Assessing Head and Neck

Objective 1: Describe the structures and function of the head and neck.

Head and cranium

The skull consists of the cranium and face.

Cranium

• Houses and protects the brain.

• Contains eight main bones according to the lecture.

The slide states eight bones but lists only seven; the remaining bone is not identified in the text.

Face

• Gives the face its shape.

• Contains 14 main bones.

• Only one facial bone is movable.

• Contains the temporal artery.

• Includes the parotid and submandibular salivary glands.

The lecture asks students to identify the movable bone without supplying the answer.

Neck

Structures include:

• Muscles

• Ligaments

• Cervical vertebrae

• Hyoid bone

• Larynx

• Trachea

Neck muscles and cranial nerve XI

The lecture identifies:

• Sternomastoid muscle

• Trapezius muscle

• Spinal accessory nerve (CN XI)

CN XI assessment: Shoulder shrugging and turning the head against resistance.

Neck blood vessels

• Internal jugular veins

• External jugular veins

• Carotid artery

Thyroid gland

• Identified as the largest endocrine gland.

• Produces thyroid hormones.

Major lymph nodes

• Preauricular

• Posterior auricular

• Occipital

• Superficial cervical

• Deep cervical

• Submental

• Submandibular

• Supraclavicular

Objective 2: Discuss risk factors associated with head and neck disorders across different cultures.

Risk factors and health history

The lecture identifies:

• Stress

• Poor posture

• Lack of exercise

• Nicotine use

• Alcohol use

• Previous head injuries

• Radiation therapy

• Family history of head or neck cancer

• Family history of migraines

Stress, poor posture, and lack of exercise may contribute to head and neck discomfort.

Cultural considerations

Nursing consideration: Be aware of cultural norms before touching or examining the head.

The lecture also emphasizes that normal facial structures and features vary across individuals and cultures.

It does not provide separate disease-risk rates for these cultural groups.

Objective 3: Interview the client for accurate assessment of the head and neck.

Importance of the interview

Symptoms can overlap across body systems.

For example, dizziness and lightheadedness may indicate cardiovascular problems.

COLDSPA

Use COLDSPA when assessing neck pain and headaches.

Subjective assessment

Ask about:

• Neck pain

• Headaches

• Difficulty moving the head or neck

• Lightheadedness or dizziness

• Spinning sensations

• Blurred vision

• Loss of consciousness

• Changes in skin, hair, or nail texture

• Changes in sleep, energy, or emotional stability

• Weakness or numbness of face, arms, or legs

The lecture also recommends a headache impact test.

Additional history

Objective 4: Use correct technique to perform a physical assessment of the head and neck.

Preparation

• Position client upright.

• Use gloves and a penlight or flashlight.

• Consider cultural needs.

Head assessment

Inspection

Assess:

• Size

• Shape

• Configuration

• Abnormalities

Do not routinely palpate unless a lump or lesion is suspected.

Face assessment

Inspect:

• Symmetry

• Features

• Movement

• Expression

• Skin conditions

Normal finding: Symmetrical face.

TMJ assessment

1. Place index fingers in front of each ear.

2. Ask the client to open their mouth.

3. Listen for grinding, clicking, or popping sounds.

Neck assessment

Inspect for:

• Symmetry

• Bulging masses

• Range of motion

Range-of-motion movements

• Turn head side to side.

• Touch chin to chest.

• Lift chin toward ceiling.

Additional assessments may include palpation of the trachea, thyroid, and lymph nodes.

Objective 5: Differentiate between normal and abnormal objective and subjective findings.

Normal findings

• Symmetrical face.

• Symmetrical neck.

• No bulging neck masses.

• Assessment of head size, shape, and configuration.

Abnormal findings

Older adult findings

• Arthritis or osteoporosis.

• Facial wrinkles.

• Lower face may appear shrunken.

• Reduced neck range of motion.

• Decreased flexion, extension, lateral bending, and rotation.

• Thyroid may feel irregular because of age-related fibrotic changes.

Analyzing data

The lecture recommends identifying abnormal findings and client strengths, clustering data, and selecting concerns.

Examples include:

• Opportunity to improve health: Client requests smoking-cessation information.

• Risk: Injury associated with poor posture.

• Actual: Poor activity level associated with fatigue and weakness.

• Actual: Poor swallowing associated with lack of gag reflex.

• Collaborative: Thyroid dysfunction.

• Collaborative: Cerebrovascular accident.

Objective 6: Describe the various types of headaches and assessment findings.

Headache comparison

Migraine statistics from lecture

10–20%

Women experience migraines

6%

Men experience migraines

Headache assessment

• Ask about headaches.

• Use COLDSPA.

• Complete the headache impact test referenced in the lecture.

Head and Neck: Final Review