Physical Assessment: Head, Face and Neck

Why is it important to do physical assessment?

Before any intervention can be done, it is vital to do physical assessment because this will serve as the basis for giving the right implementation. Physical assessment is like collecting the data that you have gathered and once done, you then now ready to formulate your intervention based on the data you have collected as you then formulate your goals as well.

Head, face and neck physical assessment is important. This will help you assess on possible causes, signs or symptoms that the patient feels or manifested to show so that you can provide the right process of giving quality care to your patient.

Part of Janet Weber, Jane Kelley and Ann Sprengel's contribution in their book, Health Assessment in Nursing Laboratory Manual, 3rd Edition (pages 73-74) reveals the physical assessment on head, face and neck. This, I will share it with you.

Assessment Skill
1. Gather equipment (gloves, penlight or flashlight, small glass of water, stethoscope).
2. Explain the procedure to the client.

Head and Face
1. Inspect head for size, shape and configuration.
2. Palpate head for consistency while wearing gloves.
3. Inspect face for symmetry, features, movement, expression and skin condition.
4. Palpate temporal artery for tenderness and elasticity.
5. Palpate temporomandibular joint for range of motion, swelling, tenderness, or crepitation by placing index finger over the front of each and asking client to open mouth. Ask if client has history of frequent headaches.

Neck
1. Inspect neck while it is in a slightly extended position (and using a light) for position, symmetry and presence of lumps and masses.
2. Inspect movement of thyroid and cricoid cartilage and thyroid gland by having client swallow a small sip of water.
3. Inspect cervical vertebrae by having client flex neck.
4. Inspect neck range of motion by having client turn chin to right and left shoulder, touch each ear to the shoulder, touch chin to chest, and lift chin to ceiling.
5. Palpate trachea by placing your finger in the sternal notch, feeling to each side, and palpating the tracheal rings. 
6. Palpate the thyroid gland.
7. Auscultate thyroid gland for bruits if the gland is enlarged (use bell of stethoscope).
8. Palpate lymph nodes for size/shape, delimination, mobility, consistency and tenderness (refer to display on characteristics of lymph nodes).
a. Preauricular nodes (front of ears)
b. Postauricular nodes (behind of ears)
c. Occipital nodes (posterior base of skull)
d. Tonsillar nodes (angle of the mandible, on the anterior edge of the sternocleidomastoid muscle)
e. Submadibular nodes (medial border of the mandible); don't confuse with the lobulated submandibular gland
f. Submental nodes (a few centimeters behind the tip of the mandible); use one hand
g. Superficial cervical nodes (superficial to the sternomastoid muscle)
h. Posterior cervical nodes (posterior to the sternocleidomastoid and anterior to the trapezius in the posterior triangle)
i. Deep cervical chain nodes (deep within and around the sternomastoid muscle)
j. Superclavicular nodes (hook fingers over clavicles and feel deeply between the clavicles and the sternomastoid muscles)

Analysis of Data
1. Formulate nursing diagnoses (weakness, risk, actual).
2.Formulate collaborative problems.
3. Make necessary referrals.