HEENT.ppt nursing health assessment for nurse or

The Head, Eye, Ear, Nose and Throat
Assessment (HEENT)
By: Solomon. B
08/05/2024 1

Session objectives
 At the end, learners will able to
 Overview the A/P of HEENT
 Identify different techniques of assessing the HEENT
 Perform complete assessment of HEENT
08/05/2024 By: Solomon.B 2

The Head
 Skull: is a rigid bony box that protects the brain and
special sense organs it includes the bones of the
cranium and the face.
 Cranial bones include the frontal, parietal, occipital,
temporal , ethmoid, and sphenoid.
 NB: Use these names to describe any of your findings
in the corresponding areas.
08/05/2024 By: Solomon.B 3

The Head…cont’d
 The seven cranial bones unite at immovable joints called the
sutures.
 The bones are not firmly joined at birth; the sutures gradually
ossify during early childhood.
 The cranium is supported by the cervical vertebrae; C1, the
“atlas”, C2, the axis and down to C7.
 The C7 vertebra has a long spinous process that is palpable when
the head is flexed
4

The Head Assessment
Subjective Data
 Ask about headache, head injury, dizziness any
lumps or swelling
08/05/2024 By: Solomon.B 5

The Head….Objective data
 The assessment of head includes:
 Inspection
 Palpation of the hair, scalp, skull, and face
Inspect and palpate the skull, scalp
 Note the general size and shape.
 Normocephalic is around symmetric skull that is
appropriately related to body size.
 microcephaly (abnormally small head); macrocephally,
abnormally large head 6

 Palpate the skull and feel symmetry and smooth.
 No tenderness to palpation
 Deformities.: lumps, depressions or abnormal protrusions.
 Palpate the temporomandibular joint as the person
opens the mouth, and note normally smooth movement
with no limitation or tenderness.
 Abnormal -Crepitation, limited ROM, or tenderness
By: Solomon.B 7

Inspect the face
 Note the facial expression and its appropriateness to
behavior.
 Facial structure should be symmetric.
 Note symmetry of eyebrows and sides of mouth.
 Note any abnormal facial structures (changes in skin color or
pigmentation) or any swelling, lesion.
 Also note any involuntary movements (tics) in the facial
muscles. Normally there is none.
08/05/2024 By: Solomon.B 8

Cont’d
Abnormal:-
 Tense rigid muscles may indicate anxiety or pain
excessive smiling may be inappropriate.
 Marked asymmetry with brain lesion such as CVA or
damage to CN VII (Bell’s palsy).
 Note grinding of the jaws or excessive blinking.
08/05/2024 By: Solomon.B 9

The EYES
External Anatomy
 The eye is the sensory organ of vision.
 It is well protected by the bony orbital cavity surrounded
with a cushion of fat.
 The eyelids further protect the eye from injury, strong
light and dust.
 The eyelashes curve outward filtering out dust and dirt.
08/05/2024 By: Solomon.B 10

The EYES…cont’d
 The canthus is the corner of the eye, the angle where lids meet.
 The lacrimal apparatus provides constant irrigation to keep the
conjunctiva and comes moist and lubricated.
08/05/2024 By: Solomon.B 11

The EYES…cont’d
 The lacrimal gland, in the upper outer cornea over the
eye, secretes tears.
 The tears wash across the eye and drain in to the
puncta at the inner canthus.
 The tears then drain in to the nasolacrimal sac through
the nasolacrimal duct and empty into the inferior
meatus inside the nose.
08/05/2024 By: Solomon.B 12

Internal anatomy
 The eye is sphere composed of three concentric coats:
1) the outer fibrous sclera,
2) the middle vascular choroids.
3) the inner nervous retina
 The only parts accessible to examination are the sclera
interiorly and the retina through the ophthalmoscope
08/05/2024 By: Solomon.B 13

The outer layer (the sclera)
 Tough, white covering is continuous interiorly with the
smooth transparent cornea which covers the iris and
the pupil.
 The cornea is a refracting media, bending the incoming
light rays to be focused on the inner retina.
08/05/2024 By: Solomon.B 14

