1
D443 NURS 3116
HEALTH ASSESSMENT
OBJECTIVE ASSESSMENT
2025
Lymph Nodes
Are variably classified. Chapter 7 pg. 259 has a chart of the classification and the direction of how
the lymph nodes drain.
Nodes are normally round or ovoid, smooth and smaller than the submandibular gland. The gland is
larger and has a lobulated, slightly irregular surface.
**Note that the tonsillar, submandibular, and submental nodes drain portions of the mount and
throat as well as the face.
**Lymphatic drainage patterns are helpful for assessing possible malignancy or infection. To look for
this, look for enlargement of the neighboring regional lymph nodes; when a node is enlarged or
tender, look for source in its nearby drainage area.
Techniques for examining lymph nodes:
First inspect the neck- is it symmetrical? Do you see any masses or scars? Look for enlargement of
the parotid or submandibular glands, and note any visible lymph nodes.
**If you see a scar from a past thyroid surgery, this is a clue to an unsuspected thyroid or
parathyroid disease.
Second, palpate the lymph nodes:
1) Use pads of your index finger and middle fingers, press gently, moving the skin over the
underlying tissues in each area.
2) Make sure the patient is relaxed, with the neck flexed slightly forward and if needed, turned
slightly toward the side being examined.
3) **You can usually examine both sides at once, noting both the presence of lymph nodes as
well as asymmetry. However, for the submental node, it is helpful to feel with one hand
while bracing the top of the head with the other hand.
4) Sequence for the following nodes:
, 2
⮚ Preauricular- in front of the ear
⮚ Posterior auricular- superficial to the mastoid process (behind the ear).
⮚ Occipital- at the base of the skull posteriorly
⮚ Tonsillar- at the angle of the mandible
⮚ Submandibular- midway between the angle and the tip of the mandible. These
nodes are usually smaller and smoother than the lobulated submandibular gland
against which they lie.
⮚ Submental- in the midline a few cm’s behind the tip of the mandible.
⮚ Superficial cervical- superficial to the sternocleidomastoid
⮚ Posterior cervical- along the anterior edge of the trapezius
⮚ Deep cervical chain- deep to the sternocleidomastoid and often inaccessible to
examination. **Hook your thumb and fingers around either side of the
sternocleidomastoid muscle to find them.
⮚ Supraclavicular- deep in the angle formed by the clavicle and the
sternocleidomastoid.
⮚ **Enlargement of the supraclavicular node, especially on the left, suggest possible
metastasis from a thoracic or an abdominal malignancy.
5) Note the following when assessing lymph nodes:
⮚ Node size
⮚ Shape
⮚ Delimitation (discrete or matted together)
⮚ Mobility
⮚ Consistency
⮚ Tenderness
6) Small, mobile, discrete, nontender nodes, sometimes called “shotty” are frequently found
in normal people.
7) Describe enlarged lymph nodes in two dimensions, maximal length and width, for example,
1 cm x 2 cm. Also note any overlying skin changes (erythema, induration, drainage or
breakdown).
8) If enlarged or tender nodes, if unexplained call for (1) re-examination of the regions they
drain and (2) careful assessment of the lymph nodes in other regions to identify regional
from generalized lymphadenopathy.
9) Techniques for preauricular and cervical lymph nodes:
⮚ Using the pads of the second and third fingers palpate the preauricular nodes with
a gentle rotary motion. Then examine the posterior auricular and occipital lymph
nodes.
⮚ **Tender nodes suggest inflammation; hard or fixed nodes suggest malignancy.
⮚ Palpate the anterior superficial and deep cervical chains, located anterior and
superficial to the sternocleidomastoid. Then palpate the posterior cervical chain
along the trapezius and along the sternocleidomastoid.
⮚ Flex the patient’s neck slightly forward toward the side being examined.
⮚ Examine the supraclavicular nodes in the angle between the clavicle and the
sternocleidomastoid.
⮚ ***If you feel supraclavicular lymph nodes, a through work-up is warranted.
10) Generalized lymphadenopathy is seen in multiple infectious, inflammatory, or malignant
conditions such as HIV or AIDS, infectious mononucleosis, lymphoma, leukemia, and
sarcoidosis.
● Occasionally, you mistake a band of muscle or an artery for a lymph node. Unlike a muscle
or an artery, you should be able to roll a node in two directions: up and down, and side to
, 3
side. Neither a muscle nor an artery will pass this test.Cranial Nerves
● HEENT Assessment and Modification for Age
● Normal VS. Abnormal Findings and Interpretation
● Visual Acuity
● Visual Acuity (Pg. 231)
To test visual acuity, you are to use a well-lit Snellen eye chart, if possible
Patient must wear correction lenses (glasses/contacts) if available
Patient is to be positioned 20 feet away from Snellen eye chart
Patient must cover one eye at a time and test each eye individually and then test vision
with both eyes uncovered
Patient must identify the smallest line of print possible where they can identify more
than half the letters
--Visual Acuity is expressed as two numbers (20/30): the first indicates the distance of
the patient from the chart, and the second number is the distance at which a normal
eye can read the line of letters
Testing near vision with a hand-held card at the bedside can help identify the need for
correction lenses for reading (card to be held 14 inches from patients’ eyes)
● Glaucoma
● Epistaxis
● Retinal Issues
Retinal artery hypertension, increased pressure damages the vascular endothelium,
leading to deposition of plasma macromolecules and thickening of the arterial wall,
causing focal and generalized narrowing of the lumen and light reflex.
