HEENT Nursing Assessment

HEENT Assessment
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In This Article

Down N Dirty on Pharm Basics: 60-Second Summary

About the HHENT Assessment

Head

Eyes

Ears

Throat

References and Nursing Resources

About the HEENT Assessment

Components of the HEENT Assessment

Head: Cranial assessment, jaw palpation, and inspection of the face

Eyes

Ears

Nose

Throat and oral cavity: Palpation and inspection of the thyroid gland

Head

Cranial Assessment

Nits

Hair distribution patterns

Cranial shape and size

Infants: fontanels and sutures

Face Inspection

Face shape

Fat distribution patterns

Symmetry of the eyes, eyebrows, nose, mouth, and ears

Stable with attempts at manipulation

Jaw Palpation

The temporomandibular joint is palpated for crepitation

The patient opens and closes the jaw as the nurse listens for audible clicks

Abnormal Findings of the Cranium and Face

Acromegaly: massive face, elongated head, prominent nose and lower jaw, heavy
eyebrow ridge, and coarse facial features

Bells palsy: asymmetry of palpebral fissures as a result of cranial nerve VII

damage

Cushings syndrome: moon face and buffalo hump, prominent jowls, erthymia of
the cheeks, and hirsutism (facial hair in women) on the upper lip, lower cheeks, and
chin

Kyphosis: head and neck is extended forward

Hematoma

Parkinson disease: mask-like expression or flat affect, elevated eyebrows, a

staring gaze, and drooling

TMJ (lock jaw): crepitation in the temporomandibular joint

Xerostomia (dry mouth)

Abnormal Cranial Findings in the Infant

Craniosynostosis: a deformity of the skull caused by premature closing of the

sutures

Hydrocephalus: enlarged head that results form increasing intracranial pressure

secondary to accumulation of cerebrospinal fluid

Cephalhematoma: a subperiosteal hemorrhage caused by bleeding into

the periosteum

Caput succedaneum: edematous swelling and ecchymosis of the head

resulting from birth trauma

Eyes
Interview Questions Regarding the Eyes

Visual changes

Pain

Photophobia

Blurred vision, diplopia

Spots, floaters

Itching or discharge

Inspecting the Eyes

Pupils: Size, shape, and reaction to light

PERRLA

EOMs (extraocular movements)

Conjunctivae and lids

Ophthalmoscopic examination: Usually performed by a specialist

Normal Findings of the Eyes

PERRLA noted

Pupils of normal size, shape, and react bilaterally to light

Vision and extraocular movements intact

Conjunctivae and lids non-inflamed

Ears
Anatomy and Function of the Ears

Inner ear: Cochlea. The cochlea interprets amplitude (volume) and frequency
(pitch). The cochlear window is also known as the round window

Middle ear: Includes the Eustachian tube (ear canal), oval window, round window,
and tympanic membrane. Many NCLEX-style questions regarding the ear are focused
on the tympanic membrane, especially the appearance

Pinna, helix, and tragus

External canal

Interview Questions Regarding the Ears

Hearing changes

Use of hearing aids

Habits that could affect hearing (loud music, occupational hazards)

Inspecting the Ears

Otoscopic examination of the external auditory canals

Otoscopic examination of the tympanic membranes

The exam begins with inspection of the ears for cerumen impaction, foreign body, infection,
inflammation, or tympanic membrane perforation or scarring that can affect hearing loss and related
issues. Otoscopy might reveal a blue or red mass behind the tympanic membrane in cases of
pulsatile tinnitus caused by vascular origin.
Cranial nerves are assessed to evaluate hearing loss or brainstem dysfunction
Hearing is assessed through methods such as the whisper test, Weber test, and Rinne tests. This
identi to determine any sensorineural or conductive hearing loss (see Determining the type of
hearing loss).18,19 An oral inspection can reveal any dental issues or palatal muscle contractions.
Temporomandibular joint (TMJ) dysfunction should be assessed, noting any snapping or clicking

during palpation. See more at: http://www.nursingcenter.com/lnc/cearticle?

