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1. SAL ALE UNIVERSITY COLLEGE OF SCIENCES
DEPARTMENT OF ADULT HEALTH NURSING
TITLE : NURSING ASSESSMENT OF NECK
SUBMIT TO: BIKILA T. ( MSC , ASSIST . PROFESSOR)
PRESENTER BY : YADETA KEBEDE ADULT HEALTH N .
ID : 194/2023
JUNE 2023
FITCHE

2. Outline
 Objective
 Introduction to neck and lymph glandular system
 Physical Examination of neck and lymphatic system
 Summary
 Reference

3. Objective
 At the end of these section the student will be identify normal and abnormal finding
during physical examination of neck and lymphatic's.
 At the end of these section the student will be perform physical examination of
neck and cervical spine.
 At the end of these section the student will be describe anatomy and function of
lymphatic system.

4. Introduction
 The Neck is Contained within hyoid bone, muscle and several major blood vessels,
the larynx, trachea, and the thyroid gland, which is in the anterior triangle of the
neck, and cervical spine.
 The thyroid gland is the largest endocrine gland in the body and butterfly shaped
gland in the front of neck. It produces thyroid hormones that increase the metabolic
rate of most body cells.
 The cervical vertebrae (C1 to C7) are located in the posterior neck and support the
cranium.
 The internal jugular veins and carotid arteries are located bilaterally, parallel and
anterior to the sternomastoid muscles of neck.
 The external jugular vein lies diagonally over the surface of these neck muscles.

5. THEANATOMY AND PHYSIOLOGY OF NECK
 The structure of the neck is composed of muscles, ligaments, and the cervical
vertebrae.
 Contained within the neck are the hyoid bone, several major blood vessels, the
larynx, trachea, and the thyroid gland, which is in the anterior triangle of the neck

6. Cont.………

7. Muscles and Cervical Vertebrae
The steno mastoid (sternocleidomastoid) and trapezius muscles are two of the
paired muscles that allow movement and provide support to the head and neck .
 The steno mastoid muscle rotates and flexes the head, whereas the trapezius
muscle extends the head and moves the sternomastoid muscles.

8. Cont.…
 These two major muscles also form two triangles that provide important
landmarks for assessment.
 The anterior triangle is located under the mandible, anterior to the sternomastoid
muscle.
 The posterior triangle is located between the trapezius and steno mastoid muscles.

9. Cont.….
 The cervical vertebrae (C1 through C7) are located in the posterior neck and
support the cranium.
 The vertebra prominent is C7, which can easily be palpated when the neck is
flexed. Using C7 as a landmark will help you to locate other vertebrae.

10. Larynx and pharynx
 Pharynx is the muscle lined space that connects the nose and mouth to the larynx and
esophagus or eating tube.
 Larynx also known as the voice box ,a cylindrical grouping of cartilage , muscle ,and soft
tissue that contain the vocal cords.
 The function of larynx and other vertebral is to protect the lower respiratory tract from
aspirating food in to the trachea while breathing.
 If damage nerve of larynx hoarseness, difficulty in swallowing or breathing, or loss voice.

11. Thyroid Gland
 The thyroid gland is the largest endocrine gland in the bodyand butterfly shaped
gland in the front of neck.
 It produces thyroid hormones that increase the metabolic rate of most body cells.
 The thyroid gland is surrounded by several structures that are important to palpate
for accurate location of the thyroid gland

12. Cont.……..
 The thyroid gland consists of two lateral lobes that curve posteriorly on both sides of
the trachea and oesophagus and are mostly covered by the stern mastoid muscles.
 In about one-third of the population, there is a third lobe that extends upward from
the isthmus or from one of the two lobes.

13. Cont.…
 These two thyroid lobes are connected by an isthmus that overlies the second
and third tracheal rings below the cricoid cartilage.
 In about one-third of the population, there is a third lobe that extends upward
from the isthmus or from one of the two lobes.
 These two thyroid lobes are connected by an isthmus that overlies the second
and third tracheal rings below the cricoid cartilage.

