Clinical meaning
The head, eyes, ears, nose, throat (HEENT), and skin assessment is a foundational component of the comprehensive nursing assessment that evaluates structures critical to sensory function, airway patency, neurological integrity, and protective barrier function. The head assessment includes evaluation of the skull for symmetry, tenderness, and lesions, as well as assessment of the temporal arteries and temporomandibular joint (TMJ). The twelve cranial nerves originate from the brainstem and provide motor and sensory innervation to the head and neck structures; the practical nurse must be able to perform a basic cranial nerve screening, particularly nerves II (optic, visual acuity), III, IV, VI (oculomotor, trochlear, abducens -- extraocular movements), V (trigeminal, facial sensation and mastication), VII (facial, facial expression and taste), VIII (vestibulocochlear, hearing and balance), IX and X (glossopharyngeal and vagus, swallowing and gag reflex), XI (accessory, shoulder shrug and head turning), and XII (hypoglossal, tongue movement). Eye assessment includes evaluation of visual acuity using a Snellen chart (normal vision is 20/20), visual fields by confrontation testing, pupil assessment using the PERRLA documentation system (Pupils Equal, Round, Reactive to Light and Accommodation), and inspection of the conjunctiva, sclera, and cornea. The pupillary light reflex is mediated by cranial nerves II and III; when light is shone into one eye, both pupils should constrict equally (consensual response). Anisocoria (unequal pupils) may be a normal variant in approximately 20% of the population or may indicate serious neurological pathology such as increased intracranial pressure, stroke, or oculomotor nerve compression. Ear assessment includes inspection of the external ear (pinna) for lesions and tenderness, otoscopic examination of the external auditory canal and tympanic membrane, and hearing assessment using the whisper test, Weber test (tuning fork on vertex of skull), and Rinne test (tuning fork on mastoid process then near ear canal). The Weber test lateralizes to the affected ear in conductive hearing loss and to the unaffected ear in sensorineural hearing loss. The nose and throat assessment includes inspection of the nasal mucosa for color, swelling, and discharge; the oral cavity for lesions, dental hygiene, and hydration status; the pharynx for erythema, exudate, and tonsillar enlargement; and the neck for lymphadenopathy, thyroid enlargement, and jugular venous distension. The skin is the body's largest organ and serves as the first line of defense against infection, regulates body temperature, prevents fluid loss, provides sensory reception, and synthesizes vitamin D. The integumentary assessment evaluates skin color, temperature, moisture, turgor, integrity, and the presence of lesions. Skin turgor is assessed by pinching the skin over the sternum or forearm; delayed return (tenting) suggests dehydration, particularly significant in elderly patients where assessment over the sternum or forehead is more reliable than the hand dorsum due to age-related loss of skin elasticity. Wound assessment follows a standardized approach documenting location, size (length x width x depth in centimeters), wound bed appearance (granulation tissue is beefy red, slough is yellow, eschar is black), surrounding skin condition, drainage characteristics (serous, sanguineous, serosanguineous, purulent), and odor. The Braden Scale is the most widely used tool for predicting pressure injury risk, scoring six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear, with scores ranging from 6 (highest risk) to 23 (lowest risk); a score of 18 or below indicates increased risk for pressure injury development.