tid=1436010#sthash.AFHhow1Q.dpuf

Normal Findings of the Ears

Hearing intact

External ears: symmetrical, no deformities

Darwins tubercle: painless nodules on the helix

Tympanic membrane: bilaterally pink, pearly colored

Abnormal Findings of the Ear

Hearing loss: Sensorineural, conductive, or presbycusis

External ears: Asymmetrical, deformities

External canal: Inflammation, redness, purulent discharge

Tinnitus: Ringing in the ear

Tympanic membrane: Foreign body present, excessive cerumen, blood or

hemotympanum

Vertigo: Altered balance that may be associated with an ear infection

Conditions of the Ear

Acoustic neuroma: Sensorineural hearing loss and tinnitus

Benign positional vertigo: Sudden onset of episodes of nausea, spinning

sensation that worsens head position changes

Otitis externa: Also known as swimmers ear, an infection that occurs in the
external ear. Presents with pain and swelling of the ear canal, fever, and purulent
drainage from the external canal

Otitis media: Infection that occurs behind the tympanic membrane; presents with
purulent discharge, and pain in the tragus and pinna. The tympanic membrane
appears as bright red. Common in children

Menieres disease: Sensorineural hearing loss and tinnitus

Perforated tympanic membrane: Presents with drainage in the ear canal and pain
resulting from high pressure in the ear. Visible upon otoscopic examination of the
tympanic membrane. Pain is usually relieved once the pressure in the ear is released

Four Major Forms of Hearing Loss

1.

Sensorineural hearing loss: Associated with inner ear damage, such as the
cochlea or auditory nerve. It may result from genetic anomalies, ototoxic
drugs, Menieres disease, or infections that damage the cochlea or the auditory nerve

2.

Presbycusis: A type of sensorineural loss caused by changes in the inner ear.

Common in older adults, it usually presents with progressive bilateral hearing loss
of high-pitched tones, acuity, auditory threshold, and pitch

3.

Conductive hearing loss: Involves hearing loss in the external or middle ear that
impacts the transmission of sound waves. It usually results from a physical
disruption, such as perforation, infection, otosclerosis, or an obstruction, including a
foreign body or severecerebrum build-up

4.

Mixed hearing loss: Associated with factors related to both sensorineural and
conductive causes of hearing loss. Damage is present in multiple areas, such as the
outer or middle ear, along with the inner ear (cochlea) or auditory nerve (AdamsWendling, Pimple, Adams, & Titler, 2008)

There are three major categories of hearing loss in older adults:

Sensorineural hearing loss is the result of damage to the inner ear, including the .
Common causes include birth-related causes; heredity; viral or bacterial infections;
mumps; spinal meningitis; encephalitis; trauma; tumors; noise; hypertension;
coronary artery or vascular disease; ototoxic drugs, including aminoglycosides,
diuretics, some antibiotics, and cancer medications; and (National Institute of
Neurological and Communicative Disorders and Stroke [NINCDS], 1982, 1984).

Presbycusis, the most common kind of hearing impairment in older adults, is

defined as a ear (Bagai et al., 2006; Gates & Mills, 2005). Presbycusis is the term
most often used to describe hearing impairment that is age related and generally
presents as a gradual and . With presbycusis, there is a loss of high-pitched tones
(1,000 to 8,000 Hz) in . Consonants such as f, sh, ch, h, t, p, and s are high-frequency

sounds that become inaudible with presbycusis, resulting in the inability to

comprehend words (Bagai et al., 2006;Brender, Burke, & Glass, 2006; Wallhagen et
al., 2006).

Conductive hearing loss results from a in the ear transmission of sound waves
through the external or middle (Ignatavicius & Workman, 2006; Wallhagen et al.,
2006). Causes of conductive hearing loss include external blockage, perforated
eardrum, genetic or congenital abnormality, otitis media, and otosclerosis (Bagai et
al., 2006; Wallhagen et al., 2006). The most common cause of conductive hearing
loss in older adults is buildup of cerumen in the auditory canal (Wallhagen et al.,
2006; Zivic & King, 1993). As individuals age, cerumen becomes drier, and the cilia
become coarse and stiff, reducing their function and causing cerumen buildup (Zivic
& King, 1993). Cerumen impaction obstructs sound transmission and can cause up to
a 40 to 45 dB loss (Meador, 1995; Zivic & King, 1993). The estimated incidence of
cerumen impaction in nursing home residents is nearly 40% (Freeman, 1995).

Mixed hearing loss includes both conductive and sensorineural components (Bagai et al.,
2006; Kennedy-Malone et al., 2004). In other words, there may be .

