JL

Objectives of Assessment

  • Review process of assessment.
  • Relate anatomy and physiology knowledge to Head, Nose, Neck & Throat (HNNT) assessment.
  • Describe relevant general survey data.
  • Identify pertinent health history questions related to HNNT.
  • Demonstrate land-marking for assessment of HNNT.
  • Choose appropriate assessment techniques and equipment.
  • Describe expected findings from assessments.
  • Recognize red flags during assessments.

Process of Assessment

  • General Survey
  • History
  • Physical Examination

General Survey Aspects:

  • Skin Colour & Obvious Lesions: Assess for any abnormal changes in skin appearance.
  • Dress, Grooming & Hygiene: Note the patient's personal care and presentation.
  • Facial Expression & Eye Contact: Observe appropriateness of facial responses and expressions.
  • Body Odours: Pay attention to any unusual body odors or breath smells.
  • Posture & Motor Activity: Assess the patient's movement and stability.

Health History Components (AMI P FROSSST):

  • A: Allergies
  • M: Medications
  • I: Immunizations
  • P: Previous Medical History
  • F: Family History
  • R: Review of Systems
  • O: Occupation / Education
  • S: Social History
  • S: Substance use
  • S: Sex Life
  • T: Travel / Sick Contacts

Symptom Review Techniques (OLDCARTS & PAMFROSSST):

  • OLDCARTS:

    • O: Onset
    • L: Location
    • D: Duration
    • C: Characteristics
    • A: Aggravating/Alleviating factors
    • R: Radiating
    • T: Timing
    • S: Severity (0-10 scale)

  • PAMFROSSST:

    • P: Presenting Illness
    • C: Chief Complaint

Physical Examination Guidelines

  • General Tips:
    • Physical exam length varies based on complexity.
    • Be systematic and thorough.
    • Ensure patient's comfort and privacy.
    • Warm hands and avoid long fingernails.
    • Logically palpate tender areas last.
    • Be aware of signs of abuse or maltreatment.

Sequence for Abdominal Assessment:

  • Inspection, Auscultation, Percussion, Palpation

Auscultation Techniques:

  • Listen for bowel sounds in each quadrant for at least 15 seconds.

Inspection Guidelines:

  • Inspect all skin areas and ensure bright lighting.
  • Look for malodors, asymmetry, color changes, rashes, and skin integrity.

Palpation Techniques:

  • Assess for texture, size, consistency, tenderness, etc.

Percussion Techniques:

  • Requires advanced skills; listen for specific resonances.

Head, Face, Neck & Throat (HNNT) Assessment

  • Varied origins of HNNT disorders.
  • Important to investigate acute/chronic issues thoroughly.
  • Neurological concerns alerted by syncope, dizziness, or unusual sensation.
  • Changes in taste, smell, or swallowing could indicate serious conditions.

Expected Findings:

  • Level of Consciousness: Awake, alert, and communicative.
  • Speech and movement should be appropriate and functional.

Common Problems in HNNT

  • Headaches, jaw pain, facial trauma, swelling, numbness, difficulty swallowing, etc.

Cranial Nerve Assessment

  • Assess CN I (Olfactory) smell; CN II (Optic) vision using Snellen chart; demonstrate other cranial nerves using specific tests for function and dysfunction.

Functions/Dysfunctions of Cranial Nerves:

  • Each cranial nerve has specific functions (e.g., movement, sensation).
  • Understanding dysfunctions can guide diagnosis.

Red Flags to Recognize in Assessment

  • Severe headaches in patients without history.
  • Persistent pain linked to other alarming signs (stiff neck, fever).
  • Neurological and motor changes should raise immediate concern.

References

  • Stephen, T.C. & Skillen, D.L. (2021). Canadian nursing health assessment: A best practice approach. Second edition. Wolters Kluwer.