14. Assessment of Neck
Subjective and objective Data Neck
Biographic data
Chief compliant
History of problems
 Neck pain
 Swelling
 Any trauma of neck

15. Cont.…
History of Present Health Concern
 Pain
Do you experience neck pain?
Character: Describe how it feels.
Onset : Did it begin after some strenuous activity, exercise, accident
or a direct injury?
Locations: Does it radiate to the back, arms, or shoulders?
Duration: How long does it last? Does it come and go?

16. Cont.…
Severity: Are you able to continue your daily schedule and sleep at night?
Pattern: Does it tend to occur more with exercise or stress? Are there any
activities that relieve it or make it worse?
Associated Factors: Do you have any limitation of movement of your head or
neck or arms with this pain? Do you have any numbness or tingling with it?
Other Symptoms
 Do you have any difficulty moving your head or neck?

17. Cont.…
Past Health History
 Describe any previous head or neck problems (trauma, injury, falls, surgery)
Family History
 Is there a history of head or neck cancer in your family?
 Socioeconomicstatus
 Psychologicalstatus(for suspectselfsucides,hunging)
 Nutritionalstatus:eatinghotfood,acidicingestion,orcorrosivechemicals.
 ReviewofSystem.

18. physical examination of neck
 Assessment of neck assists the nurse to detect enlarged or tender lymph nodes.
 Thyroid enlargement, nodules, masses, or tenderness may be detected by
palpating the thyroid gland.
 Palpation may also detect abnormalities of the neck and facial muscles.

19. Cultural Considerations
 Preparing the Client
Prepare the client for the head and neck examination by instructing him or
her to remove any wig, hat, hair ornaments, pins, rubber bands, jewellery,
and head or neck scarves
 Ask the client to sit in an upright position with the back and shoulders
held back and straight.

20. Cont.…
 Tell the client what you are doing and share your assessment findings.
Equipment
 Small cup of water
 Stethoscope

21. INSPECTION
Inspect the neck.
 movement
 symmetry
 masses.
 swelling.
NORMAL FINDINGS
Neck is symmetric, with head cantered and without bulging masses.

22. Cont.…
 Swelling, enlarged masses or nodules may indicate an enlarged thyroid
gland, inflammation of lymph nodes, and a tumour.

23. Assessment Procedure
 Inspect movement of the neck structures.
 Ask the client to swallow a small sip of water.
 Observe the movement of the thyroid cartilage, thyroid gland.
Normal Findings
The thyroid cartilage, cricoid cartilage move upward symmetrically as the client
swallows.

24. Cont.…
Abnormal Findings
 Asymmetric movement or generalized enlargement of the thyroid gland is
considered abnormal.
PALPATION
 Palpate the trachea. Place your finger in the sternal notch. Feel each side of the
notch and palpate the tracheal rings.
 The first upper ring above the smooth tracheal rings is the cricoid cartilage.

25. Cont.…
Normal Findings
Trachea is midline.
Abnormal Findings
 The trachea may be pulled to the affected side in cases of large atelectasis,
fibrosis or pleural adhesions.
 The trachea is pushed to the unaffected side in cases of a tumor, enlarged
thyroid lobe, pneumothorax, or with an aortic aneurysm.

26. Auscultation
 Auscultate the thyroid only if you find an enlarged thyroid gland during inspection
or palpation.
 Place the bell of the stethoscope over the lateral lobes of the thyroid gland .
 Ask the client to hold his or her breath (to obscure any tracheal breath sounds while you auscultate).
 Normal Findings
 No bruits are auscultated
Abnormal Findings
A soft, blowing, swishing sound auscultated over the thyroid lobes is often heard in
hyperthyroidism because of an increase in blood flow through the thyroid arteries.

27. Lymphatic system
 Lymphatic system is essential drainage system which is accessory
to venous system.
 Most tissue fluid formed at the arterial end of capillaries is
absorbed back into the blood by venous end capillaries and rest of
tissue fluid (10- 20%) is absorbed by lymphatics.