Rinne Test and Conductive Hearing Loss

The Rinne test assesses for hearing loss related to air conduction. It uses a tuning fork to measure
bone conduction (BC) versus air conduction (AC). Normally, bone conduction hearing is longer or
equal to air conduction. In patients with conductive hearing loss, air conduction is heard longer than
bone conduction. To conduct the Rhinne test, strike a tuning fork against a hard object in order to
produce a vibration. Place the base of the vibrating instrument on the patients mastoid bone.
Instruct the patient to report when the vibration is no longer heard. Once the noise is no longer
heard, the tuning fork is placed in front of the ear. If the patient can not hear the vibration, the Rinne
test is said to be positive. A positive Rinne test indicates conductive hearing loss

Weber Test and Unilateral Hearing Loss

The Weber test evaluates unilateral hearing loss

Whisper Test and Conductive Hearing Loss

The Whisper test evaluates loss of high-frequency sounds

Communication and Patients with Hearing

Loss

Face the patient so your face in in direct view

Avoid ambient noise (background noise)

Do not raise your voice but talk slow and clear

Use plain English (Adams-Wendling, Pimple, Adams, & Titler, 2008)

Do not yell into the good ear

Do not assume thy can understand you

Nose
Interview Questions Regarding the Nose

Nasal discomfort

Epistasis (nosebleed)

Sinus issues

Rhinorrhea

Congestion

Inspecting the Nose

Nasal septum midline

nasal mucosa

Turbinates

Throat

Normal Swallowing Process

Oral: tongue propels mass towards oropharynx, and then muscle of the pharynx
(risk: pocketing and aspiration)

Pharyngeal: propelled to the oropharynx, which triggers the swallow reflex

Esophageal

Palpation of the Throat

Normal finding: neck is supple

Trachea

Lymph nodes

Salivary glands

Thyroid gland

Normal Findings in the Neck

Neck: supple

Clavicles: symmetrical

Trachea: midline

Thyroid gland: no masses and not enlarged

Abnormal Findings in the Neck

Neck: non-supple, vertebral point, paraspinal tenderness, step-offs, palpable

muscular spasms, jugular vein distention, thyromegaly,
lymphadenopathy, trachea deviated from midline, carotid bruits

Clavicles: crepitus, asymmetrical

Trachea: deviated from midline

Thyroid gland: masses, lumps, or enlargement (thyromegaly is an enlarged

thyroid gland; similar to a goiter)

Oral Cavity
Interview

Have you ever had your tonsils removed?

Do you have a history of frequent infections of your tonsils (tonsillitis)?

Difficulty chewing?

Oropharynx Inspection

Appearance of the tongue

Oral mucosa

Salivary glands

Hard and soft palates

Palatine tonsils

Salivary Glands

Sublingual salivary glands

Submandibular salivary glands

Parotid glands: not normally palpable

Normal Findings

Mouth: clear of lacerations or deformities

Tonsils: same color as the surrounding mucous membrane, granular appearance

with deep crypts on the surface

Oral mucosa: mucous membranes should appear to be pink and not inflamed

Abnormal Findings of the Oral Cavity

Abnormal findings of the tongue: enlarged, strawberry-like appearance, or furry

Tonsils: tonsillitis, peritonsillar abscess, or tonsil asymmetry

Laryngospasm

Lymph Node Assessment

Lymph Node Palpation

Lymph nodes are mobile- they can be moved up and down and side to side

Muscles and arteries cant be moved in this way

The lymph nodes can be palpated on the neck, axillae, groin, or other areas

Lymph Nodes

Axillary lymph node

Preauricular nodes: in front of the ear

Posterior auricular nodes: superficial to the mastoid process

Occipital nodes: base of the skull

Submental nodes: midline behind the tip of the mandible

Submandibular nodes: midway between the angle of the mandible and its tip

Jugulodigastric nodes: under the angle of the mandible

Superficial cervical nodes: overlay the sternomastoid muscle

Deep cervical nodes: deep under the sternomastoid muscle

Posterior cervical nodes: posterior triangle along the edge of the trapezius
muscle

Supraclavicular nodes: above and behind the clavicle, at the sternomastoid

muscle

Abnormal Findings of the Lymph Nodes

Infection

Swollen

Tender

Thyroid Gland Assessment

Thyroid Gland Function

Secretes thyroxine (T4) and tri-iodothyronine (T3), hormones that are imperative
to metabolic function

Thyroid Gland Palpation

Located on the midline of trachea

The thyroid cartilage lies above the thyroid isthmus and has a small palpable
notch

The thyroid gland normally enlarges during pregnancy

Abnormal Findings of the Thyroid Gland

Nodes, masses, and nodules

Hypothyroidism

Hyperthyroidism, most commonly caused by Graves disease