Head and Neck

Technique	Findings
Head and Face
Observe head position
	EXPECTED: Upright, midline, still.
	UNEXPECTED: Tilted, horizontal jerking or bobbing, tics, nodding.
Inspect facial features
• Shape Observe eyelids, eyebrows, palpebral fissures, nasolabial folds, mouth at rest, during movement, with expression.	EXPECTED: Variations according to race, sex, age, body build.
	UNEXPECTED: Change in shape. Unusual features: edema, puffiness, coarsened features, prominent eyes, hirsutism, lack of expression, excessive perspiration, pallor, or pigmentation variations.
• Symmetry Note if asymmetry affects all features of one side or a portion of face.	EXPECTED: Slight asymmetry.
	UNEXPECTED: Facial nerve weakness or paralysis, or problem with peripheral trigeminal nerve.
Inspect skull and scalp
• Size/shape/symmetry • Scalp condition • Systematically part hair from frontal to occipital region. • Hair pattern Pay special attention to areas behind ears, at hairline, at crown.	EXPECTED: Symmetric.
	UNEXPECTED: Lesions, scabs, tenderness, parasites, nits, scaliness.
	EXPECTED: Bitemporal recession or balding over crown in men.
	UNEXPECTED: Random areas of alopecia or alopecia totalis.
Palpate head and scalp
• Symmetry Palpate in gentle, rotary motion from front to back.	EXPECTED: Symmetric and smooth with bones indistinguishable. Ridge of sagittal fissure occasionally palpable.
	UNEXPECTED: Indentations or depressions.
Palpate hair
• Texture/color distribution	EXPECTED: Smooth, symmetrically distributed.
• Texture/color distribution	UNEXPECTED: Splitting or cracked ends. Coarse, dry, or brittle. Fine and silky.
Palpate temporal arteries
Note course of arteries.	UNEXPECTED: Thickening, hardness, or tenderness.
Auscultate temporal arteries and over skull and eyes
	EXPECTED: No bruits.
Inspect salivary glands
• Symmetry/size Palpate if asymmetry noted. Have patient open mouth and press on salivary duct to attempt to express material.	UNEXPECTED: Asymmetry or enlargement. Tenderness. Discrete nodule.
Neck
Inspect neck
• Symmetry Inspect in usual position, in slight hyperextension, and during swallowing. Look for landmarks of anterior and posterior triangles.	EXPECTED: Bilateral symmetry of sternocleidomastoid and trapezius muscles.
	UNEXPECTED: Asymmetry, torticollis webbing, excessive posterior skinfolds, unusually short
	neck, distention of jugular vein; prominence of carotid arteries, or edema.
• Trachea Inspect in usual position, in slight hyperextension, and while patient swallows.	EXPECTED: Midline placement.
	UNEXPECTED: Masses.
Evaluate range of motion
Have patient flex, extend, rotate, laterally turn head and neck.	EXPECTED: Smooth.
	UNEXPECTED: Pain, dizziness, or limitation of motion.
Palpate neck
• Trachea Place thumb on each side of trachea in lower portion of neck, and compare space between trachea and sternocleidomastoid on each side.	EXPECTED: Midline position.
	UNEXPECTED: Deviation to right or left.
• Hyoid bone/thyroid and cricoid cartilages Have patient swallow.	EXPECTED: Smooth. Moves during swallowing.
	UNEXPECTED: Tender.
• Cartilaginous rings of trachea Have patient swallow. Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: The History Mental Status Heart Musculoskeletal System Stay updated, free articles. Join our Telegram channel Tags: Seidels Physical Examination Handbook Apr 2, 2017 \| Posted by admin in NURSING \| Comments Off on Head and Neck Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access