Guided Lecture Notes
Chapter 15: Assessing Head and Neck
Learning Objective # 1. Describe the structures and functions of the head and neck.

Describe the structure and function of the cranium. List the following bones in the
cranium (Refer to Figure 15.1 and PowerPoint slides 02-04):
o Frontal
o Parietal
o Temporal
o Occipital
o Ethmoid
o Sphenoid

State the fact that in the adult client the cranial bones are joined together by
immovable sutures.

Describe the structure and function of the face. In addition, list the following
facial bones that give shape to the face. (Refer to PowerPoint slides 05 - 08):
o Maxilla
o Zygomatic
o Inferior conchae
o Nasal
o Lacrimal
o Palatine
o Vomer
o Mandible

Discuss the muscles that produce facial movement and expressions.

Discuss the following important structures located in the facial region
o Parotid glands
o Submandibular salivary glands

Explain the following structures in the neck (Refer to Figure 15.2 and
PowerPoint slides 09 - 10):
o Hyoid bone
o Several major blood vessels
o Larynx
o Trachea
o Thyroid gland

Explain the muscles and cervical vertebrae located in the neck.(Refer to Figures
15.3 and15.4 and PowerPoint slides 11–13)

Discuss the internal jugular veins and carotid arteries, which are located
bilaterally, parallel and anterior to the sternomastoid muscles.

Discuss the functions of the thyroid gland.

Discuss the functions of the lymph nodes.

Describe the following lymph nodes located in the head and neck(Refer to Figure
15.5 and PowerPoint slide 14):
o Preauricular
o Postauricular
o Tonsillar
o Occipital
o Submandibular
o Submental
Learning Objective # 2. Discuss risk factors for head and neck disorders across cultures
and ways to reduce one’s risks.

Traumatic Brain Injuries (Refer to Evidence-Based Health Promotion And
Disease Prevention 15-1: Traumatic Brain Injury (TBI and Power Point
slides 15 - 18)
o Presence of transportation accidents involving automobiles, motorcycles,
bicycles, and pedestrians
o Presence of violence, such as firearm assaults and child abuse or selfinflicted wounds
o Falling
o Excessive alcohol ingestion
o Infants and elderly being cared for by caregivers

To assess for risk, determine the age of the individual, the physical and mental
health status, and the lifestyle. Assess for the following factors:
o Infantsand Toddlers

Environmental risks (for falls)

Lack of parental knowledge of shaken baby syndrome

Caregivers risk of shaken baby syndrome
o Children and Teens

Knowledge and use of protective equipment in sports and bicycle use


Knowledge and use of safety practices when driving
Adults and Older Adults


Knowledge and use of safety practices when driving

Impairment of physical or mental stability

Potential for maltreatment or domestic violence
Risk Reduction (Refer to PowerPoint slides 19 -22)

Buckling your child in the car using a child safety seat, booster seat, or seat
belt (according to the child's height, weight, and age).Know the Stages
o Birth Through Age 2
o Between Ages 2-4/Until 40 lbs
o Between Ages 4-8 or Until 4'9" Tall
o After Age 8 and/or 4'9" Tall

Wearing a seat belt every time you drive or ride in a motor vehicle.

Never driving while under the influence of alcohol or drugs.

Wearing a helmet and making sure your children wear helmets when:
o Riding a bike, motorcycle, snowmobile, scooter, or all-terrain vehicle;
o Playing a contact sport, such as football, ice hockey, or boxing;
o Using in-line skates or riding a skateboard;
o Batting and running bases in baseball or softball;
o Riding a horse; or
o Skiing or snowboarding.

Making living areas safer for seniors, by:
o Removing tripping hazards such as throw rugs and clutter in walkways;
o Using nonslip mats in the bathtub and on shower floors; Installing grab
bars next to the toilet and in the tub or shower;
o Installing handrails on both sides of stairways; and
o Improving lighting throughout the home.

Maintaining a regular physical activity program, if your doctor agrees, to
improve lower body strength and balance.

Making living areas safer for children, by:
o Installing window guards to keep young children from falling out of open
windows; and
o Using safety gates at the top and bottom of stairs when young children are
around.
o Making sure the surface on your child's playground is made of shock
absorbing material, such as hardwood mulch or sand.
o
Learning Objective # 3.Interview a client for an accurate nursing history of his/her head
and neck.

Describe the ways to collect history of present health concern, past history of
illness, family history, lifestyle and health practices when assessing the head and
neck. (Refer to PowerPoint slide 23)
Learning Objective # 4. Use the HEADACHE IMPACT TEST with a client to
determine how his/her headaches affect his/her activities of daily living..(Refer to
PowerPoint slides 23-24)
o Character: Describe how the headache feels (sharp, throbbing, dull)?
o Onset: When did it first begin?
o Does it tend to occur with other factors (i.e., Menstrual cycle, emotional or
physical stress, ingestion of alcohol or other certain foods like cheese or
chocolate)?
o Locations: Where does your headache begin? (Ask client to point to area in
head if possible). Does it radiate or spread to other areas?
o Duration: How long does it last? How often does it recur? Has there been any
change in the duration of your headaches? Explain.
o Severity: How severe is the headache? Rate it on a scale of 1-10 (10 being
most severe). Does the headache keep you from doing your usual activities of
daily living? Explain.
o Pattern: What aggravates it? What makes the pain go away? What pain
relievers work best for you?
o Associated Factors: Do you have other symptoms with the headache such as
nausea, visual changes, dizziness, or sensitivity to noise or light?
Learning Objective # 5.Perform a physical assessment of the heart and neck vessels
using the correct techniques.

