HEENT Assessment Mallory Manuel, MSN, RN, CEN N661K Applied Assessment and Fundamentals University of San Francisco HEENT Head Eyes Ears Nose Throat Also includes mouth and neck Eyes Visual acuity – Snellen or Jaeger chart Inspect: alignment of eyes, symmetry, eyebrows, eyelids, lashes, lacrimal apparatus, conjunctiva, cornea, lens, and iris – discoloration, deformity, hair placement, shape, discharge, etc Pupils: size, shape, reaction, symmetry, accommodation, consensual Extraocular movements (EOMs): 6 cardinal positions Abnormal findings – eye exam Nose Inspect: external nose for shape, deformity, skin color, nostril flaring, discharge/bleeding Inspect internal nares for wounds, discharge, bleeding, septal deviation, patency Palpate maxillary and frontal sinuses Ears Assess auditory acuity with whisper test Whisper a word about 2-3 feet behind the patient in each ear and have patient repeat the word back Inspect and palpate external ears for deformity and drainage Inspect ear canal and tympanic membrane: light reflex (cone of light) Ruptured TM Cerumen Impaction Neck Inspect: symmetry, scars, visible nodules, thyroid masses, tracheal alignment Palpate the trachea and thyroid gland for alignment, presence of nodules and masses Palpate lymph nodes Auscultate for thyroid and carotid bruits Mouth/Throat Inspect lips, buccal mucosa, tongue, gums, teeth, soft palate, uvula, tonsils, pharynx for color, moisture, ulcers, masses, movement, and enlargement Also inspect for airway obstruction – particularly unilateral tonsil enlargement that can obstruct airway Gag reflex Temporomandibular joint (TMJ) – palpate the TMJ during mouth opening/closing, palpate for clicking/popping, ask about pain Abnormal Findings
