ASSESSING THE HEAD,

NECK AND RELATED

LYMPHATICS
EDWIN DR. ABU RN,MN
FACULTY, COLLEGE OF NURSING
Ateneo de Zamboanga University

TERMINOLOGIES
ACROMEGALY An enlargement of the skull
and cranial bones due to increased growth
hormone.
ANTERIOR TRIANGLE One of the trapezius
muscles, also innervated by cranial nerve XI,
originates on the occipital bone of the skull and
spine of several vertebrae and the insertion of
these muscles is on the scapulae and lateral
third of the clavicles. The mandible, the midline
of the neck, and the anterior aspect of the
sternocleidomastoid muscles border this triangle.

 AXIS The second cervical vertebra (C2), allows for

movement of the head.
BELL'S PALSY A temporary disorder affecting cranial
nerve VII and producing a unilateral facial paralysis.
GOITER Enlarged thyroid caused by an iodine
deficiency.
HYDROCEPHALUS The enlargement of the head
caused by inadequate drainage of cerebrospinal fluid,
resulting in abnormal growth of the skull.

 HYPERTHYROIDISM The excessive

production of thyroid hormones,
resulting in enlargement of the gland,
exophthalmos (bulging eyes), fine hair,
weight loss, diarrhea, and other
alterations.
HYPOTHYROIDISM Metabolic disorder
causing enlarged thyroid due to iodine
deficiency.
HYOID A bone that is suspended in the
neck approximately 2 cm (1 in.) above

 POSTERIOR TRIANGLE One of the trapezius

muscles, also innervated by cranial nerve XI,
originates on the occipital bone of the skull and
spine of several vertebrae and the insertion of
these muscles is on the scapulae and lateral
third of the clavicles.
The trapezius muscle, the sternocleidomastoid
muscle, and the clavicle form the posterior
triangle.

 SUTURES Nonmovable joints.

THYROID GLAND The largest gland of the
endocrine system.It is butterfly shaped, and
is located in the anterior portion of the neck.
TORTICOLLIS A spasm of the
sternocleidomastoid muscle on one side of
the body, which often results from birth
trauma.

PURPOSES
Assess condition of clients head, neck,
thyroid gland and lymph nodes by
gathering subjective and objective data.
Use data to assess clients general
health condition.
Differentiate expected from unexpected
findings in physical assessment.

EQUIPMENTS

Prepare a warm, comfortable

and private assessment
environment.
Prepare the following
equipments: examination gloves,
glass of water, stethoscope

INTERVIEW ASSESSMENT
Do you have any problems that affect
your scalp?
Describe the condition of your scalp
today. Is it different from two months
ago, two years ago?
Have you experienced hair loss
(gradual, sudden, symmetrical). Have
you experienced recent change in

INTERVIEW ASSESSMENT
Is there anyone in your family who has had a problem
with their scalp or a problem that affected their scalp?
Do you have any problems that affect your neck or
thyroid (or trachea)
Neck pain, limitation of motion
Lumps or swelling
History of head or neck injury
Is there anyone in your family who has had a problem
with their thyroid (or trachea)?

PREPARATION
Know the norms or expected findings
to determine the meaning of the data
as one proceeds in the examination.
Identify client and introduce self.
Explain each step of the procedure,
including specific instructions about
what is expected of the client such as
removal of hats and jewelry may be
required for thorough assessment.

PREPARATION
Explain the purpose of each
procedure and if and when discomfort
will accompany any procedure.
Tell the client to inform you of any
discomfort or difficulty during the
assessment.
Provide for client privacy.
Perform hand hygiene and adhere to
standard precautions.

TECHNIQUE (HEAD EXAMINATION)

Practice proper hand hygiene before seeing

a client.
Ensure all equipments are properly cleaned.
After an assessment interview, instruct the
client by telling him/her that you will be
examining his/her head, neck and thyroid
gland.
It is best to have client sit comfortably. Start
by inspecting the face and hair.

 Ask client to remove items that would

interfere with the assessment including
jewelry, hairpieces or wigs.
Note facial expression, symmetry of
structure.
Note the size, shape, symmetry and
integrity of head and scalp. Identify
prominences or irregularities of the
head. Note any unexpected findings.
Put on gloves.

