HNN

Absolutely. I’ll structure these as a study guide that follows each learning objective and use your pasted material as the primary source. I’ll also make sure every vocabulary term you listed is included and clearly distinguish expected vs. unexpected findings.

Head, Neck & Neurological Assessment

Comprehensive Nursing Notes

1. LEARNING OBJECTIVES

By the end of this material, you should be able to:

1. Define terminology related to assessment of the head, neck, and neurological system.

2. Describe the anatomy and physiology of the head, neck, and neurological system.

3. Identify equipment needed to assess the head, neck, and neurological system.

4. Identify positioning for a head, neck, and neurological examination.

5. Identify techniques used to assess the head, neck, and neurological system.

6. Explain the process of performing a head, neck, and neurological assessment.

7. Recognize normal/expected findings and identify abnormal/unexpected findings.

Source note: These notes are based primarily on the pasted material. Where the material names a structure or assessment but does not provide detailed anatomy/physiology, the explanation is kept at the level needed to understand the assessment.

2. MAJOR ASSESSMENT TECHNIQUES

The three assessment techniques identified in the material are:

Inspection

Looking/observing the patient.

Used to assess:

• Appearance

• Symmetry

• Shape

• Size

• Skin and structures

• Eye findings

• Ear findings

• Nose and mouth

• Neck

• Neurological status

Palpation

Using touch to assess structures.

Used to assess:

• Head

• Sinuses

• TMJ

• Sensation

• Outer ears

• Neck

• Trachea

• Thyroid

• Lymph nodes

• Carotid arteries

Auscultation

Listening with a stethoscope.

Used in the neck to assess the carotid arteries for bruits.

Easy memory:

I-P-A = Inspect → Palpate → Auscultate

3. EQUIPMENT

Equipment for all assessments

Penlight

A penlight is identified in the material as equipment needed for all assessments.

It can assist with examination of structures such as the eyes and oral cavity.

Equipment for selected assessments

Ophthalmoscope

Used for selected eye assessments.

Otoscope

Used for selected ear assessments.

Tongue blade

Used for selected mouth/throat assessments.

Snellen chart

Used to assess visual acuity.

Tuning fork

Used for selected hearing assessments.

Reflex hammer

Used for assessment of reflexes, including the deep tendon reflex (DTR).

Stethoscope

Used for auscultation, including assessment of carotid bruits.

Tape measure

Used for selected measurements.

4. HEALTH HISTORY

A thorough history helps identify potential neurological and head/neck problems.

Ask about:

• History of seizures

• Headaches/migraines

• Light sensitivity

• Past medical history

• Family history

• Medications

• Recent or past falls

• Dizziness

• Difficulty swallowing

• Vision changes

• Difficulty hearing

• Changes in smell/taste

5. SEIZURE HISTORY

If the patient reports a history of seizures, ask follow-up questions.

Ask:

• When was your last seizure?

• What do seizures look like to you?

• Do you know what your triggers are?

• What do you take for seizure management?

• Who manages your seizures?

• When was the last time you saw your doctor?

Important nursing principle

If the patient answers yes to a concerning history question, ask follow-up questions.

The material emphasizes identifying potential triggers and obtaining more information.

6. HEADACHE HISTORY

Ask:

• Do you have migraines?

• Do you have sensitivity to light?

• If the patient currently has a headache, assess OLDCARTS.

The purpose is to obtain additional information about the patient's headache rather than simply documenting that a headache exists.

7. HEAD ASSESSMENT

Inspection

Assess:

• Appearance

• Symmetry

• Shape

• Size

• Smile

• Frown

Expected findings

The head should be assessed for expected appearance and symmetry.

Unexpected findings

Look for:

• Asymmetry

• Abnormal shape

• Abnormal size

• Abnormal facial expression

8. HEAD VOCABULARY

Normocephalic

Normocephalic means the head has an expected/normal shape and size.

This is a common documentation term when the head assessment is expected.

Example:

Head normocephalic and symmetrical.

Alopecia

Alopecia means hair loss.

It is an abnormal finding that may be identified during inspection of the head/scalp.

Nodule

A nodule is a localized lump or small mass.

A nodule may be identified through inspection or palpation.

9. PALPATION OF THE HEAD

Palpate:

• Entire head

• Sinuses

• TMJ

• Sensation

TMJ

The temporomandibular joint is assessed as part of the head examination.

Sinuses

Palpate the sinus areas and assess for abnormalities such as tenderness.

Sensation

Assess sensation as part of the neurological component of the examination.