The middle layer
 Vascular choroid is continuous interiorly with the
ciliary body and the iris.
 The muscle fibers of the iris contract the pupil in the
bright light and to accommodate for near vision, and
dilate the pupil when the light is dim and for far
vision.
08/05/2024 By: Solomon.B 15

The Inner layer- Retina
 The retina is the visual receptive layer in which light
waves are changed into nerve impulses.
 The retinal structures viewed through the
ophthalmoscope are the optic disc, the retinal vessels,
the general background and the macula.
08/05/2024 By: Solomon.B 16

The Eye…Subjective data
 Vision difficultly (decreased acuity, blurring),
 pain
 diplopia
 redness
 swelling
 watering and discharge
 past history of ocular problems, any eyeglasses.
08/05/2024 By: Solomon.B 18

The Eye…Objective Data
Important areas of examination
Visual acuity
 Visual fields
Conjunctiva and sclera
Cornea, lens, and pupils
Extraocular movements
Funduscopic and ophthalmoscope
08/05/2024 By: Solomon.B 19

The Eye…Objective Data
1. visual acuity
 Test the acuity of central vision by Snellen eye chart
 has lines of letters arranged in decreasing size.
 Position the patient 20 feet from the chart.
 Hand the person an opaque card to shield one eye.
 Ask the person to read through the chart to the smallest
line of letters possible. (Note: use a Snellen “E” chart for
people who cannot read letters). 20

The Eye…visual acuity
Visual acuity is expressed as two numbers (e.g. 6/6)
 the first indicates the distance of patient from chart, and
 the second, the distance at which a normal eye can read the
line of letters.
 Thus “20/20” means you can read at 20 feet what the normal
eye could have read at 20 feet.
 The larger the denominator the poorer the vision.
The human finger is about the same size as the top letter on the
chart 21

The Eye…visual acuity
If vision is below 1/60, use the patient to detect motion of
hand in front of the eye; ‘hand motion’ (HM)
If the patient can’t see HM, the final test is to shine a light into
his eye
 If he can perceive light – LP
 If he can’t perceive light – NPL
Interpretation of V/A, the WHO classification of Visual
impairment and blindness
 6/6(1.0) - 6/18(0.3): Normal
<6/18(0.3) - 6/60(0.1): Visual impairment
<6/60(0.1) - 3/60(0.05) : severe Visual impairment
 <3/60(0.05) - NPL : blindness

The Eye…
2. Visual fields by confrontation
This is a gross measure of peripheral vision
The visual fields can be roughly assessed with so-called
finger perimetry
Position yourself at eye level with the person about 2 feet
away.
The examiner sits directly in front of the patient and the
patient fixes one eye on the examiner’s nose.
Hold your fingers midline between you and the other
person and slowly advance it in from the periphery in
several directions

Confrontation Test cont’d
 The examiner then moves a finger in each of the four
quadrants of the visual field, testing each eye separately.
 The patient is asked whether he or she can see the finger.
 Normally, a person sees both sets of fingers at the same
time. If so, fields are usually normal.
 The test suggests peripheral field loss.
e.g. Bitemporal hemianopsia .
08/05/2024 By: Solomon.B 25

3. Conjunctiva and sclera
 Ask the person to look up. Using your thumbs, slide the
lower lids down along the body orbital rim.
 The eyeball looks moist and glossy.
 Blood vessels seem through the transparent conjunctive,
the conjunctivas are clear pink over the lower lids and white
over the sclera.
 Note any color change swelling, or lesions. Sclera is gray
blue or “muddy” in color.
08/05/2024 By: Solomon.B 26

3. Conjunctiva and sclera…cont’d
Abnormal:
 General reddening, cyanosis of the lower lids pallor near
the outer canthus of the lower lid may indicate anemia.
 Sclera icterus is a yellowing of the sclera extending up to
the cornea, indicating jaundice
08/05/2024 By: Solomon.B 27
Normal Jaundice

