Head,Neck,Ears,Eyes,Mouth

Assessment of Head, Face, Neck, Eyes, Ears, Nose, Mouth and Throat

HEENT (Head, Eyes, Ears, Nose, Throat)

 Assessment of Head, Face, Neck, Eyes, Ears, Nose, Mouth and Throat

HEENT (Head, Eyes, Ears, Nose, Throat)

Informative Web Videos:

http://youtu.be/FHWw8opmQdg

http://youtu.be/8vd-t-uYfbY

http://youtu.be/gv4jJr4aly0

 Head and Face-Head is rounded, normocephalic, symmetrical, and non-tender.  Look for scars, lumps, rashes, hair loss, or other lesions.  Look for general facial symmetry, hair distribution, general facial expressions, involuntary movements, or edema.  Palpate to identify any areas of tenderness or deformity and no nodules or masses and depression. Assess color and texture of hair and color, texture and temperature of skin.

Neck-Inspect for asymmetry, scars, or other lesions.  The neck muscles are equal in size and the client can show coordinated, smooth head movement and has normal range of motion with no discomfort.  Palpate the neck to detect areas of tenderness, deformity, or masses.   The lymph nodes should be non-palpable and non-tender.  The trachea should be midline in the neck and the thyroid gland should not be visible on inspection. You should assess for movement of the glands while the patient swallows.

Eyes-Check the sclera for color, the conjunctiva for color and moistness, the pupils for equally rounded, reactive to light and accommodating (PERRLA).  Use a Sneelen chart to check visual acuity.  Assess for color vision with an Ishihara test.  Check for extraocular movements and evaluate visual fields.  The external structures are symmetrical. Eyebrows and eyelashes are evenly distributed and eyelids open and close completely.  Corneas and lenses should be clear and irises should be round and illuminate when light is shined across them. An assessment of the inner eye can be done with an opthalmoscope in a darkened room.  The lacrimal apparatus can be palpated for discharge and tenderness.

Ears- The auricles are in proper alignment, symmetrical and have the same color as the facial skin.   When palpating for texture, the auricles are mobile, firm and non-tender.  The pinna recoils when folded.  You should check for lesions. The ear canal should be free of foreign bodies, redness, swelling or discharge.  Cerumen is expected.  The internal ear can be viewed by pulling the ear up and back.  Using an otoscope the tympanic membranes should be pearly grey and intact.  Light reflex is visible and well defined and cone shaped.  The other structures of the ear are clearly visible.  The ear canal should be pink with fine hairs.  A hearing aquity can be done with a watch tick test to see if the client can hear the ticking in both ears.

Nose-The nose should be appear straight, be midline, symmetrical and of normal color.  There should be no discharge or excessive flaring.  Each nostril should be patent.  The internal structures can be examined with a nasal speculum. The septum should be midline and intact and the mucosa should be pink and moist.  When the nose is lightly palpated there should be no lesions or tenderness.  Assess the smell factor by asking the client to occlude one nostril and identify a familiar smell.  Sinuses may be palpated for tenderness.

Mouth & Throat-The lips of the client are uniformly pink and darker than the skin color, moist, symmetrical and have a smooth texture.  The lips should not be cracked, blistered, or have lesions and should be non-tender.  Teeth should not be missing, loose or show discoloration.  Teeth should be shiny and white.  Dental caries, dentures or cracked teeth should be noted.  Gums should be pink and be tight against teeth with no retractions or bleeding noted when palpated.  The mucosal membranes should be uniformly pink, moist, soft and shiny with an elastic texture and free of lesions.  The tongue is centrally positioned.  It is pink in color, moist and slightly rough.  The underside should be smooth with a vascular pattern.  Ask client to move tongue in different ways to assess and check for lesions, white patches or ulcers. You can check taste by having client identify different foods with their eyes closed.  The hard and soft palate should be intact, pink, symmetrical and free of lesions.  The hard palate is firm and concave and the soft palate moves with vocalization.  The uvula is midline in the soft palate and should be pink, intact and move with vocalization.  The tonsils that are visible should be the same color as the surrounding mucosa and size, color and any discharge should be noted.  A gag reflex can be checked by using a tongue blade in the back of the throat.  Speech should be assessed during exam. For each category you should ask basic questions.  Have you noticed any pain, discharge, swelling, redness or change.

 References

Jarvis, Carolyn. (2012). Physical Examination & Health Assessment. St. Louis, MO:     Elsevier/Saunders.

(2012). Overview of Nursing Health Assessment-RN.com.  Retrieved from rn.com/.

(2012). Complete Head-to-Toe Physical Assessment Cheat Sheet.  Retrieved from nurseslabs.com.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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