28. Cont.…
 Larger particles like proteins and particulate matter can be removed from the
tissue fluid only by the lymphatic.
 Therefore, lymphatic system may be regarded as drainage system of “coarse
type” & venous system as “fine type”
 Tissue fluid flowing in the lymphatic are called lymph.( clear fluid)
 It passes through filters called (lymph nodes) placed in the course of
lymphatic .

29. Anatomy of lymphatic system
 Each lymph node is a bean shaped organ, with an outer connective tissue frame
work, which dips into the structure forming numerous Septa

30. FUNCTION
 They are centres of lymphocyte production. Both B-lymphocytes and T-
lymphocytes are produced here by multiplication of pre-existing lymphocytes.
 Filter the products from lymph such as bacteria and other particulate matter and
to prevent their entry into systemic circulation.
 The antibodies produced by the B-Lymphocytes are carried to the circulation
and indirectly help in mounting an immune response.

31. COMPONENTS OF LYMPHATIC SYSTEM
 Lymph vessels
 Central lymphoid organs: Bone marrow and Thymus
 Peripheral lymphoid organs: Lymph nodes, Spleen and Tonsils
 Circulating lymphocytes

32. Lymphadenopathy
lymph nodes which are abnormal in size, number or consistency and is often used as
a synonym for swollen or enlarged lymph nodes.
Classified :
Generalised - 2 or more non contiguous area.
Localised - involve one area.

33. Causes of Enlargement of Lymph Node
Inflammatory
 Acute or chronic
 lymphadenitis
 Infection
 Tuberculosis
 Filariares
 Secondary syphilis
 Infectious mononucleosis
Haematological
 Hodgkins disease
 Non- hodgkins
 lymphoma
 Chronic lymphatic
 leukaemia

34. Cont.…
Neoplastic
 Carcinoma
 Sarcoma
Immunological
 Aids
 Drug reaction
 Systemic lupus
 Erythromatosus
 Rheumatoid arthritis

35. Clinical examination
History
 age
 duration
 group first affected
 pain
 fever
 pressure effects
 past history
 Family history
 primary focus
 loss of appetite & wt. loss

36. Local examination
Inspection- position, size , skin over lying swelling , pressure effects.
Palpation- inspector findings, consistency, matted or not , fixity to surrounding
structures, drainage area.

37. General examination
Lymph nodes in other parts of the body
Age : Tuberculosis and syphilis , primary malignant lymphomas affect young age .
Duration: Short (acute lymphadenitis)
Group affected first : E.g.: cervical group affects first in Hodgkin's disease ,
tuberculosis etc. where as inguinal lymph node affects first in filariases.

38. Cont.…
Pain: Acute and chronic infection are painful where as painless in syphilis , primary
malignant lymphomas and secondary carcinoma.
Fever: evening rise of temperature is characteristic feature of TB.
Periodic fever in filarial (once in month).
 Number: single or multiple. A few conditions are known to produce generalised
involvement of lymph nodes like Hodgkin's disease , Tb Lympho sarcoma ,
sarcoidosis.

39. Cont.…
Primary focus: when ever lymph node enlarged, it is usual practice to look for
primary focus in drainage area of lymph nodes. This should be done in acute and
chronic septic lymphadenitis.
Loss of appetite & wt.: in case of malignant lymphadenopathies.
 Family history : sometimes history of tbc in families

40. Inspection
Position: cervical group e.g. Tbc Epitro chlear and occipital e.g. Secondary
syphilis.
Skin over the swelling: In acute lymphadenitis skin becomes inflamed with
redness, oedema, brawny induration.
Skin over Tuberculous lymphadenitis and cold abscess remains “cold” in true
sense till they reach a point of bursting when skin becomes red and glossy.

