Health Assessment NUR 230 The Head and Neck

Common or Concerning Symptoms Head Eyes Ears Headache, history of head injury Visual disturbances,

Head – Inspection and Palpation • Inspect • Palpate – Hair distribution, quantity –

Eye Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eyes - Inspection • Position and alignment of eyes • Eyebrows – Quantity, distribution

Eyes – Techniques of Examination • Visual acuity – Distance/Central vision: Snellen eye chart;

Eyes – Techniques of Examination • Visual acuity Jaeger chart – Near vision: use

Eyes – Techniques of Examination (cont. ) • Visual fields by confrontation o sitting

Eyes – Techniques of Examination (cont. ) • Extraocular movements/six cardinal directions of gaze/wagon

Eyes – Techniques of Examination (cont. ) • Accommodation An object held about 10

Ears – Inspection and Palpation • Inspection – Auricle for redness, lesions – Ear

Straightening the Ear Canal and Inserting the Speculum Copyright © 2009 Wolters Kluwer Health

Ears – Hearing acuity Test one ear at a time § Whisper test –

Ears – Hearing acuity Air and bone conduction (AC and BC) – Rinne o

Ears – Hearing acuity Air and bone conduction (AC and BC) – Weber o

Ears – Romberg test: • Ask the patient to remain still and close their

Nose – Inspection/Palpation Inspection • Size, shape • Symmetry • Lesions/signs of infection •

Mouth and Pharynx - Inspection • Lips – • Tongue and floor of mouth

The Mouth and Gums Copyright © 2009 Wolters Kluwer Health | Lippincott Williams &

Under the Tongue Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Above and behind the tongue Copyright © 2009 Wolters Kluwer Health | Lippincott Williams

Neck – Inspection and Palpation • Inspection – Skin color, integrity, shape, and symmetry

Midline Structures of the Neck Copyright © 2009 Wolters Kluwer Health | Lippincott Williams

Neck – Thyroid Gland • Flex neck slightly forward • Place fingers of both

The thyroid can be examined while you stand in front of or behind the

Slides: 25

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Common or Concerning Symptoms Head Eyes Ears Headache, history of head injury Visual disturbances, use of corrective lenses, pain, redness, excessive tearing, double vision (diplopia) Hearing loss, ringing (tinnitus), vertigo, pain, discharge Nose Drainage (rhinorrhea), congestion, sneezing, nose bleeds (epistaxis) Oropharynx Sore throat, gum bleeding, hoarseness, Neck Swollen glands, goiter Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Head – Inspection and Palpation • Inspect • Palpate – Hair distribution, quantity – Hair texture – Skull – size, contour – Skull – lumps and lesions – Face – expression, and symmetry of structure – Skin – color, pigmentation – Skin – texture, temperature – Hair distribution, lesions Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eyes - Inspection • Position and alignment of eyes • Eyebrows – Quantity, distribution • Eyelids – Edema, color, lesions • Cornea and lens • Iris • Pupils – size, shape, symmetry, reaction to light • Conjunctiva and sclera – color, vascular pattern Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eyes – Techniques of Examination • Visual acuity – Distance/Central vision: Snellen eye chart; position patient 20 feet (6 meters) from the chart o Patients should wear glasses if needed o Test one eye at a time Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eyes – Techniques of Examination • Visual acuity Jaeger chart – Near vision: use (Jaeger or Rosenbaum chart (hand-held card) – can also use to test visual acuity at the bedside – hold 14 inches (about 30 cm) from patient’s eyes Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Rosenbaum chart

Eyes – Techniques of Examination (cont. ) • Visual fields by confrontation o sitting 60 -90 cm from you and at eye level o Test one eye at a time o The client’s peripheral visual fields are compared to that of the examiner. o This test assumes the examiner has normal peripheral vision Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Eyes – Techniques of Examination (cont. ) • Extraocular movements/six cardinal directions of gaze/wagon wheel method • The client must keep the head still while following a pen that you will move in several directions to form a star in front of the client’s eyes. • Always return the pen to the center before changing direction. Nystagmus: involuntary eye movement Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ears – Inspection and Palpation • Inspection – Auricle for redness, lesions – Ear canal o Discharge, foreign bodies, redness, swelling – Tympanic membrane (by Use otoscope ) o Color, contour • Palpation – Auricle for lumps, tenderness Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ears – Hearing acuity Test one ear at a time § Whisper test – Ask the client to occlude the other ear or the ear may be occluded by the nurse. – Cover your mouth so the client cannot see your lips – Standing 30 -60 cm behind patient, softly say “nine-four, ” “baseball” – Ask the client to repeat the phrase. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ears – Hearing acuity Air and bone conduction (AC and BC) – Rinne o Compare time of air vs. bone conduction o Place the base of the tuning fork on the client’s mastoid process- and note the number of seconds. o Then move the fork in front the external auditory meatus (1 -2 cm) o If bone conduction is equal or greater than air conduction, then suspect conductive hearing loss Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ears – Hearing acuity Air and bone conduction (AC and BC) – Weber o Lateralization of sound to impaired ear; suspect unilateral conductive hearing loss Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Ears – Romberg test: • Ask the patient to remain still and close their eyes (for about 20 seconds). • If the patient loses their balance, the test is positive. Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Nose – Inspection/Palpation Inspection • Size, shape • Symmetry • Lesions/signs of infection • Patency test • Septum (by use nasal speculum)-deviation, inflammation or perforation Palpate for tenderness, swelling Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mouth and Pharynx - Inspection • Lips – • Tongue and floor of mouth Note color, moisture, lumps, ulcers, cracking • Gums and teeth – Note color, presence and position of teeth • Roof of mouth – – Note color and texture, ulcers • uvula, tonsils, pharynx – Note color, symmetry, presence of exudate, swelling, ulceration or tonsillar enlargement Note color Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Neck – Inspection and Palpation • Inspection – Skin color, integrity, shape, and symmetry – Masses, scars, enlarged glands or lymph nodes – Thyroid gland - enlargement • Palpation – Trachea – position (should be midline) – Thyroid gland: consistency, masses, tenderness Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins

Neck – Thyroid Gland • Flex neck slightly forward • Place fingers of both hands with index fingers just below the cricoid cartilage • Ask patient to swallow; feel for the thyroid isthmus rising up under your finger pads (not always palpable) • Note the size, shape, and consistency • Identify any nodules or tenderness • If enlarged, listen over lateral lobes to detect a bruit Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins