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