1
Ch. 15: Assessing Head & Neck
Structure & Function:
Cranial bones – frontal, parietal, occipital and temporal
Facial bones – Zygomatic, maxilla, mandible
Symmetry of facial structures – eyebrows, eyes, ears, nose, mouth, palpebral fissures,
nasolabial folds also includes the temporal artery
Neck muscles – sternomastoid & trapezius-innervated by cranial nerve XI, spinal
accessory nerve; C7 vertebra prominens; neck also include blood vessels: internal jugular
veins, carotid arteries
Lymph Nodes: names and location, an enlarged hard, nontender nose on the left may be
metastasis
o Preauricular: in front of the ears
o Postauricular: behind the ears
o Occipital: at the posterior base of the skull
o Tonsillar: at the angle of the mandible; anterior edge of the sternomastoid muscle
o Submandibular: on the medial borer of the mandible
o Submental: a few centimeters behind the tip of the mandible
o Superficial cervical: in the area superficial to the SM
o Posterior cervical: in the area posterior to the SM & anterior to the trapezius in the
posterior triangle
o Deep cervical: deeply between the clavicles and the sternomastoid muscles
Know differences in abnormal lymph node findings
Acute infection:
Chronic infection:
Metastatic cancers: Virchow’s Node
Subjective Data: Know questions to ask and rationale
o Neck pain with muscular, cervical spine problems, stress, tension, meningitis
o Headaches: COLDSPA questions
Medications taken for headaches
Cough and difficulty swallowing?
Head injury? Regardless of when it happened (Snowboarding accidents)
Change in energy level, skin, hair and nails
Different types of Headaches (Sinus, Cluster, Tension, Migraine, Tumor-related)
Migraine headaches
o N/V and sensitivity to noise or light
o Visual disturbances, vertigo, tinnitus, numbness/tingling
o Located around eyes, temples, cheeks, forehead can last up to 3 days
o Precipitated by emotions, anxiety, ingestion of alcohol, chocolate, cheese
o Throbbing, severe; rest may bring relief
Cluster headaches
o Stabbing; tearing, lid drooping, red eye, runny nose
o Sudden onset; precipitated by alcohol
o Localized-eye and orbit; radiates to face, temporal regions
o Intense; movement, walking may relieve
, 2
Tension headache
o Dull, tight, stress, anxiety, depression
o Frontal, temporal or occipital area
o Lasts days, month, years
o Aching; relieved w/local heat, massage
Tumor-related
o Aching, steady; neurologic & mental symptoms, N/V
o Aggravated by coughing, sneezing, sudden movements
o Commonly occurs in the morning; lasts several hours
Sinus headache
o Deep, constant, throbbing pain; in 1 specific area of face or head (behind eyes)
o Occurs w/ a cold or acute sinusitis; nasal drainage, fever, congestion
o Pain worse with sudden head movements
o Lasts until underlying condition improves
Other causes
o Meningitis or encephalitis (nuchal rigidity & fever)
o Hypertension, fever
o Medications/substances
Oral contraceptives, bronchodilators, alcohol, nitrates, carbon
monoxide
COLDSPA elements and RED FLAG is severe headache in an adult or child
o Difficulty moving head or neck, lumps or lesions, dizziness, lightheaded, spinning
sensation, blurred vision, loss of consciousness; change in texture of skin, hair, nails,
weakness, numbness
o Head injury: with/without loss of consciousness; fall?