, 4
Copper wiring: sometimes the arteries, especially those close the disc, become full
and somewhat tortuous and develop an increased light reflex with a bright coppery
luster, called copper wiring.
Silver wiring: occasionally the wall of a narrowed artery becomes opaque so there is
no visible blood called silver wiring.
AV Crossing is when the arterial walls lose their transparency, changes appear in the
arteriovenous crossing. Decreased transparency of the retina probably also
contributes to Concealment or AV Nicking and Tapering.
Concealment or AV Nicking: the vein appears to stop abruptly on either side of the
artery.
Tapering: the vein appears to taper down the either side of the artery.
Banking: the vein is twisted on the distal side of the artery and forms a dark wide
knuckle.
Superficial Retinal Hemorrhages: small, linear, flame-shaped, red streaks in the
fundi, shaped by the superficial bundles of the nerve fibers that radiate from the
optic disc in the pattern illustrated ( 0= optic disc, F=fovea). Sometimes the
hemorrhages are seen in severe hypertension papiledema and occlusion of the
retinal vein among the other conditions. An occasional superficial hemorrhage has a
white center consisting of fibrin, which has many causes.
Preretinal hemorrhage: develops when the blood escapes into the potential space
between the retina and vitreous. This hemorrhage is typically larger than retinal
hemorrhages. Because it is anterior to the retina, it obscures any underlying retinal
vessels. In an erect patient, red cells settle, creating a horizontal line of demarcation
between plasma above and cells below. Causes include a sudden increase in
intracranial pressure.
Deep Retinal Hemorrhages: small, rounded, slightly irregular red spots that are
sometimes called dot or blot hemorrhages. They occur in a deeper layer of the
retina than flame-shaped hemorrhages. Diabetes is a common cause.
Microaneurysms: Tiny, round, red spots commonly seen in and around the macular
area. They are minute dilations of the very small retinal vessels, the vascular
D443 NURS 3116
HEALTH ASSESSMENT
OBJECTIVE ASSESSMENT
2025
Lymph Nodes
Are variably classified. Chapter 7 pg. 259 has a chart of the classification and the direction of how
the lymph nodes drain.
Nodes are normally round or ovoid, smooth and smaller than the submandibular gland. The gland is
larger and has a lobulated, slightly irregular surface.
**Note that the tonsillar, submandibular, and submental nodes drain portions of the mount and
throat as well as the face.
**Lymphatic drainage patterns are helpful for assessing possible malignancy or infection. To look for
this, look for enlargement of the neighboring regional lymph nodes; when a node is enlarged or
tender, look for source in its nearby drainage area.
Techniques for examining lymph nodes:
First inspect the neck- is it symmetrical? Do you see any masses or scars? Look for enlargement of
the parotid or submandibular glands, and note any visible lymph nodes.
**If you see a scar from a past thyroid surgery, this is a clue to an unsuspected thyroid or
parathyroid disease.
Second, palpate the lymph nodes:
1) Use pads of your index finger and middle fingers, press gently, moving the skin over the
underlying tissues in each area.
2) Make sure the patient is relaxed, with the neck flexed slightly forward and if needed, turned
slightly toward the side being examined.
3) **You can usually examine both sides at once, noting both the presence of lymph nodes as
well as asymmetry. However, for the submental node, it is helpful to feel with one hand
while bracing the top of the head with the other hand.
4) Sequence for the following nodes:
, 2
⮚ Preauricular- in front of the ear
⮚ Posterior auricular- superficial to the mastoid process (behind the ear).
⮚ Occipital- at the base of the skull posteriorly
⮚ Tonsillar- at the angle of the mandible
⮚ Submandibular- midway between the angle and the tip of the mandible. These
nodes are usually smaller and smoother than the lobulated submandibular gland
against which they lie.
⮚ Submental- in the midline a few cm’s behind the tip of the mandible.
⮚ Superficial cervical- superficial to the sternocleidomastoid
⮚ Posterior cervical- along the anterior edge of the trapezius
⮚ Deep cervical chain- deep to the sternocleidomastoid and often inaccessible to
examination. **Hook your thumb and fingers around either side of the
sternocleidomastoid muscle to find them.
⮚ Supraclavicular- deep in the angle formed by the clavicle and the
sternocleidomastoid.
⮚ **Enlargement of the supraclavicular node, especially on the left, suggest possible
metastasis from a thoracic or an abdominal malignancy.
