Assessment of Head, Neck, Eye, Ear, Nose, Throat, Mouth

Assessment of Head, Neck, Eye, Ear, Nose, Throat, and Mouth - NURS 2270

• Instructor: Dr. D. Mager

Subjective History in Head and Neck Assessment

• Ask patients about their history related to:
  • Headaches
  • Head injuries
  • Dizziness
  • Neck pain and/or limitation of motion
  • Presence of lumps or swelling
  • Past surgeries related to the head or neck

Inspection and Palpation of Head

• Evaluate the following aspects:
  • Size and shape:
  • Should be normocephalic and symmetrical.
  • Abnormal findings may include:
  • Hydrocephalus: Enlarged head due to accumulation of cerebrospinal fluid.
  • Acromegaly: Enlarged features due to excess growth hormone.
  • Microcephaly: Abnormally small head size.

Inspection and Palpation of Face

• Focus on:
  • Facial structures for symmetry, shape, swelling, and unusual movements.
  • Abnormal findings may include:
  • Bell’s palsy: Sudden weakness or paralysis of the facial muscles on one side of the face.
  • Cachexia: Extreme weight loss and muscle loss associated with chronic illness.

Inspection and Palpation of Neck

• Assess for:
  • Symmetry of the neck and range of motion (ROM).
  • Ensure the head is in a central position.
  • Palpate lymph nodes and trachea.

Auscultation of the Neck

• Listening to the carotid artery:
  • Check for bruit, which is a soft, pulsating sound with a whooshing/blowing quality.
  • Use the bell of the stethoscope for detection.
  • The presence of a bruit indicates turbulent blood flow, which is abnormal.

Thyroid Assessment

• Procedure:
  • Palpate the thyroid gland; auscultation is necessary if enlarged.
  • Right lobe, Isthmus, Left lobe, Thyroid cartilage, Trachea are areas to assess.

Inspection and Palpation of Lymph Nodes

• Locations to inspect:
  • Preauricular
  • Posterior auricular
  • Occipital
  • Submental
  • Submandibular
  • Superficial cervical
  • Deep cervical
  • Posterior cervical
  • Supraclavicular

Enlarged Lymph Nodes

• Commonly referred to as swollen glands.

Assessment of the Eye

Subjective History

• Gather information regarding:
  • Blurred vision.
  • Blind spots.
  • Eye pain.
  • Double vision (diplopia).
  • Redness, watering, or discharge from eyes.
  • Any swelling and past problems like glaucoma.
  • Vision aids like glasses.

Inspect External Ocular Structures

• Examine:
  • General appearance, eyebrows, eyelids, lashes, eyeballs, conjunctiva, sclera.
  • Eversion of the upper lid and lacrimal apparatus.

Inspect Anterior Eyeball Structures

• Important components to inspect:
  • Cornea, Lens, Iris, Pupil.
  • Assess light reflex and accommodation of the pupil.

Pupils Assessment

• Method:
  • Use a ruler for accuracy in measuring pupil sizes.
  • Normal pupil size ranges from 2-6 mm, dependent on lighting conditions.
  • Document pupil size as required (e.g., 3 mm, 4 mm).
  • Ideal response: Pupils Equal and Reactive to Light (PEARL).

Inspect the Ocular Fundus

• Key components:
  • Back surface of the eye includes:
  • Retina.
  • Macula.
  • Optic disk.
  • Fovea.
  • Blood vessels.

Retinal Conditions

• Normal Retina: Visualize normal appearance.
• Retinal Detachment: Condition of concern needing immediate attention.
• Glaucoma: Increased intraocular pressure resulting in optic nerve damage.

Test Central Visual Acuity

• Methods include:
  • Snellen eye chart.
  • Near vision test.
  • Visual field testing.

Inspect Extraocular Muscle Function

• Evaluate:
  • Corneal light reflex for symmetry.
  • Diagonal positions test (6 Cardinal Fields of Gaze).

Assessment of the Ear

Subjective History

• Ask about:
  • Earaches, infections, discharge.
  • Past surgery such as tubes and history of hearing loss.
  • Use of hearing aids and exposure to environmental noise.
  • Symptoms such as tinnitus and vertigo.

Inspect and Palpate External Ear

• Evaluate:
  • Size, shape, skin texture, tenderness, and external auditory meatus.

Inspection with Otoscope

• Procedure:
  • For adults, pull pinna up and towards the back of the head; for infants, pull down.
  • Aim the otoscope slightly forward and down; avoid contacting the canal wall.
  • Inspect external canal and tympanic membrane.

Conditions Visualized

• Perforated Ear Drum: Indicates possible infection or trauma.
• Otitis Media: Ear infection that results in fluid accumulation behind the tympanic membrane.

Hearing Acuity Tests

• Conducted tests include:
  • Voice Test (Whisper Test).
  • Tuning Fork Test: Although no evidence supports its use in screening for hearing loss, it may aid in differentiating between conductive vs. sensorineural loss.
  • Weber Test: Compare bone conduction in both ears.
  • Rinne Test: Compare air and bone conduction.

Assessing Nose, Mouth, and Throat

Subjective Data via History

• Inquire about:
  • Discharge, colds, and infections.
  • Sinus pain and pressure.
  • Previous trauma and surgeries.
  • Allergies and altered sense of smell.
  • Presence of sores, lesions, or bleeding gums.
  • Altered taste perceptions.
  • History of smoking.

Inspect and Palpate the Nose

• Areas to evaluate:
  • External nose.
  • Nasal cavity.

Palpate the Sinuses

• Key sinuses to examine:
  1. Frontal
  2. Ethmoid
  3. Maxillary
  4. Sphenoid: Located posterior to the ethmoid; perform a transillumination test for assessment.

Inspect the Mouth

• Assess:
  • Lips, teeth, gums, tongue, and buccal mucosa.

Inspect the Throat

• Evaluate and grade the tonsils:
  • 1+: Visible.
  • 2+: Halfway between tonsillar pillars and uvula.
  • 3+: Touching the uvula.
  • 4+: Touching each other.

Visual Assessment of Tonsils

• Visualize tonsils at grades 1+ and 3+ for comparative assessment.

References

• Key texts and resources:
  • Wilson & Giddons (6th and 7th ed.)
  • Google images for reference visuals.
  • PowerPoints created and presented by Dr. D. Mager.