NORTHWESTERN UNIVERSITY,INC

Laoag City, Ilocos Norte

II. HEAD AND NECK

ASSESSMENT NORMAL ABNORMAL

PROCEDURE
A. HEAD & FACE
(Inspection and
Palpation)
Usually the head is An abnormally small head.
1. Inspect the head. symmetric, round, erect, (MICROCEPHALY)
- size and in midline and
-shape appropriately related to An abnormally large head.
body size (MACROCEPHALY)
(NORMOCEPHALIC).
No lesions are visible. The skull and facial bones
are larger and thicker in
patients with
ACROMEGALY.
2. Inspect for involuntary Head should be still and Neurologic disorders may
movement. upright. cause a horizontal jerking
movement.
3. Palpate the head. The head is normally hard Lesions or lumps on the
and smooth, without head may indicate trauma
** Wear gloves to protect lesions. or sign of cancer.
yourself for possible
drainage.
4. Inspect the face. The face is symmetric with Drooping, weakness or
- symmetry a round, oval, elongated or paralysis on one side of the
-features square appearance. No face may result from a
-movement abnormal movements stroke (CVA) or Bell’s
-expression noted. palsy.
-skin condition
 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

A ‘mask-like” face marks

Parkinson’s disease; a
sunken face with
depressed eyes and hollow
cheeks is typical of
cachexia (emancipation or
wasting), and a pale,
swollen face may result
from nephrotic syndrome.
5. Palpate the temporal The temporal ear is elastic An acute urgent condition
artery. and not tender. is seen when the temporal
(located between the top artery is hard, thick and
of the ear and the eye) tender with inflammation,
as seen with temporal
arteritis. (which may lead
to blindness)
6. Palpate the Normally there is no Limited range of motion,
temporomandibular swelling, tenderness or selling, tenderness or
joint. (TMJ) crepitation with movement. crepitation may indicate
(place you index finger Mouth opens and closes TMJ syndrome.
over the front of each ear fully (3-6 cm between
as you ask the client to upper and lower teeth).
open the mouth.) Lower jaw moves laterally
1-2 cm in each direction.

B. NECK
(Inspection, Palpation,
Auscultation)

1. Inspect the neck. Neck is symmetric, with Swelling, enlarged masses

-position head centered and without or nodules may indicate an
-symmetry bulging masses. enlarged thyroid gland,
-lumps/masses inflammation of lymph
nodes or a tumor.

BSN NCM 101: HEALTH ASSESSMENT

Page 2 of 6
 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

(Shine a light from the

side of the neck across to
highlight any swelling.)
2. Inspect movement of The thyroid cartilage and Asymmetric movement or
the neck. the cricoid cartilage move generalized enlargement of
upward symmetrically as the thyroid gland is
(Ask the client to the client swallows. considered abnormal.
swallow a small sip of
water. Observe the
movement of the thyroif
cartilage, thyroid gland.)

3. Inspect the cervical C7 (VERTEBRAE Prominence or swelling

vertebrae. PROMINENCE) is usually other than the C7 vertebrae
visible and palpable. may be abnormal.
(Ask the client to flex the
neck.)

4. Inspect range of Normally neck movement Muscle spasms,

motion (ROM). should be smooth and inflammation or cervical
controlled. arthritis may cause
(Ask the client to turn the stiffness, rigidity and
head to the right and to Older Adult Consideration: limited mobility of the
the left (chin to Older clients usually have neck, which may affect
shoulder), touch each ear somewhat decreased daily functioning.
to the shoulder, touch flexion, extension, lateral
chin to chest, and lift chin bending and rotation of the
to the ceiling.) neck due to arthritis.
5. Palpate the trachea. The trachea is midline. The trachea is pushed to
the unaffected side in cases
of a tumor, enlarged
thyroid lobe,
 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

(Place your finger in the pneumothorax, or an aortic

sternal notch. Feel each aneurysm.
side of the notch and
palpate the tracheal rings.
The first upper ring
above the smooth
trachealis rings is the
cricoid cartilage.)
6. Palpate the thyroid Landmarks are positioned Landmarks deviate from
gland. midline. the midline or are obscured
due to masses or abnormal
Locate key landmarks growths.
with your index fingers
and thumb:
a. Hyoid bone- located
high in the anterior neck
b. Thyroid cartilage-
Adam’s apple
c. Cricoid cartilage-
smaller upper tracheal
ring under the thyroid
cartilage.

(Use a posterior Unless the client is In cases of

approach. Stand behind extremely thin with a long hyperthyroidism, Grave’s
the client and ask the neck, the thyroid gland is disease, or an endemic
client to lower the chin to usually not palpable. If the goiter, the thyroid gland
the chest and turn the thyroid can be palpated, the may palpated. Rapid
neck slightly to the right. lobes are smooth, firm and enlargement of a single
This will relax the nontender. The right lobe is nodule suggests a
client’s neck muscles. often 25 % larger than the malignancy and must be
Then place your thumbs left lobe. evaluated further.
on the nape of the client’s
neck with your other
fingers on either side of
the trachea below the

BSN NCM 101: HEALTH ASSESSMENT

Page 4 of 6
 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

cricoid cartilage. Use

your left fingers to push
the trachea to right. Then
use your right fingers to
feel deeply in front of the
sternomastoid muscle.
Ask the client to swallow
as you palpate the right
side of the gland. Reverse
the technique to palpate
the left lobe of the
thyroid.
7. Auscultate the thyroid No bruits are auscultated A soft, blowing, whishing
only if you find an sound auscultated over the
enlarged thyroid gland thyroid lobes is often heard
during inspection and in hyperthyroidism,
palpation. because of an increase in
blood flow through the
(Place the bell of the thyroid arteries.
stethoscope over the
lateral lobes of the
thyroid gland. Ask the
client to hold his or her
breath (to obscure any
tracheal breath sounds
while you auscultate)
C. LYMPH NODES OF
THE HEAD AND
NECK

a. Palpate the lymph No enlargement or Enlargement and

nodes. tenderness is present. tenderness are abnormal.
1. Preauricular nodes (in
front of the ear)
2. Postauricular nodes
(behind the ears)
 NORTHWESTERN UNIVERSITY,INC
Laoag City, Ilocos Norte

3.Occipital nodes
(posterior base of the
skull)
4. Submental nodes (few
centimeters behind the
tip of the mandible)
5. Submandibular nodes
(medial border of the
mandible)
6. Jugulodigastric node
(crosses the internal
jugular vein)
7. Superficial cervical
nodes(superficial to the
sternomastoid muscle)
8. Deep cervical chain
nodes (deeply within and
around the sternomastoid
muscle)
9. Posterior cervical
nodes (in the area
posterior to the
sternomastoid and
anterior to the trapezius
in the posterior triangle.
10. Supraclavicular
nodes ( hook your fingers
over the clavicles and
feeling deeply between
the clavicles and the
sternomastoid muscle)

BSN NCM 101: HEALTH ASSESSMENT

Page 6 of 6