41. Cont.…
Over rapidly growing lymph sarcoma skin becomes tense, shining , with dilated
subcutaneous veins.
Pressure effects: Careful inspection must be made of whole body to detect any
pressure effect due to enlargement of lymph nodes.
 Oedema & swelling of upper limb- enlargement of axillary lymph nodes.
 Oedema & swelling of lower limb- enlargement of inguinal lymph nodes.
 Swelling & venous engorgement of face and neck may occur due to pressure

42. Cont.…
 Most of the lymph nodes are best palpated with the examiner standing
behind the patient who is comfortably seated in a dental chair
 Palpation of the lymph nodes is ideally done commencing from the most
superior lymph node and then working down to the clavicle region.
 Nodes are palpated for consistency, size, tenderness, and local Rise In
Temperature
 Consistency – Enlarged lymph nodes should be carefully palpated with
palmar aspects of 3 fingers. While rolling the fingers against the swelling
slight pressure is maintained to know the actual consistency.

43. METHOD OF PALPATION:
 Pre auricular lymph nodes- they are palpated anterior to the tragus of ear.
Normal finding
 There is no swelling or enlargement and no
Tenderness.
Abnormal finding
Enlarged nodes are indication of abnormality.

44. Cont.…
Post auricular lymph nodes: are palpated behind the ear, on the mastoid process.
Normal finding
 There is no swelling or enlargement and no
Tenderness
Abnormal finding
Enlarged and tenderness nodes are abnormal

45. Cont..
 Occipital nodes palpated at the base or lower border of skull
Normal finding
 There is no swelling or enlargement and no
Tenderness
Abnormal finding
Enlarged and tenderness nodes are abnormal

46. Submental nodes
 They are palpated under the chin
 The clinician can stand behind the patient to palpate.
 The patient is instructed to bend his/her neck slightly forward so
that the muscles and fascia in that regions relax.

47. Cont.…
 Fingers of both hands can be placed just below the chin, under the lower
border of mandible and the lymph nodes should be tried to be cupped
with fingers
Abnormal finding
Enlarged and tenderness nodes are abnormal

48. Submandibular nodes
 Are palpated at the lower border of the mandible approximately at the
angle of the mandible.
 The patient is instructed to passively flex the neck towards the side that is
being examined.
 This maneuverer helps relaxing the muscles and fascia of neck, thereby
allowing easy examination.

49. Cont.…
 The palmar aspect of the fingers is pushed on to the soft tissue below the
mandible near the midline, then the clinician should then move the fingers
laterally to draw the nodes outwards and trap them against the lower border of
the mandible.
Normal finding
 There is no swelling or enlargement and no
Tenderne
Abnormal finding
Enlarged and tenderness nodes are abnormal

50. Cont.…
 Anterior Cervical: (both superficial and deep): Nodes that lie both on top of
and beneath the sternocleidomastoid muscles (SCM) on either side of the
neck, from the angle of the jaw to the top of the clavicle .
Normal finding
 There is no swelling or enlargement and no
Tenderness
Abnormal finding
Enlarged and tenderness nodes are abnormal

51. Cont.…
 Posterior Cervical: Extend in a line posterior to the SCMs but in front of the
trapezius, from the level of the mastoid bone to the clavicle.
Normal finding
 There is no swelling or enlargement and no
Tenderness
Abnormal finding
Enlarged and tenderness nodes are abnormal

52. INVESTIGATIONS
 Complete Blood Count
 Chest Radiography
 Serological investigation
 Nodal Biopsy
 Fine Needle Aspiration cytology .
 C. T. Scan
 M.R.I

53. summary
 The structure of the neck is composed of muscles, ligaments, and the cervical
vertebrae.
 Neck examination include inspection palpation and Auscultation
 Knowledge of lymph nodes is important to prognosticate the probable
involvement certain lymph
nodes in case of known site of tumour or infection.

54. Reference
1. Health Assessment in Nursing Janet R. Weber, RN, EdD 6th edition
2. Nursing Health Assessment a critical thinking, case studies
approach 2nd edition
3. Text book of head and neck anatomy – Hiatt, Gartner 4/E

55. THANK YOU.