o Dizziness, lightheadedness, faintness (syncope), vertigo
o Past Health history, family history and lifestyle factors
Box 15-1 Signs and Symptoms of altered thyroid function-hypothyroidism/hyperthyroidism
Evidence-Based Information: Traumatic Brain Injury
o Hypothyroidism (Myxedema)
o Increased sensitivity to cold, constipation, depression, fatigue, heavier menstrual
periods, pale & dry skin, thin brittle hair/nails, weakness, unintentional weight
gain
o If untreated may decreased taste/smell, hoarseness, puffy face/hands/feet, slow
speech, thickening of skin, thinning eyebrows
o Hyperthyroidism (graves’ disease)
o Sudden weight loss without changes in appetite, increased appetite, tachycardia &
arrhythmia, nervousness anxiety & irritability, tremor in hands fingers, sweating,
changes in menstrual patterns, increased sensitivity to heat, changes in bowel
patters (more frequent), enlarged thyroid gland (goiter), fatigue, insomnia, muscle
weakness
o Traumatic brain injury
, 3
o Results from a bump, jolt, blow or penetrating injury to the head (falls, MVA,
assaults, struck by or against solid surfaces)
o Risk assessment
Age, transportation accidents, violence, falls, excessive ETOH, infants and
elderly being cared for by caregivers
o Client education
Seat belts, car seats
avoid driving under the influence of alcohol
helmets/head gear w/ risky activities, contact sports, skateboards; baseball,
horseback riding, skiing.
Seniors: removing trip hazards; using nonslip mats, install grab bars
o Bell’s palsy
o Lower motor neuron
o CN VII; Complete paralysis of 1⁄2 face
o Usually unilateral
o Cannot wrinkle forehead, raise eyebrow, close eye, whistle, or show teeth on
affected side
o Can start suddenly and peaks w/in 48 hrs.
o Occurs often in pregnant women
o Brain attack (CVA)
o Upper motor neuron
o Neurological deficit
o Paralysis of lower facial muscles; upper half not affected
Objective Data: Pay attention to procedure/technique, normal and abnormal findings.
Inspect and palpate the head for size, shape, and configuration/consistency
o Normocephalic, hard, smooth, symmetric without lesions
o Head is still, upright
– No involuntary movements
o Abn. Microcephaly, acromegaly, jerking or nodding movements, head tilt;
shortening of the sternomastoid muscle; malignant lumps; parotid enlargement
Temporal artery: Should be elastic & nontender
Ch. 15: Assessing Head & Neck
Structure & Function:
Cranial bones – frontal, parietal, occipital and temporal
Facial bones – Zygomatic, maxilla, mandible
Symmetry of facial structures – eyebrows, eyes, ears, nose, mouth, palpebral fissures,
nasolabial folds also includes the temporal artery
Neck muscles – sternomastoid & trapezius-innervated by cranial nerve XI, spinal
accessory nerve; C7 vertebra prominens; neck also include blood vessels: internal jugular
veins, carotid arteries
Lymph Nodes: names and location, an enlarged hard, nontender nose on the left may be
metastasis
o Preauricular: in front of the ears
o Postauricular: behind the ears
o Occipital: at the posterior base of the skull
o Tonsillar: at the angle of the mandible; anterior edge of the sternomastoid muscle
o Submandibular: on the medial borer of the mandible
o Submental: a few centimeters behind the tip of the mandible
o Superficial cervical: in the area superficial to the SM
o Posterior cervical: in the area posterior to the SM & anterior to the trapezius in the
posterior triangle
o Deep cervical: deeply between the clavicles and the sternomastoid muscles
Know differences in abnormal lymph node findings
Acute infection:
Chronic infection:
Metastatic cancers: Virchow’s Node
Subjective Data: Know questions to ask and rationale
o Neck pain with muscular, cervical spine problems, stress, tension, meningitis
o Headaches: COLDSPA questions
Medications taken for headaches
Cough and difficulty swallowing?