 Part the hair & systematically evaluate

the characteristics of the hair and
scalp. Evaluate hair distribution,
quality, quantity and hygiene.
Inspect scalp for scaliness, lesions or
foreign bodies
Thoroughly palpate scalp, noting
contour, size texture and areas of
tenderness.
Palpate the temporal artery. Palpate

Auscultate the temporal

artery. Use the bell of
stethoscope to auscultate for
a bruit or a soft blowing
sound.
Remove gloves and dispose

THYROID & LYMPH EXAMINATION

Inspect neck for skin color, integrity, shape
and symmetry.
Observe the carotid arteries and jugular
veins for distention or pulsations.
Palpate the external notch. Lightly palpate
the area and feel the C-rings of the trachea.
Identify the lateral borders of the trachea.
As the trachea begins to widen, you have
identified the thyroid cartilage. Continue to
slide your thumb and index finger high into
the neck.

 Inspect the thyroid gland. Distinguish

the thyroid from other structures in the
neck by asking the client to drink a sip
of water.
Palpate thyroid gland from behind the
client. As client swallows, it moves
superiorly.
With the fingers of your left hand, push
the trachea to the right. With your right
hand fingers, gently palpate the

 Palpate the hyoid bone. Confirm that the hyoid

bone and tracheal cartilages move when the
client swallows.
To evaluate the thyroid from the front, gently
displace the sternocleidomastoid muscle with
the left hand. Feel for any thyroid enlargement
of the right lobe as the client swallows.
Reverse the procedure for the left side.

 If the thyroid is enlarged, auscultate the

gland with the bell of the stethoscope. Note
any bruit or vascular sounds.
Palpate the lymph nodes by applying gentle
circular pressure with the finger pads of
both hands.
Begin with the pre-auricular.
Move next to the post-auricular and
occipital nodes.
Ask the client to bend head to relax the
muscles and make the nodes easier to

 Next, move more anteriorly to evaluate

the retro-pharyngeal and sub-maxillary
nodes. The submental nodes are located
directly under the chin.
There are additional lymph node chains
that should be evaluated. These include
the superficial cervical chain and the
deep cervical chain.
Finish the lymph node examination by
evaluating the supraclavicular lymph
nodes located superior to the clavicles.

SAMPLE
DOCUMENTATIONS

Nurses Notes

Subjective Data

Denies problems with the head and neck,

reports no current headache, no lesions,
and no changes in skin or hair. Recalls no
problem with swollen glands or breathing.
No personal or family history of headache,
allergy, or thyroid disease. Takes 2
Tylenol for occasional headache, that is
once a week during busy season at work
(1 month) and maybe one a month.
Headache is associated with lack of sleep
or stress and relieved with single dose (2

Objective Data
Skull round with symmetrical protuberances. Skull
nontender to palpation. Hair even distribution, scalp
free of lesions, clean. Eyebrows symmetrical, equal
distances of brow to pupil and outer canthus to
pinna. Nose is midline with equal nasolabial folds.
Lips symmetrical. Facial movement and expression
symmetrical. Trachea mobile, midline with palpable
C rings. TMJ movement smooth and symmetrical.
Thyroid nonpalpable, rises with swallow. Lymph
nodes of neck nonpalpable.

ASSESSMENT
FORM

General Overview
Skull: round, symmetrical
palpable Protuberances: symmetrical
rises with swallow Hair: even distribution

Neck
Trachea: midline, mobile, C rings
Thyroid: nonpalpable,
Lymph Nodes

Scalp: clean, no lesions

PALPABLE
NO
YES Eyes
Preauricular:
x
Brows: symmetrical
Postauricular:
x
Distance Brow to Pupil: equal
Occipital:
x
Distance Outer Canthus to Pinna:
equal
Retropharyngeal:
x
Nose
Submaxillary:
x
Position: midline
Submental:
x
Deviation: none, straight
Superficial cervical:
x Nasolabial Folds:
equal
Deep cervical:
x
Supraclavicular:
x
Mouth
Lips: symmetrical