Describe the preparation of a client for head and neck examination.

Enlist the equipment required for examination of the head and neck. (Refer to
PowerPoint slide 26)

Describe the techniques used in the examination of the head for size, shape,
configuration, and consistency. (Refer to PowerPoint slide 27)

Describe the techniques used in examination of facial symmetry, features,
movement, expression, and condition of the skin.(Refer to PowerPoint slide 28)
Assess the temporal arteries for tenderness and elasticity

Explain the technique to assess the temporal arteries for tenderness and elasticity.
(Refer to PowerPoint slide 29)

Describe the technique to examine the temporomandibular joint for full range of
motion, swelling, tenderness, and crepitation. (Refer to PowerPoint slide 29)

Explain the techniques used to examine the neck for symmetry and range of
motion. (Refer to PowerPoint slide 30)

Enlist the examination techniques to assess the thyroid gland. ( Refer to
PowerPoint slide 31)

Explain the assessment of thyroid gland for enlargement, consistency, and bruit.
(Refer to PowerPoint slide 31).

Describe the technique for assessment of the trachea. (Refer PowerPoint slide
31)

Describe the techniques of assessment of lymph nodes in the head and neck for
size, shape, delineation, mobility, consistency, and tenderness. (Refer to
PowerPoint slides 32-33)
o State abnormal findings of lymph nodes assessment.
o Enlarged nodes

Swelling, tenderness, hardness, immobility
Learning Objective # 6. Differentiate between normal and abnormal findings of the
head and neck.

Review and discuss findings of client’s head and neck with class peers (Refer to
PowerPoint slide 34)

Signs and symptoms of early stages of hypothyroidism include (Refer to Box
15.1 Signs and Symptoms of Altered Thyroid Function and Power Point slide
35)


Increased sensitivity to cold

Constipation

Depression

Fatigue

Heavier menstrual periods

Pale, dry skin,

Thin, brittle hair or nails

Weakness

Unintentional weight gain.
Symptoms of hyperthyroidism include (Refer to Box 15.1 Signs and Symptoms
of Altered Thyroid Function and Power Point slides 36 - 37)
o Sudden weight loss, without changes in appetite and diet
o Increased appetite
o Rapid heartbeat (tachycardia) greater than 100 beats a minute, irregular
heartbeat (arrhythmia), or palpitations
o Nervousness, anxiety and irritability
o Tremor in the hands and fingers
o Sweating
o Changes in menstrual patterns
o Increased sensitivity to heat
o Changes in bowel patterns, more frequent bowel movements
o Enlarged thyroid gland (goiter)
o Fatigue, insomnia
o Muscle weakness

Types and Characteristics of Headaches (Refer to Abnormal Findings 15.1
Types and Characteristics of Headaches and PowerPoint slide 38)
o Sinus
o Cluster
o Tension
o Migraine
o Tumor related

Abnormal findings of head and neck (Refer to Abnormal Findings 15.2
Abnormalities of the Head and Neck and PowerPoint slide 39)
o Acromegly
o Cushing’s Syndrome
o Scledodema
o Hypothryoidism
o Bell’s Palsy
Learning Objective # 7. Describe findings frequently seen when assessing older
adults.(Refer to PowerPoint slides 40-41)
o Older clients who have arthritis or osteoporosis may experience neck pain
and a decreased range of motion
o In older clients, facial wrinkles are prominent because subcutaneous fat
decreases with age. In addition, the lower face may shrink and the mouth
may be drawn inward as a result of resorption of mandibular bone, also an
age-related process.
o The strength of the pulsation of the temporal artery may be decreased in the
older client.
o In older clients, cervical curvature may increase because of kyphosis of the
spine. Moreover, fat may accumulate around the cervical vertebrae
(especially in women). This is sometimes called a “dowager’s hump.”
o Older clients usually have somewhat decreased flexion, extension, lateral
bending, and rotation of the neck. This is usually due to arthritis.
o If palpable, the older client’s thyroid may feel more nodular or irregular
because of fibrotic changes that occur with aging; the thyroid may also be
felt lower in the neck because of age-related structural changes.
Learning Objective # 8. Analyze data from the interview and physical assessment of the
head and neck to formulate valid nursing diagnoses, collaborative problems, and/or
referrals.

Discuss as a group the data obtained of a client’s general survey and vital signs
risk to formulate valid nursing diagnoses, collaborative problems and/or referrals.
(Refer to PowerPoint slide 42)