4. Iris and pupils
 The iris normally appears flat with a round regular
shape and even coloration.
 Normally the pupils appear round regular and of
equal size in both sides.
 In the adult resting size is from 3-5mm.
 To test the papillary light reflex, darken the room
and ask the person to gaze into the distance
08/05/2024 By: Solomon.B 28

Iris and pupils …
 Advance a light in from the side and note the response.
Normally you will see:-
 Constriction of the same sided pupil (direct light reflex)
 Simultaneous constriction of the other pupil (consensual
light reflex)
 Miosis refers to constriction of the pupils, &
mydriasis refers to dilation.

5. Extraocular Muscles Function
1.Corneal light Reflex (Hirschberg Test)
 Assess the parallel alignment of the eye axes by
shining a light toward the person’s eyes.
 Direct the person to stare straight ahead as you hold
the light about 30cm (12 inches) away
 Note the reflection of the light on the corneas; it should be
in exactly the same spot on each eye.

5. Extraocular Muscles Function…
Abnormal:
 Asymmetry of the light reflex indicates deviation in
alignment due to eye muscle weakness or paralysis
08/05/2024 By: Solomon.B 31

Test for the corneal touch Reflex:
 The corneal reflex is controlled by cranial nerve V
(trigeminal) and nerve VII (facial).
 Take a sterile cotton ball and twist it into a very thin
strand. Using a lateral approach, gently touch the
cornea on the outer aspect of each eye.
 Confirm both eyes blink when either cornea is
touched
08/05/2024 By: Solomon.B 32

2.Diagnostic positions test
 Leading the eyes through the six cardinal positions
of gaze will elicit any muscle weaknesses during
movement.
 Ask the person to hold the head steady and to
follow the movement of your finger or pen only with
the eyes.
08/05/2024 By: Solomon.B 33

2.Diagnostic positions test…
 Hold the object back about 12 inches(30ccm) and move it
to each of the six positions hold it momentarily then back
to center progress clockwise.
 Failure to follow in certain direction indicates weakness
of an extra ocular muscle (EOM) or dysfunction of
cranial nerve innervating it.
08/05/2024 By: Solomon.B 34

6. Test for Accommodation
 Ask the person to focus on a distant
 This process dilates the pupils, then have the person
shift the gaze to a near object such as your finger held
about 5-8cm from the nose
 A normal response includes pupillary constriction and
convergence (turn inward) of the eyes
 Record the normal response as PERRLA (Pupils,
Equal, Round, React to Light and Accommodation).

6.Test for Accommodation …
 Abnormal- failure of the eyes to converge and the
pupils to constrict indicates dysfunction of CN III IV &
VI.

7. Eyebrows and eye lid
 Inspect the eyebrows
 Noting their quantity and distribution
 Any scaliness of the underlying skin.

Eyelids
• Note the position of the lids in relation to the
eyeballs.
• Inspect for the following:
– Width of the palpebral fissures
– Edema of the lids
– Color of the lids (e.g., redness) I.e. Blepharitis
– Lesions
– Condition and direction of the eyelashe

8. Ophthalmoscope & funduscopic
 Ophthalmoscope is used for Inspection of the optic nerve
papillae (optic discs) .
 Abnormal: indicates
Optic nerve lesion,
Papilledema,
Enlarged retinal veins
Funduscopy : Can be used to visualize the optic disk which
could be inflamed or edematous due to ICP

The Ear
The ear has three parts
I. The external ear
 called the auricle, or pinna and consists of moveable
cartilage and skin.
 The external ear funnels sound in to external auditory canal
that terminates at the tympanic membrane
 It is lined with glands that secrete cerumen, a yellow waxy
material that lubricates the ear
 The mastoid process, the bony prominence behind the
lobule, is not part of the ear but is an important landmark
40

