Head Assessment
Objectives:
At the end of this lab the student will be able to:
I . Demonstrate the ability to safely and
accurately complete a comprehensive
examination of Head, Neck, and Lymph Nodes.
2. Demonstrate the ability to accurately &
comprehensively document assessment data in organized and legible manner.
3. Evaluate assessment data to determine
problems and identify client's concerns.
Preparation
I. Nurse
II. Environment
III. Client
IV. Equipment
Equipment:
V. Stethoscope
VI. Cup of water
Subjective data:
1. Headache
2. Dizziness
3. Lumps or swelling
4. Head injury
5. Neck pain, limitation of motion
6. History of head or neck surgery
Head Assessment
PE:
Inspection:
Symmetry : symmetrical
Shape : Normocephalic
Abnormal :
Hydrocephalic: enlargement of the head without change facial structure .
Acromegaly: enlargement of skull and facial bones cause by excessive secretion of growth hormone laceration S calp should be intact, free of lesion and (wound)
Palpation :
Palpate scalp begin with frontal ,parietal,
temporal and occipital Normal skull should be smooth ,no tenderness and no masses
Assess temporal artery it should be smooth ,non tender pulse is within +1
Abnormal: artery may be tender, hard
consistency because of arteritis
Face Assessment
Inspection:
1-Color : evenly white ,brown ,free of
pigmentation
Abnormal: Butterfly distributed on cheeks and nose
2-Shape: symmetry ,rounded ,oval or square Hair distribution: evenly distributed on eye brow
3-Movement : ask client to close his eyes,
clench his eye brow and elevate them , smile than puffy his cheeks it should be symmetry
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