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.