Checklists for Clinical Nursing Skills

21

skill 2-4 Assessing the head and neck (continued)

Comments

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Satisfactory

Needs practice

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23. Palpate and lightly percuss over the frontal and maxillary sinuses. 24. Occlude one nostril externally with a finger while the patient breathes through the other; repeat for the other side. 25. Inspect the internal nostrils using an otoscope with a nasal speculum attachment. 26. Palpate the temporomandibular joint by placing your index fingers over the front of the patient’s ears as you ask them to open and close their mouth. 27. Inspect the lips, oral mucosa, hard and soft palates, gingivae, teeth and salivary gland openings by asking the patient to open their mouth wide, then using a tongue blade and penlight. 28. Inspect the tongue. Ask the patient to stick out their tongue. Place a tongue blade at the side of the tongue while the patient pushes it to the left and right with their tongue. Inspect the uvula by asking the patient to say ‘ahh’ while sticking out their tongue. Palpate the tongue for muscle tone and tenderness. 29. Palpate from the forehead to the posterior triangle of the neck for the posterior cervical lymph nodes using your finger pads in a slow, circular motion. 30. Inspect and palpate in front of and behind the ears, under the chin and in the anterior triangle for the anterior cervical lymph nodes. 31. Inspect and palpate the left and right carotid arteries. Palpate one carotid artery at a time. Use the bell of the stethoscope to auscultate the arteries. 32. Inspect and palpate the trachea. 33. Palpate the thyroid gland by standing behind the patient and placing your hands around their neck with your fingertips over the lower half of the trachea. Ask the patient to swallow and feel for enlargement of the gland as it rises. Palpate each lobe of the thyroid by having the patient turn their head slightly towards the side to be examined and then gently displace the trachea with one hand. Ask the patient to swallow and palpate the thyroid with your other hand. Feel for size, shape, symmetry, tenderness and any nodules. Repeat for the other side. If enlarged, auscultate the thyroid gland using the bell of the stethoscope.

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Copyright © 2014 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Checklists for Clinical Nursing Skills by Louise Sparkes, Jennifer Bassett and Elisabeth Jacob.