5) Note the following when assessing lymph nodes:
⮚ Node size
⮚ Shape
⮚ Delimitation (discrete or matted together)
⮚ Mobility
⮚ Consistency
⮚ Tenderness
6) Small, mobile, discrete, nontender nodes, sometimes called “shotty” are frequently found
in normal people.
7) Describe enlarged lymph nodes in two dimensions, maximal length and width, for example,
1 cm x 2 cm. Also note any overlying skin changes (erythema, induration, drainage or
breakdown).
8) If enlarged or tender nodes, if unexplained call for (1) re-examination of the regions they
drain and (2) careful assessment of the lymph nodes in other regions to identify regional
from generalized lymphadenopathy.
9) Techniques for preauricular and cervical lymph nodes:
⮚ Using the pads of the second and third fingers palpate the preauricular nodes with
a gentle rotary motion. Then examine the posterior auricular and occipital lymph
nodes.
⮚ **Tender nodes suggest inflammation; hard or fixed nodes suggest malignancy.
⮚ Palpate the anterior superficial and deep cervical chains, located anterior and
superficial to the sternocleidomastoid. Then palpate the posterior cervical chain
along the trapezius and along the sternocleidomastoid.
⮚ Flex the patient’s neck slightly forward toward the side being examined.
⮚ Examine the supraclavicular nodes in the angle between the clavicle and the
sternocleidomastoid.
⮚ ***If you feel supraclavicular lymph nodes, a through work-up is warranted.
10) Generalized lymphadenopathy is seen in multiple infectious, inflammatory, or malignant
conditions such as HIV or AIDS, infectious mononucleosis, lymphoma, leukemia, and
sarcoidosis.
● Occasionally, you mistake a band of muscle or an artery for a lymph node. Unlike a muscle
or an artery, you should be able to roll a node in two directions: up and down, and side to
, 3
side. Neither a muscle nor an artery will pass this test.Cranial Nerves
● HEENT Assessment and Modification for Age
● Normal VS. Abnormal Findings and Interpretation
● Visual Acuity
● Visual Acuity (Pg. 231)
To test visual acuity, you are to use a well-lit Snellen eye chart, if possible
Patient must wear correction lenses (glasses/contacts) if available
Patient is to be positioned 20 feet away from Snellen eye chart
Patient must cover one eye at a time and test each eye individually and then test vision
with both eyes uncovered
Patient must identify the smallest line of print possible where they can identify more
than half the letters
--Visual Acuity is expressed as two numbers (20/30): the first indicates the distance of
the patient from the chart, and the second number is the distance at which a normal
eye can read the line of letters
Testing near vision with a hand-held card at the bedside can help identify the need for
correction lenses for reading (card to be held 14 inches from patients’ eyes)
● Glaucoma
● Epistaxis
● Retinal Issues
Retinal artery hypertension, increased pressure damages the vascular endothelium,
leading to deposition of plasma macromolecules and thickening of the arterial wall,
causing focal and generalized narrowing of the lumen and light reflex.
, 4
Copper wiring: sometimes the arteries, especially those close the disc, become full
and somewhat tortuous and develop an increased light reflex with a bright coppery
luster, called copper wiring.
Silver wiring: occasionally the wall of a narrowed artery becomes opaque so there is
no visible blood called silver wiring.
AV Crossing is when the arterial walls lose their transparency, changes appear in the
arteriovenous crossing. Decreased transparency of the retina probably also
contributes to Concealment or AV Nicking and Tapering.
Concealment or AV Nicking: the vein appears to stop abruptly on either side of the
artery.
Tapering: the vein appears to taper down the either side of the artery.
Banking: the vein is twisted on the distal side of the artery and forms a dark wide
knuckle.
Superficial Retinal Hemorrhages: small, linear, flame-shaped, red streaks in the
fundi, shaped by the superficial bundles of the nerve fibers that radiate from the
optic disc in the pattern illustrated ( 0= optic disc, F=fovea). Sometimes the
hemorrhages are seen in severe hypertension papiledema and occlusion of the
retinal vein among the other conditions. An occasional superficial hemorrhage has a
white center consisting of fibrin, which has many causes.
Preretinal hemorrhage: develops when the blood escapes into the potential space
between the retina and vitreous. This hemorrhage is typically larger than retinal
hemorrhages. Because it is anterior to the retina, it obscures any underlying retinal
vessels. In an erect patient, red cells settle, creating a horizontal line of demarcation
between plasma above and cells below. Causes include a sudden increase in
intracranial pressure.
Deep Retinal Hemorrhages: small, rounded, slightly irregular red spots that are
sometimes called dot or blot hemorrhages. They occur in a deeper layer of the
retina than flame-shaped hemorrhages. Diabetes is a common cause.
Microaneurysms: Tiny, round, red spots commonly seen in and around the macular
area. They are minute dilations of the very small retinal vessels, the vascular