10. EARS

Inspection

Assess:

• Symmetry

• Drainage

• Lesions

Expected findings

• Symmetrical ears

• No abnormal drainage

• No lesions

Unexpected findings

• Asymmetry

• Drainage

• Lesions

Palpation

Assess the:

• Outer ear

• Tenderness

Cerumen

Cerumen is earwax.

The nurse should recognize cerumen when inspecting the ear.

Hearing

A whisper test may be performed when applicable.

The material identifies the whisper test as assessing cranial nerve VIII.

Tinnitus

Tinnitus refers to ringing or other abnormal sounds perceived in the ears.

It is an abnormal auditory symptom to recognize during the health history.

11. EYES

Inspection

Assess:

• Eyelids

• Conjunctiva

• Sclera

• PERRLA

12. PERRLA

PERRLA is a pupil assessment.

The material identifies it as:

P — Pupils
E — Equal
R — Round
R — Reactive
L — Light
A — Accommodation

The material identifies PERRLA as:

• Noninvasive

• Testing cranial nerve III

Expected finding

Pupils are:

• Equal

• Round

• Reactive to light

• Accommodating appropriately

13. EOM

EOM means extraocular movements.

The patient follows commands through the six cardinal gazes.

The material identifies EOM as testing cranial nerves:

• III — Oculomotor

• IV — Trochlear

• VI — Abducens

Expected finding

The patient follows commands without involuntary eye movement.

14. EYE VOCABULARY

Nystagmus

Nystagmus is involuntary eye movement.

Unexpected finding:

Involuntary eye movement during assessment.

Strabismus

Strabismus is abnormal alignment of the eyes.

Unexpected finding:

Eyes are not properly aligned.

Ptosis

Ptosis is drooping of the eyelid.

It is an abnormal eye finding identified through inspection.

Exophthalmia

Exophthalmia refers to abnormal protrusion of the eyeball.

It is an abnormal eye finding identified through inspection.

Visual acuity

Visual acuity refers to the clarity/sharpness of vision.

The material identifies the Snellen chart as the equipment used to assess visual acuity.

The Snellen chart is associated with testing cranial nerve II.

15. NOSE

Inspection

Assess:

• Symmetry

• Nasal patency

• Drainage

Expected findings

• Symmetrical nose

• Patent nasal passages

• No abnormal drainage

Unexpected findings

• Asymmetry

• Impaired patency

• Abnormal drainage

Sense of smell

The material identifies assessment of the sense of smell as testing:

Cranial nerve I — Olfactory

Epistaxis

Epistaxis means a nosebleed.

It is an abnormal finding that should be recognized during the health history or assessment.

16. MOUTH AND THROAT

Inspection

Assess:

• Symmetry

• Lips

• Mucosa

• Teeth

• Sores

• Ulcers

• Edema

• Uvula rise/fall

• Speech pattern

Expected findings

Look for:

• Symmetry

• Expected appearance of lips and mucosa

• No sores or ulcers

• No abnormal edema

• Appropriate uvula movement

• Expected speech pattern

Unexpected findings

Look for:

• Asymmetry

• Sores

• Ulcers

• Edema

• Abnormal uvula movement

• Abnormal speech

17. DYSPHAGIA

Dysphagia means difficulty swallowing.

The health history specifically asks about difficulty swallowing.

Swallowing assessment is associated with cranial nerves:

• IX — Glossopharyngeal

• X — Vagus

18. GAG REFLEX

The gag reflex is assessed as part of the mouth/throat neurological examination.

The material associates the gag response with:

Cranial nerve IX — Glossopharyngeal

19. DYSPHASIA

Dysphasia refers to impaired language/speech ability.

Assess speech pattern during the mouth/neurological examination.

Related term: Aphasia

Aphasia is an abnormal language finding involving impaired ability to communicate through language.

Both should be recognized as abnormal neurological findings.

20. UVULA AND TONGUE

Assess:

• Uvula rise/fall

• Tongue movement

The material identifies tongue movement as testing:

Cranial nerve XII — Hypoglossal

21. NECK ASSESSMENT

Inspection

Assess:

• Symmetry

• Trachea

• Thyroid

• JVD

• Cervical spine ROM

• Shoulder shrug

Cranial nerve XI

The material identifies the shoulder shrug as testing:

Cranial nerve XI — Spinal Accessory

22. NECK PALPATION

Palpate:

• Trachea

• Thyroid

• Lymph nodes

• Carotid artery

Important safety point

Assess the carotid arteries one at a time.

