abnormalities in the tear drainage area.

What does visual acuity measure?

The clarity or sharpness of vision.

Which cranial nerve is primarily assessed during visual acuity testing?

Cranial nerve II, the optic nerve.

What is the Snellen chart used for?

Assessing distance visual acuity.

What is the Rosenbaum chart used for?

Assessing near visual acuity.

How should you prepare a patient for a visual acuity test?

Explain the test, position the patient at the appropriate distance for the chart being used, and follow the chart's testing instructions.

What does EOM stand for?

Extraocular movements.

What do extraocular movement tests assess?

The coordinated movement of the eyes and the function of the extraocular muscles.

How do you generally assess extraocular movements?

Ask the patient to keep the head still and follow a moving target with the eyes through the prescribed directions of gaze.

What should you observe during extraocular movement testing?

Observe whether the eyes move together smoothly and whether the patient reports double vision or discomfort.

What is the corneal light reflex test used for?

Assessing eye alignment by observing where light reflects from the corneas.

How is the corneal light reflex generally performed?

Ask the patient to look straight ahead while shining a light toward the eyes from the front, then compare the position of the light reflections in the two eyes.

What does the cover/uncover test assess?

It helps identify ocular misalignment or strabismus.

How is the cover/uncover test generally performed?

Ask the patient to focus on a target, cover one eye, observe the uncovered eye, then uncover the eye and observe for corrective movement. Follow the instructor's required technique.

What pupil characteristics should you assess?

Pupil size, shape, direct and consensual light reflexes, and accommodation.

What is the direct pupillary light reflex?

Constriction of the pupil in the eye receiving the light stimulus.

What is the consensual pupillary light reflex?

Constriction of the opposite pupil when light is shone into one eye.

What is accommodation during pupil assessment?

The eyes adjust for near vision, typically involving convergence of the eyes and constriction of the pupils when shifting focus to a near object.

What does PERRLA stand for?

Pupils Equal, Round, Reactive to Light and Accommodation.

When would you document PERRLA?

When pupil findings are within defined limits and the pupils are equal, round, reactive to light, and accommodate appropriately.

Which cranial nerves are listed on the check-off sheet for pupil reflexes and accommodation?

The sheet lists cranial nerves III, IV, and VI. Clinically, pupil constriction and accommodation are primarily associated with CN III; CN II is the sensory limb of the light reflex, while CN IV and VI control specific eye movements.

What should you inspect and palpate when assessing the ears?

Assess the external ears for size, shape, color, and configuration, and palpate them for abnormalities or tenderness.

What is the purpose of the whisper test?

To screen hearing ability.

Which cranial nerve is assessed during the whisper test?

Cranial nerve VIII, the vestibulocochlear nerve.

How is the whisper test generally performed?

Stand slightly behind the patient, prevent visual cues, occlude the opposite ear as instructed, whisper a combination of letters and numbers, and ask the patient to repeat them. Repeat on the other side.

What is the Weber test used for?

Assessing lateralization of sound between the two ears.

How is the Weber test generally performed?

Place a vibrating tuning fork at the midline of the skull and ask whether the sound is heard equally in both ears or louder in one ear.

What does a normal Weber test generally show?

The sound is heard equally in both ears, without lateralization.

What does lateralization during the Weber test mean?

The sound is perceived more strongly in one ear than the other.

What is the Romberg test used for?

Assessing balance and equilibrium, including the contribution of proprioception and the vestibular system.

How is the Romberg test generally performed?

Ask the patient to stand with feet together and arms at the sides, first with eyes open and then closed, while remaining close enough to prevent a fall.

What safety precaution is essential during the Romberg test?

Stay close to the patient and be prepared to support them if they lose balance.

What does the vestibular apparatus help control?

Balance and awareness of head position and movement.

What should you inspect and palpate during the nose assessment?

Inspect and palpate the external nose, assess nasal patency, and inspect the nasal cavities without an otoscope.

How do you assess nasal patency?

Ask the patient to close one nostril at a time and breathe through the other, then repeat on the opposite side.

How should you inspect the nasal cavities according to the check-off sheet?

Inspect the nasal cavities without using an otoscope, following the instructor's required technique.

Which sinuses should you palpate and percuss?

The frontal and maxillary sinuses.

Where are the frontal sinuses located?

In the forehead region above the eyes.

Where are the maxillary sinuses located?

In the cheek region, below the eyes and beside the nose.

What does palpation of the sinuses assess?

Tenderness or discomfort over the frontal and maxillary sinus areas.

What does percussion of the sinuses involve?

Gently tapping over the frontal and maxillary sinus areas to assess for tenderness or discomfort.

What should you inspect and palpate during the oral assessment?

Inspect and palpate the lips.

What should you inspect inside the mouth?

Inspect the buccal mucosa, teeth, gums, tongue, floor of the mouth, and hard and soft palates.

What is the buccal mucosa?

The mucous membrane lining the inside of the cheeks.

What should you assess when inspecting the teeth and gums?

Observe the condition and appearance of the teeth and gums, including any visible abnormalities.

What is the hard palate?

The firm, bony anterior portion of the roof of the mouth.

What is the soft palate?

The flexible posterior portion of the roof of the mouth.

What should you assess when examining the tongue?

Inspect its appearance and assess controlled movement as part of the hypoglossal nerve examination.

What should you inspect when assessing the tonsils?

Observe the tonsils and grade their size using the required 0–4 grading scale.

What does a tonsil grade of 0 generally mean?

Tonsils are absent or not visible, such as after tonsillectomy.

What does a tonsil grade of 1+ generally mean?

Tonsils are visible and relatively small.

What does a tonsil grade of 2+ generally mean?

Tonsils are moderately enlarged but do not extend substantially toward the midline.

What does a tonsil grade of 3+ generally mean?

Tonsils are enlarged and extend further toward the midline.

What does a tonsil grade of 4+ generally mean?

Tonsils are very enlarged and may approach or touch one another at the midline, sometimes called kissing tonsils.

Which cranial nerve controls tongue movement?

Cranial nerve XII, the hypoglossal nerve.

How do you test cranial nerve XII?

Ask the patient to protrude the tongue and move it in a controlled manner as instructed. Observe the movement and symmetry.

Which cranial nerve is associated with movement of the uvula and soft palate on the check-off sheet?

Cranial nerve IX, the glossopharyngeal nerve, is listed on the sheet for this assessment.

How can you generally assess soft palate and uvula movement?

Ask the patient to open their mouth and say “ah,” then observe elevation of the soft palate and position of the uvula.