The middle ear
 Is a tiny air filled cavity inside the temporal bone containing
tiny ear bones (the malleus, the incus and stapes).
 has three functions:
 It conducts sound vibrations from the outer ear to the
central hearing apparatus in the inner ear.
 Protects the inner ear by reducing the amplitude of loud
sounds.
 Eustachian tube allows equalization of air pressure on each
side of the tympanic membrane and prevents from rupture.
08/05/2024 By: Solomon.B 41

Inner Ear
 Contains bony labyrinths, which holds the sensory
organs for equilibrium and hearing.
 These include the cochlea, vestibule and semi-circular
canals.
 Although the inner ear is not accessible to direct
examination, its functions can be assessed.
08/05/2024 By: Solomon.B 42

THE Ear…
08/05/2024 By: Solomon.B 43

The Nose
 Is the first segment of respiratory system.
 It warms, moistens, and filters the inhaled air and is the
sensory organ for smell.
 The nasal cavity is divided medially by the septum into
two air passages.
 Nasal mucosa appears redder than oral mucosa
because of the rich blood supply present to warm the
inhaled air
08/05/2024 By: Solomon.B 44

The Nose…Cont’d
 The paranasal sinuses are air filled pockets within the
cranium that communicate with the nasal cavity.
 Two pairs of sinuses are accessible to examination;
 The frontal sinuses in the frontal bone above and medial
to the orbits and
 The maxillary sinuses in the maxilla along the sidewalls of
the nasal cavity
 Others not accessible the sphenoid and ethmoid sinuses,
located deeper in the skull over the nasal.
08/05/2024 By: Solomon.B 45

Mouth and pharynx
 The mouth is the first segment of the digestive system
and an airway for the respiratory system.
 The oral cavity is bordered by the lips, palate, cheeks
and tongue.
 It contains the teeth , gums, tongue and salivary
glands.
08/05/2024 By: Solomon.B 46

The throat or pharynx
 Is the area behind the mouth and nose.
 The oro-pharynx is separated form the mouth by a fold
of tissue on each side, the anterior tonsillar pillar.
 Behind the folds are the tonsils, each a mass of
lymphoid tissue.
08/05/2024 By: Solomon.B 47

The Ears …Subjective data
Ask for any
 earache
 infections
 discharge
 hearing loss
 tinnitus
 vertigo and self care behaviors ( How do you clean your
ears?).
08/05/2024 By: Solomon.B 48

The Ears … Objective Data
The external Ear
Inspect and palpate the external ear:
Size and shape:- the ears are of equal size bilaterally
with no swelling or thickening.
Tenderness:- move the pinna and push on the tragus.
 They should feel firm and movement should produce
no pain.
 Palpating the mastoid process should be painless.
08/05/2024 By: Solomon.B 49

The Ears … Objective Data Cont’d
The external Ear
Abnormal:–
 pain with movement occurs with otitis external and
furuncle.
 Pain at the mastoid process may indicate mastoiditis
08/05/2024 By: Solomon.B 50

The otoscope Examination
Inspect using the Otoscope
 Choose the largest speculum that fit the ear canal.
 Tilt the person’s head slightly away from you toward
the opposite of the shoulder.
08/05/2024 By: Solomon.B 51

The otoscope …Cont’d
 Pull the pinna up and back on an adult or older child to
straighten the canal, pull the pinna down on an infant and
child under 3 years of age.
 Hold the otoscope “upside down” along your fingers and
have the dorsa (back of your hand) along the person’s
cheek. It prevents forceful insertion.
 Insert the speculum slowly and carefully along the canal
08/05/2024 By: Solomon.B 52

The otoscope …Cont’d
 Watch the insertion then put your eye up to the
otoscope.
 Once it is in place, you may need to rotate the otoscope
slightly to visualize the entire drum; do this gently.
 In the external canal note any redness, swelling, lesions,
foreign bodies or discharge.
 Purulent pus discharge may indicate otitis media if the
drum has ruptured.
08/05/2024 By: Solomon.B 53

