Health Assessment BSN201: Nose, Mouth, and Throat

Health Assessment BSN201: Week 6 Lecture 10 - Nose, Mouth, and Throat

• Learning Objectives: Students will be able to identify nose, mouth, and throat structures, pertinent history questions (subjective data), perform physical assessments (objective data), differentiate between normal and abnormal findings, and document assessments.

Nose

• Function: The nose is the first part of the respiratory system. It warms, moistens, and filters inhaled air.
• Nasal Cavity: Larger than the external nose, extending across the roof of the mouth, and divided medially by the septum.
• Structures: The nasal cavity includes turbinates, meatus, vestibule, and hard palate. Important structures identified in the presentation include the olfactory nerve (CN I), frontal sinus, sphenoid sinus, pharyngeal tonsil, eustachian tube opening, soft palate, and palatine tonsil.
• Kiesselbach Plexus: A rich vascular network in the anterior part of the septum, common site for nosebleeds (epistaxis).
• Olfactory Receptors: Located in the roof of the nasal cavity and the upper one-third of the septum which are responsible for smell.
• External Nose: Shaped like a triangle, with a bridge, tip, and nares (nostrils). The columella divides the two nares and the ala nasi is the lateral outside wing of the nose.

Sinuses

• Paranasal Sinuses: Four pairs of air-filled pockets within the cranium. Two pairs are easy to access-frontal and maxillary sinuses.
• Accessibility: Frontal and maxillary sinuses are the two pairs of sinuses that are easily examined.
• Depth: The ethmoid and sphenoid sinuses are located deeper and are smaller.

Mouth

• Function: The mouth is the initial part of the digestive system and respiratory tract.
• Oral Cavity: A short passage bordered by lips, palate, cheeks, and tongue. It contains teeth, gums, tongue, and salivary glands.
• Teeth: Adults have 32 permanent teeth, with 16 in each arch. Include incisors, canines, premolars, and molars.
• Palate: The arched roof of the mouth, divided into a hard anterior part and a soft posterior part.

Uvula and Frenulum

• Uvula: A free projection hanging down from the middle of the soft palate.
• Frenulum: A midline fold of tissue connecting the tongue to the mouth.

Throat (Pharynx)

• Function: The throat is the area behind the mouth and nose, an airway and part of the digestive system.
• Oropharynx: Separated from the mouth by a fold of tissue (anterior tonsillar pillar).
• Tonsils: Structures containing lymphoid tissue (four types- pharyngeal, tubal, palatine, and lingual).

Subjective Data: Nose

• Discharge: Presence of nasal discharge (watery, purulent, mucoid, bloody). Frequency of colds (upper respiratory infections (URIs)).
• Sinus Pain: Presence of sinus pain and sinusitis, and chronic postnasal drip.
• Trauma: History of trauma to the nose, breathing sufficiency.
• Nosebleeds: Presence and frequency of nosebleeds. Amount and colour/clots of blood.
• Allergies: History of allergies and hay fever (e.g. pollens, dust, etc.).
• Altered Sense of Smell: Change in sense of smell.

Subjective Data: Mouth and Throat

• Sores/Lesions: Any sores or lesions in the mouth, tongue, or gums?
• Sore Throat: Frequency of sore throats, current sore throats, and onset of pain.
• Bleeding Gums: Duration of bleeding gums.
• Toothache: Presence of toothache and tooth sensitivity to hot and cold. Tooth loss history.
• Dysphagia: Difficulty swallowing (duration).
• Altered Taste: Changes in the sense of taste.
• Smoking/Alcohol Consumption: Smoking habits, pipe, cigarettes, or smokeless tobacco use, frequency, and duration.

Objective Data: Nose

• Inspection: Position, symmetry, and presence of any discharge, flaring, inflammation, or skin lesions. Should be symmetrical and no lesions/signs of infection.
• Patency Test: Test to see if both nostrils are open.
• Otoscopic Examination: Examination of the nasal cavity using an otoscope. Looking for smooth, moist, red surfaces, and absence of swelling, discharge, bleeding, or foreign bodies. Polyps are a possible finding.

Objective Data: Mouth and Throat

• Inspection of Lips: Color, moisture, cracking, and lesions which should be normally pink with no cracking or lesions.
• Examination of mouth including teeth, gums, and tongue
• Palpation of Mouth: Presence of nodules or ulcerations.

Nose, Mouth, and Throat Abnormalities

• Examples of abnormalities: Epistaxis, sinusitis, nasal polyps, seasonal allergic rhinitis, dental caries, gingival hyperplasia, ankyloglossia, cleft lip, cleft palate, and tonsillitis.
• Additional Abnormal Findings in Mouth and Throat: Kopliks spots

Sample Charting

• Patient history: Includes subjective data from client about nose, mouth, and throat problems.
• Clinical Signs: Includes objective data found from examination of the nose, mouth, and throat.