23. THYROID

The thyroid is assessed through:

• Inspection

• Palpation

Goiter

A goiter is an enlarged thyroid gland.

It is an unexpected finding to recognize during assessment of the neck.

24. LYMPH NODE ASSESSMENT

Expected lymph-node findings

Lymph nodes may be:

• Nonpalpable

OR

• Small, less than 1 cm

• Soft

• Moveable

• Nontender

Unexpected lymph-node findings

Be alert for nodes that are:

• Large

• Tender

• Fixed in place

• Hard

Memory

Expected = small, soft, movable, nontender

Unexpected = large, tender, fixed, hard

25. CAROTID AUSCULTATION

The carotid arteries are auscultated for:

Bruit

A bruit is an abnormal sound heard during auscultation of a blood vessel.

The material specifically identifies carotid bruits as part of the neck assessment.

Equipment:

Stethoscope

Important:

The carotid arteries are assessed one at a time.

26. NEUROLOGICAL ASSESSMENT

The neurological assessment is integrated throughout the head and neck assessment.

The material specifically identifies:

• Level of consciousness

• Orientation

• Cranial nerves

• Sensory findings

• Motor findings

• Neurological symptoms

27. LEVEL OF CONSCIOUSNESS (LOC)

Level of Consciousness (LOC) describes the patient's state of awareness/responsiveness.

The material identifies five levels:

Alert

Patient is awake and responsive.

Lethargic

Patient has a decreased level of alertness.

Obtunded

Patient has a significantly decreased level of responsiveness.

Stupor

Patient has a severely decreased level of consciousness.

Comatose

Patient is in a state of unconsciousness.

28. GLASGOW COMA SCALE

The Glasgow Coma Scale (GCS) is a neurological assessment tool used to evaluate level of consciousness.

For this material, remember:

GCS = neurological assessment of consciousness.

The pasted material does not provide the individual scoring components, so those are not added here.

29. ORIENTATION

Assess orientation to:

1. Person

2. Place

3. Time

4. Situation

Example of an oriented patient

The patient should be able to correctly identify:

• Who they are

• Where they are

• The current time/date

• Why they are receiving care

Important

Orientation questions should be appropriate to the patient's situation and baseline.

30. NEUROLOGICAL VOCABULARY

Paresthesia

Abnormal sensation.

Ataxia

Impaired coordination.

Tremors

Involuntary shaking movements.

Paralysis

Loss or impairment of motor function.

Paresis

Weakness or partial loss of motor function.

Important comparison:

Paresis = weakness

Paralysis = loss/impaired motor function

Syncope

Temporary loss of consciousness.

Vertigo

A sensation of dizziness or spinning.

The health history specifically includes asking about dizziness.

Delirium

An abnormal change in mental status.

Dementia

Cognitive impairment.

Seizures

Neurological events that should be identified through health history and neurological assessment.

31. SEIZURE ASSESSMENT

When assessing a patient with a seizure history, ask:

• When was the last seizure?

• What does the seizure look like?

• What are the triggers?

• What medications are used for seizure management?

• Who manages the seizures?

• When was the last physician visit?

Nursing principle

A "yes" answer to seizure-history questions requires follow-up questions.

32. TREMORS

Tremors are involuntary shaking movements.

During neurological assessment, observe for unexpected involuntary movements.

33. DTR — DEEP TENDON REFLEX

Deep Tendon Reflex (DTR) is a neurological assessment of reflex response.

The equipment identified for reflex assessment is a:

Reflex hammer

34. CLONUS

Clonus is a neurological finding involving repetitive/involuntary muscle contractions.

It is an abnormal neurological finding to recognize during neurological assessment.

35. PROPRIOCEPTION

Proprioception refers to awareness of body position.

It is a sensory/neurological concept to recognize when assessing neurological function.

36. NEUROLOGICAL ASSESSMENT — SENSORY FUNCTION

Neurological assessment may involve evaluating sensory function.

Important vocabulary includes:

• Paresthesia

• Proprioception

• Facial sensation

The material identifies facial sensation as part of the cranial nerve assessment.

37. CRANIAL NERVES

There are 12 cranial nerves identified in the material.

38. CRANIAL NERVE ASSESSMENT

CN I — Olfactory

Assess:

Sense of smell

CN II — Optic

Assess:

Visual acuity

Use:

Snellen chart

CN III — Oculomotor

Assess:

• PERRLA

• Eye movements

CN IV — Trochlear

Assessed through:

EOM / six cardinal gazes

CN V — Trigeminal

Assess:

• Facial sensation

CN VI — Abducens

Assessed through:

EOM / six cardinal gazes

CN VII — Facial

Assess:

• Facial expressions

• Salivation

• Lacrimation

The material specifically mentions facial expressions, salivation, and lacrimation.