Hearing Acuity
1. Voice test
 Test one ear at a time while masking hearing in the
other ear to prevent sound transmission place one
finger on the tragus and pushing it in and out of the
auditory meatus.
 Shield your lips and exhale slowly some two syllable
words such as Tuesday ,Armchair.
 Normally the person repeats each word correctly.
08/05/2024 By: Solomon.B 54

Hearing Acuity…
2. Tuning Fork Tests (Rinne test)
 Measure hearing by air conduction (AC) or by bone
conduction (BC) in which the sound vibrates through the
cranial bones to the inner ear.
 Place a lightly vibrating tuning fork on the mastoid bone
with its base, behind the ear and level with the canal.
 Immediately when the patient can no longer hear the
sound, quickly place the ‘‘u’’ of the fork near the canal
and ascertain whether the sound can be heard again .
55

Hearing Acuity…
 Normally the sound is heard longer through air than
through bone (AC >BC) i.e. positive rinne test
 In conductive hearing loss sound is heard through bone
as long as or longer than it is through air (BC = AC or BC >
AC).
08/05/2024 By: Solomon.B 56

3. Weber test: Test for lateralization
 The weber test is valuable when a person reports
hearing better with one ear than the other.
 Place a vibrating tuning fork in the midline of the
person’s skull and ask if the tone sounds the same in
both ears or better in one
• Normally the sound is heard in the midline or equally
in both ears. i.e. positive weber test
08/05/2024 By: Solomon.B 57
Hearing Acuity…

Weber test …Cont’d
 In unilateral conductive hearing loss, sound is heard
in (lateralized to) the impaired ear.
 In unilateral sensorineural hearing loss, sound is heard
in the good ear.
 Abnormal:- Ratio of AC to BC is altered with hearing
loss, Sound is heard longer by bone conduction
08/05/2024 By: Solomon.B 58

The Nose
Subjective Data
 Discharge, frequent colds, sinus pain, epistaxis,
allergies.
08/05/2024 By: Solomon.B 59

The Nose…Objective Data
Inspect and palpate the Nose:
 Healthy nasal function has patent airway with intact
mucous membrane lining.
External Nose:
 Normally the nose is symmetric in the midline.
 Inspect for any deformity, asymmetry, inflammation or
skin lesions.
08/05/2024 By: Solomon.B 60

The Nose…Objective Data, Cont’d
 Test the potency of the nostrils by pushing each nasal
wing shut with your finger while asking the person to
sniff through the other naris.
 This reveals any obstruction that can be further
explored with nasal speculum
08/05/2024 By: Solomon.B 61

Nasal Cavity:
 Could be explored either through a nasal speculum
 Nasal speculum will help to open the vestibule and a
penlight to illuminate the cavity.
 Hold the speculum in your left palm with its blades
pointing away from you.
08/05/2024 By: Solomon.B 62

 View each nasal cavity with the person’s head erect
and tilted back.
 Inspect the nasal mucosa noting its normal red color
and smooth moist surface.
 Note any swelling, discharge, bleeding or foreign body.
Abnormal:
 Rhinitis, sinusitis, chronic allergy, swollen nasal mucosa
with upper respiratory infection
08/05/2024 By: Solomon.B 63

The sinus Areas
Palpate the sinus areas
 Using your thumbs, press the frontal sinuses below the
eyebrows and over the maxillary sinuses below the
cheekbones.
Abnormal:– sinus areas are tender to palpation in
persons with chronic allergies and acute infection
(sinusitis).
08/05/2024 By: Solomon.B 64

08/05/2024 By: Solomon.B 65
The sinus Areas

The Mouth
Inspect the Mouth:
 Begin with the anterior structures and move posterior.
 Use a tongue blade to retract structures and a bright
light for visualization.
08/05/2024 By: Solomon.B 66

The Lips
 Inspect the lips for color, moisture, ulcers, lump, pallor or
cyanosis, cracking or lesions.
 Retract the lips and note their inner surface.
Abnormal= pallor with anemia, cyanosis with hypoxemia,
cheilosis-cracking at the corners herpes simplex
 (inflammation of lips: redness, swelling, and sometimes
pain in the lips), other lesions.
08/05/2024 By: Solomon.B 67

