Physical Assessment/Head & Face

HEAD: Normal Findings

Size and shape vary, esp in accord with ethnicity -usually the head is symmetric, round, erect and in midline, no lesions visible

HEAD: Abnormal Findings

Skull and Facial bones are larger and thicker in ACROMEGALY, which occurs when there is an increased production of growth hormone

Inspect the Face

Abnormal: -Asymmetry in front of the earlobes occurs with Parotid Gland Enlargement from an Abscess or Tumor -Unusual or Asymmetric Orofacial Movements may be from an Organic Disease or Neurologic Problem, which should be referred for medical follow-up -Drooping of 1 side of the face may result from a STROKE-or CEROBROVASCULAR ACCIDENT(CVA)-or a Neurologic Condition known as BELL'S PALSY -"MASKLIKE FACE" marks Parkinson's Disease -"Sunken Face" with depressed eyes and hollow cheeks is typical of CACHEXIA(emaciation or wasting) -a "PALE SWOLLEN FACE" may result from Nephrotic Syndrome

Palpate the HEAD for Consistency

Abnormal: -Lesions or lumps on the head may indicate Recent Trauma or Cancer

Palpating the Temporomandibular Joint

Abnormal: -Limited range of motion, swelling, tenderness, or crepitation(crackling or popping sound) may indicate TMJ Syndrome

Palpate the Temporal Artery, which is located between the top of the ear and the eye

Abnormal: -the Temporal Artery is hard, thick, and tender with inflammation as seen with TEMPORAL ARTERITIS(inflammation of the Temporal Arteries that may lead to blindness)

Inspect HEAD for Involuntary Movement

Abnormal: -Tremors associated with Neurologic Disorders may cause a Horizontal Jerking Movement -an Involuntary Nodding Movement may be seen in patients with Aortic Insufficiency -Head tilted to one side may indicate Unilateral Vision or Hearing Deficiency or Shortening of the Sternomastoid Muscle

HEAD: Abnormal Findings

Acorn-shaped, enlarged skull bones are seen in Paget's Disease of the Bone

Inspection and Palpation of the HEAD

Inspect for : -size -shape -configuration

Palpate the Temporal Artery, which is located between the top of the ear and the eye

Normal: -The Temporal Artery is Elastic and Not Tender -The Strength of the Pulsation of the Temporal Artery may be Decreased in the Older Client

Palpate the HEAD for Consistency

Normal: -head is normally hard and smooth without lesions

Palpating the Temporomandibular Joint

Normal: -normally no swelling, tenderness or crepitation(crackling or popping sound) with movement -mouth opens and closes fully (3-6cm between upper and lower teeth) -lower jaw moves laterally 1-2 cm in each direction

Inspect the Face : In older clients

Normal: -wrinkles are prominent, because subcutaneuous fat decreases with age -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

Inspect the FACE for Symmetry, Features, Movement Expression and Skin Condition

Normal: -face is symmetric with a round, oval, elongated, or square appearance -no abnormal movements noted

Inspect HEAD for Involuntary Movement

Normal: head held still and upright

Nasolabial Folds and Palpebral Fissures

are ideal places to check facial features for Symmetry

When assessing TMJ Syndrome

be sure to explore the client's history of headaches, if any

To Palpate the Temporomandibular Joint

place your index finger over the front of each ear as you ask the client to open her mouth

Wear Gloves

to protect yourself from possible drainage