CN VIII — Acoustic

Assess:

Hearing

Example:

Whisper test

CN IX — Glossopharyngeal

Assess:

• Swallowing

• Gag response

CN X — Vagus

Assess:

Swallowing

CN XI — Spinal Accessory

Assess:

Shoulder shrug

CN XII — Hypoglossal

Assess:

Tongue movement

39. COMPLETE HEAD-TO-NECK ASSESSMENT FLOW

STEP 1 — HEALTH HISTORY

Ask about:

• Seizures

• Headaches/migraines

• Light sensitivity

• Past medical history

• Family history

• Medications

• Falls

• Dizziness

• Difficulty swallowing

• Vision changes

• Hearing changes

• Changes in smell/taste

STEP 2 — INSPECTION

Head

Assess:

• Appearance

• Symmetry

• Shape

• Size

• Smile

• Frown

Ears

Assess:

• Symmetry

• Drainage

• Lesions

Eyes

Assess:

• Eyelids

• Conjunctiva

• Sclera

• PERRLA

• EOM

Nose

Assess:

• Symmetry

• Nasal patency

• Drainage

Mouth

Assess:

• Symmetry

• Lips

• Mucosa

• Teeth

• Sores

• Ulcers

• Edema

• Uvula

• Speech pattern

Neck

Assess:

• Symmetry

• Trachea

• Thyroid

• JVD

• Cervical ROM

• Shoulder shrug

40. STEP 3 — PALPATION

Head

Palpate:

• Entire head

• Sinuses

• TMJ

• Sensation

Ears

Palpate:

• Outer ear

• Tenderness

Neck

Palpate:

• Trachea

• Thyroid

• Lymph nodes

• Carotid arteries one at a time

41. STEP 4 — AUSCULTATION

Auscultate:

Carotids

Listen for:

Bruits

Equipment:

Stethoscope

42. STEP 5 — NEUROLOGICAL ASSESSMENT

Assess:

LOC

• Alert

• Lethargic

• Obtunded

• Stupor

• Comatose

Orientation

• Person

• Place

• Time

• Situation

Cranial nerves

Assess the appropriate cranial nerves based on the examination.

Neurological findings

Watch for:

• Paresthesia

• Ataxia

• Tremors

• Paresis

• Paralysis

• Nystagmus

• Strabismus

• Ptosis

• Aphasia/dysphasia

• Dysphagia

• Seizures

• Syncope

• Vertigo

• Delirium

43. NORMAL/EXPECTED FINDINGS

Based on the material, expected findings include:

Head

• Symmetry

• Expected shape and size

• Expected facial movements

Normocephalic is an expected head finding.

Ears

• Symmetry

• No abnormal drainage

• No lesions

• No tenderness

Eyes

• Expected eyelid appearance

• Expected conjunctiva/sclera

• PERRLA

• EOM without involuntary movement

Nose

• Symmetry

• Patent nares

• No abnormal drainage

Mouth

• Symmetry

• Expected lips and mucosa

• No sores/ulcers

• No edema

• Appropriate uvula rise/fall

• Expected speech

Neck

• Symmetry

• Trachea appropriately assessed

• Expected thyroid

• Appropriate cervical ROM

• Appropriate shoulder shrug

Lymph nodes

Expected:

• Nonpalpable

OR:

• Small <1 cm

• Soft

• Moveable

• Nontender

Neurological

Expected findings include:

• Alert LOC

• Appropriate orientation

• Expected cranial nerve responses

• No abnormal involuntary movements

• Appropriate sensation

44. ABNORMAL/UNEXPECTED FINDINGS

Head/scalp

• Alopecia

• Nodule

• Abnormal shape/size

• Asymmetry

Eyes

• Nystagmus

• Strabismus

• Ptosis

• Exophthalmia

• Abnormal PERRLA

• Abnormal EOM

• Changes in visual acuity

Ears

• Drainage

• Lesions

• Tenderness

• Tinnitus

• Hearing changes

• Abnormal cerumen findings

Nose

• Epistaxis

• Drainage

• Impaired nasal patency

• Asymmetry

Mouth/throat

• Dysphagia

• Aphasia/dysphasia

• Sores

• Ulcers

• Edema

• Abnormal uvula movement

• Abnormal gag response

• Abnormal tongue movement

Neck

• Enlarged thyroid/goiter

• Abnormal lymph nodes

• JVD

• Abnormal cervical ROM

• Abnormal tracheal finding

• Carotid bruit

Neurological

• Altered LOC

• Disorientation

• Delirium

• Dementia

• Paresthesia

• Ataxia

• Tremors

• Paresis

• Paralysis

• Clonus

• Abnormal proprioception

• Seizures

• Syncope

• Vertigo

• Abnormal DTR

• Nystagmus

45. HIGH-YIELD VOCABULARY TABLE

46. EQUIPMENT MEMORY GUIDE

ALL ASSESSMENTS

Penlight

SELECT ASSESSMENTS

Ophthalmoscope → eye

Otoscope → ear

Tongue blade → mouth/throat

Snellen chart → visual acuity

Tuning fork → hearing

Reflex hammer → DTR

Stethoscope → auscultation/bruits

Tape measure → measurements

47. EXAM MEMORY GUIDE

"LOOK, FEEL, LISTEN"

LOOK = Inspection

• Head

• Eyes

• Ears

• Nose

• Mouth

• Neck

• LOC/neurological appearance

FEEL = Palpation

• Head

• Sinuses

• TMJ

• Sensation

• Ears

• Trachea

• Thyroid

• Lymph nodes

• Carotids

LISTEN = Auscultation

• Carotid arteries

• Listen for bruits

48. CRANIAL NERVE MEMORY

I — Olfactory

Smell

II — Optic

Vision

III — Oculomotor

PERRLA/EOM

IV — Trochlear

EOM

V — Trigeminal

Facial sensation

VI — Abducens

EOM

VII — Facial

Facial expression

VIII — Acoustic

Hearing

IX — Glossopharyngeal

Swallowing/gag

X — Vagus

Swallowing

XI — Spinal Accessory

Shoulder shrug

XII — Hypoglossal

Tongue movement

49. FINAL HEAD-TO-NEURO ASSESSMENT CHECKLIST

HISTORY

☐ Seizures
☐ Headaches/migraines
☐ Light sensitivity
☐ Past medical history
☐ Family history
☐ Medications
☐ Falls
☐ Dizziness/vertigo
☐ Dysphagia
☐ Vision changes
☐ Hearing changes/tinnitus
☐ Smell/taste changes

INSPECTION

☐ Head
☐ Ears
☐ Eyes
☐ Nose
☐ Mouth
☐ Neck
☐ LOC
☐ Orientation

PALPATION

☐ Head
☐ Sinuses
☐ TMJ
☐ Sensation
☐ Outer ears
☐ Trachea
☐ Thyroid
☐ Lymph nodes
☐ Carotids one at a time

AUSCULTATION

☐ Carotids
☐ Bruit

NEUROLOGICAL

☐ LOC
☐ Orientation
☐ Cranial nerves
☐ PERRLA
☐ EOM
☐ Sensation
☐ DTR
☐ Proprioception
☐ Coordination
☐ Gait/tandem walking
☐ Motor function
☐ Abnormal movements

50. MOST IMPORTANT TAKEAWAYS

1. Inspection, palpation, and auscultation are the primary techniques in this assessment.

2. Use the appropriate equipment for the assessment: penlight, ophthalmoscope, otoscope, tongue blade, Snellen chart, tuning fork, reflex hammer, stethoscope, and tape measure.

3. Assess the head, ears, eyes, nose, mouth, and neck systematically.

4. Neurological assessment is integrated throughout the head and neck examination.

5. Always assess LOC and orientation.

6. Know the 12 cranial nerves and what assessment corresponds to each.

7. Know PERRLA and EOM.

8. Assess the neck for thyroid enlargement, lymph-node abnormalities, JVD, and carotid bruits.

9. Expected lymph nodes are nonpalpable or small (<1 cm), soft, movable, and nontender.

10. Recognize abnormal neurological findings such as paresthesia, ataxia, tremors, paresis, paralysis, seizures, syncope, vertigo, delirium, and altered LOC.

11. Recognize abnormal head/eye/ear/nose findings such as alopecia, nodules, nystagmus, strabismus, ptosis, exophthalmia, tinnitus, epistaxis, and abnormal visual acuity.

12. Recognize abnormal mouth/neck findings such as dysphagia, aphasia/dysphasia, goiter, abnormal lymph nodes, and bruits.

13. A complete assessment combines health history + inspection + palpation + auscultation + neurological assessment.