Cont’d
Teeth and Gums
 Note any diseased, abscess, loose teeth.
 Normally, the gums look pink and check for
swelling, bleeding, inflammation.
08/05/2024 By: Solomon.B 68

Tongue
 Check the tongue for color, surface characteristics, and
moisture. The color is pink and even.
 Note any patches, nodules or ulcerations.
 If lesions are preset put on a glove and palpate the area.
Notice any in duration.
69

Buccal mucosa
 Hold the cheek open with a wooden tongue blade and
check the buccal mucosa for color, nodules, or lesions.
 It looks pink, smooth and moist.
Abnormal:- Koplik’s spots sign of measles, leukoplakia-
chalky white raised patch.
08/05/2024 By: Solomon.B 70

Roof of the mouth (palate)
 Shine your light up to the roof of the mouth.
 The anterior hard palate is white with irregular transverse
rugae and the posterior soft palate is pink and smooth.
 Observe the uvula, it normally looks like a fleshy hanging
in the midline.
 Ask the person to say “Ahhh” and note the soft palate and
uvula rise in the midline.
 It tests function of CNX, the vagus nerve.
08/05/2024 By: Solomon.B 71

The throat /phayrnx
 Inspect the throat using your light observe the oval rough
surfaced tonsils behind the anterior tonsil pillar. Their
color is pinkish.
 There should be no exudates on the tonsils.
08/05/2024 By: Solomon.B 72

Cont’d
Tonsils are graded in size as:-
 1+ Visible
 2+ halfway between tonsillar pillars and uvula
 3+ touching the uvula
 4+ touching each other.
 You may normally see 1+ or 2+ tonsils in healthy
people Esp. in children
08/05/2024 By: Solomon.B 73

Cont’d
 Engage your view of the posterior pharyngeal wall by
depressing the tongue with a tongue blade.
 Push down half way back on the tongue.
 Note the posterior wall for color, exudates or lesions.
08/05/2024 By: Solomon.B 74

Cont’d
Abnormal:–
 Bright red swollen with exudates or large white spots-
Tonsilitis.
 Enlargement of tonsils as 2+, 3+or 4+ with an acute
infection.
 Damage to CN XII tongue deviates toward the
paralyzed side.
 Fine tremor of the tongue- Hyperthyroidism
08/05/2024 By: Solomon.B 75

The Neck
 The neck contains important blood vessels, such as the
carotid artery and the internal jugular vein that lie beneath
the sternocleidomastoid muscle.
 The external jugular vein runs diagonally across the
sternoclidomastoid muscle.
 The major neck muscles are the sternoclidomasoid and the
trapezius, which are innervated by cranial nerve XI, the
spinal accessory.
08/05/2024 By: Solomon.B 76

Neck….
 The sternocleidomastoid muscles arise from the sternum
and the medial part of the clavicle and extend diagonally
across the neck to the mastoid process behind the ear.
 It accomplishes head rotation and head flexion.
 Trapezius muscle arises from the occipital bone and the
vertebrae and extends to the scapula.
 The trapezius muscles move the shoulders and extend
and turn the head.
08/05/2024 By: Solomon.B 78

Neck..
 The thyroid gland is found in the middle of the neck
anterior to the trachea.
 It is shaped like a butterfly with two lobes lying on
either side of the trachea and a body, called the
isthmus, lying directly over the trachea.
 Used for hormone production
08/05/2024 By: Solomon.B 80

Lymphatics
The head and neck have a rich
supply of lymph nodes (9 groups)
This includes:-
Pre- auricular in front of the
ear.
Posterior auricular
(mastoid), superficial to the
mastoid process.
Occipital at the base of the
skull.
Submental midline behind
the tip of the mandible
08/05/2024 By: Solomon.B 82

