Head and Neck Assessment with Vision and Hearing Basics

Chapter 12: Head and Neck Assessment

Overview

• Assessment includes examination of the head, neck, vision, and hearing.

The Head

Skeletal Structures

• Cranium and facial skeleton, held together by sutures.

Muscles

• Involved in chewing, speaking, smiling, and frowning.

Blood Supply

• Supplied by carotid arteries and drained by jugular veins.

Nerve Supply

• Trigeminal nerve (Cranial Nerve V).

Salivary Glands

• Parotid, submandibular, sublingual glands.

Vision

• PERRLA: Pupils are equal, round, reactive to light and accommodation, indicating normal function.

• Main components: Cornea, central fovea, retina.

• Neural pathway includes optic nerves, optic chiasm, and optic tracts, which are part of the central nervous system.

• if your pupils are less than 3 pinpoint and greater than 7 dialated, it may indicate potential neurological issues that require further evaluation. Assessing the reaction of the pupils to light and accommodation is crucial in determining the health of the optic nerves and the overall function of the visual pathway.

Hearing

External Auditory Canal

• Includes the tympanic membrane.

Middle Ear

• Contains ossicles and oval window.

Inner Ear

• Comprises cochlea, organ of Corti, and auditory nerve.

The Neck

Cervical Vertebrae

• C1 to C7 with C7 being the vertebral prominence.

Neck Muscles

• Sternocleidomastoid and trapezius.

Trachea

• Important anatomical landmark known as Adam’s apple.

Thyroid and Parathyroid Glands

• Usually not palpable.

Lymphatics

• Includes lymph nodes: preauricular, posterior auricular, occipital, superficial cervical, deep cervical, posterior cervical, submental, submandibular, tonsillar, supraclavicular.

• Approximately 80 lymph nodes in the head and neck; enlargement may indicate upstream inflammation or infection.

Older Adults

• Changes may include:

  • Wrinkling, sagging skin, and skin lesions.

  • Hair thinning.

  • Exaggerated concave curve of the spine and reduced neck range of motion.

  • Common conditions: Hypothyroidism and Hyperthyroidism.

Cultural Variations & Health Disparities

• Variations include skin color and feature shapes.

• Hypothyroidism more common in older females; Hyperthyroidism more common in females and among African Americans compared to Whites.

• Thyroid cancer prevalence higher in females, especially Asian/Pacific Islanders and Whites.

Priority Urgent Assessment

Acute Head and Neck Injuries

• Focus on stabilizing head and neck; conducting trauma assessments.

• Neck pain typically due to muscle tension or spasm; watch for signs of fever and headache which may suggest cardiac issues.

Lymphatics Assessment

• Enlarged lymph nodes (> 1 cm) that are fixed, irregular, or hard require emergency investigation for cancer.

Hyperthyroidism

• Also termed thyroid storm or crisis; associated with tachycardia and hypermetabolism.

• Acute bacterial thyroiditis poses high risk for airway compromise.

Subjective Data Collection

Risk Factors

• Past medical history, lifestyle habits, medications, family history.

Teaching and Health Promotion

• Focus on injury risk reduction, thyroid disorder complication prevention, cancer risk factors: male gender, age over 50, tobacco, alcohol.

Common Signs and Symptoms

• Include headache, neck pain, limited neck movement, facial pain, lumps, hypothyroidism, hyperthyroidism, sleepiness, and cultural considerations.

Objective Cues

Head and Neck Techniques

• Inspect head, vision, hearing, hair, neck; palpate scalp, thyroid, lymph nodes; auscultate thyroid if enlarged.

Equipment Needed

• Ambient lighting, penlight, gloves, stethoscope, small cup of water.

Preparation

• Patient should remove wigs, wash hands, and sit facing the examiner; instruct on the process.

Comprehensive Physical Examination

Inspection

• Assess head, facial features, hair, eyes, external ear, neck, trachea, cervical spine.

Palpation

• Check temporal artery, scalp, thyroid, and lymph nodes.

Auscultation

• Consider if thyroid is enlarged.

Clinical Decisions

• Analyzing lab tests (radiographs, CT, MRI, etc.), prioritize findings, collaborate with the healthcare team, and evaluate outcomes.

Questions

Q1

• Expected finding with neck palpation is lymph nodes larger than 1 cm? False.

• 1 cm, fixed, irregular, hard require emergency investigation for cancer.

Q2

• Is it important for the nurse to auscultate the thyroid gland during a comprehensive assessment? False.

• Auscultation is focused and only if the thyroid appears enlarged.