Head injury? Regardless of when it happened (Snowboarding accidents)
Change in energy level, skin, hair and nails
Different types of Headaches (Sinus, Cluster, Tension, Migraine, Tumor-related)
Migraine headaches
o N/V and sensitivity to noise or light
o Visual disturbances, vertigo, tinnitus, numbness/tingling
o Located around eyes, temples, cheeks, forehead can last up to 3 days
o Precipitated by emotions, anxiety, ingestion of alcohol, chocolate, cheese
o Throbbing, severe; rest may bring relief
Cluster headaches
o Stabbing; tearing, lid drooping, red eye, runny nose
o Sudden onset; precipitated by alcohol
o Localized-eye and orbit; radiates to face, temporal regions
o Intense; movement, walking may relieve
, 2
Tension headache
o Dull, tight, stress, anxiety, depression
o Frontal, temporal or occipital area
o Lasts days, month, years
o Aching; relieved w/local heat, massage
Tumor-related
o Aching, steady; neurologic & mental symptoms, N/V
o Aggravated by coughing, sneezing, sudden movements
o Commonly occurs in the morning; lasts several hours
Sinus headache
o Deep, constant, throbbing pain; in 1 specific area of face or head (behind eyes)
o Occurs w/ a cold or acute sinusitis; nasal drainage, fever, congestion
o Pain worse with sudden head movements
o Lasts until underlying condition improves
Other causes
o Meningitis or encephalitis (nuchal rigidity & fever)
o Hypertension, fever
o Medications/substances
Oral contraceptives, bronchodilators, alcohol, nitrates, carbon
monoxide
COLDSPA elements and RED FLAG is severe headache in an adult or child
o Difficulty moving head or neck, lumps or lesions, dizziness, lightheaded, spinning
sensation, blurred vision, loss of consciousness; change in texture of skin, hair, nails,
weakness, numbness
o Head injury: with/without loss of consciousness; fall?
o Dizziness, lightheadedness, faintness (syncope), vertigo
o Past Health history, family history and lifestyle factors
Box 15-1 Signs and Symptoms of altered thyroid function-hypothyroidism/hyperthyroidism
Evidence-Based Information: Traumatic Brain Injury
o Hypothyroidism (Myxedema)
o Increased sensitivity to cold, constipation, depression, fatigue, heavier menstrual
periods, pale & dry skin, thin brittle hair/nails, weakness, unintentional weight
gain
o If untreated may decreased taste/smell, hoarseness, puffy face/hands/feet, slow
speech, thickening of skin, thinning eyebrows
o Hyperthyroidism (graves’ disease)
o Sudden weight loss without changes in appetite, increased appetite, tachycardia &
arrhythmia, nervousness anxiety & irritability, tremor in hands fingers, sweating,
changes in menstrual patterns, increased sensitivity to heat, changes in bowel
patters (more frequent), enlarged thyroid gland (goiter), fatigue, insomnia, muscle
weakness
o Traumatic brain injury
, 3
o Results from a bump, jolt, blow or penetrating injury to the head (falls, MVA,
assaults, struck by or against solid surfaces)
o Risk assessment
Age, transportation accidents, violence, falls, excessive ETOH, infants and
elderly being cared for by caregivers
o Client education
Seat belts, car seats
avoid driving under the influence of alcohol
helmets/head gear w/ risky activities, contact sports, skateboards; baseball,
horseback riding, skiing.
Seniors: removing trip hazards; using nonslip mats, install grab bars
o Bell’s palsy
o Lower motor neuron
o CN VII; Complete paralysis of 1⁄2 face
o Usually unilateral
o Cannot wrinkle forehead, raise eyebrow, close eye, whistle, or show teeth on
affected side
o Can start suddenly and peaks w/in 48 hrs.
o Occurs often in pregnant women
o Brain attack (CVA)
o Upper motor neuron
o Neurological deficit
o Paralysis of lower facial muscles; upper half not affected
Objective Data: Pay attention to procedure/technique, normal and abnormal findings.
Inspect and palpate the head for size, shape, and configuration/consistency
o Normocephalic, hard, smooth, symmetric without lesions
o Head is still, upright
– No involuntary movements
o Abn. Microcephaly, acromegaly, jerking or nodding movements, head tilt;
shortening of the sternomastoid muscle; malignant lumps; parotid enlargement
Temporal artery: Should be elastic & nontender