The Neck ….Cont’d
Inspect and palpate the Neck
Symmetry
Head position is centered in the midline and
the accessory neck muscles should be
symmetric.
The neck should be held erect and still.
Abnormal:- Head tilt occurs with muscle spasm.
08/05/2024 By: Solomon.B 83

Cont’d
Range of Motion (neck)
 Note any limitation of movement during active motion.
 Ask the person to touch the chin to the chest turn head
to right and left, extend the head backward.
Abnormal:–
 note pain at any particular movement.
 Note limitation of movement that may be due to cervical
arthritis.
08/05/2024 By: Solomon.B 84

Cont’d
 Also note thyroid gland enlargement.
 Also note any obvious pulsations.
 The carotid artery runs medial to the sterno mastoid
muscle and creates localized pulsations just below the
angle of the jaw.
08/05/2024 By: Solomon.B 85

Lymph Nodes
 Using a gentle circular motion of your finger pads
palpate the lymph nodes.
 Beginning with pre auricular lymph nodes in front of the
ear, palpate the 9 groups of lymph nodes in a routine
order use gentle pressure because strong pressure
could push the nodes into the neck muscles.
 It is usually most efficient to palpate with both hands,
comparing the two sides, except the sub mental gland .
08/05/2024 By: Solomon.B 86

Lymph Nodes …Cont’d
 If any nodes are palpable note their location, size,
shapes,(discrete or matted together) mobility and
tenderness.
 Certain nodes often are palpable in healthy persons.
 Normal nodes feel movable, discrete, soft and non-
tender.
 Abnormal:- Lymphadenopathy- enlargement of the
lymph nodes due to infection, allergy or neoplasm.
08/05/2024 By: Solomon.B 88

Lymph Nodes …Cont’d
 The following criteria are common clues, but are not
definitive in all.
 Acute infection- nodes are bilateral enlarged, warm, tender
and firm but freely movable.
 Chronic inflammation- Ex. TB- nodes are clamped (matted
together)
 Cancerous nodes- is hard, unilateral, non- tender and fixed.
 An enlarged supra clavicular node may indicate a
neoplasm in the thorax or abdomen
89

Trachea
 Normally the trachea is midline, palpate for any tracheal
shift.
 Place your index finger on the trachea in the sternal
notch and slip it off to each side.
 The space should be symmetric on both sides.
 The trachea is pushed to the unaffected side with tumor,
unilateral thyroid lobe enlargement and pneumothorax.
 The trachea is pulled toward the affected side with
atelectasis, pleural adhesions or fibrosis.
08/05/2024 By: Solomon.B 91

Thyroid Gland
 The thyroid gland is difficult to palpate.
 Supply the person with a glass of water and first
inspect the neck as the person takes a sip and
swallows.
 Thyroid tissue moves up with a swallow.
 Abnormal:- Look for diffuse enlargement or a
nodular lump.
08/05/2024 By: Solomon.B 92

Cont’d
 To palpate move behind the person.
 Ask the person to sit up very straight and then bend the head
slightly forward and to the right.
 Use the fingers of your left hand to push the trachea slightly to
the right.
 Then curve your right fingers between the trachea and the
sternomastoid muscle, and ask the person to take a sip of
water and detect thyroid moves up on swallow
 Reverse the procedure for the left side.
08/05/2024 By: Solomon.B 93

Cont’d
 Usually you cannot palpate the normal adult thyroid.
 Abnormal:– enlarged lobes that are easily palpable
before swallowing or is tender to palpation, or the
presence of nodules or lumps.
08/05/2024 By: Solomon.B 94

cont’d
Auscultate the Thyroid
 If the thyroid gland is enlarged, auscultate it for the
presence of a bruit.
 This is a soft palatial, whooshing, blowing sound heard
best with the bell of the stethoscope.
 Bruit is not present normally.
Abnormal:– present with accelerated blood flow, indicating
hyperplasia of the thyroid Ex. Hyperthyroidism
08/05/2024 By: Solomon.B 95

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