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

Health Assessment BSN201 Week 6 Lecture 10 Nose, Mouth and Throat. 1 Learning Objectives Upon completion of this lecture, the student will be able to:  Identify the structures of nose, mouth and throat  Identify pertinent nose, mouth and throat history questions...

Health Assessment BSN201 Week 6 Lecture 10 Nose, Mouth and Throat. 1 Learning Objectives Upon completion of this lecture, the student will be able to:  Identify the structures of nose, mouth and throat  Identify pertinent nose, mouth and throat history questions (subjective data)  Perform nose, mouth and throat physical assessment (objective data)  Differentiate between normal and abnormal nose, mouth and throat assessment findings  Document the nose, mouth and throat assessment findings  Nose  Nose is first segment of respiratory system. It warms, moistens, and filters the inhaled air  Nasal cavity is much larger than external nose. It extends back over roof of mouth; divided medially by septum  Nose (Cont….) Anterior part of septum holds a rich vascular network, “Kiesselbach plexus’’ the most common site of nosebleeds  Olfactory receptors lie at roof of nasal cavity and in upper one-third of septum  Nose (Cont….)  External nose is shaped like a triangle; superior part is bridge, and free corner is tip  Oval openings at base of triangle are nares; each naris widens into vestibule  Columella divides two nares. Ala nasi is lateral outside wing of nose on either side  Sinuses  Four pairs of paranasal sinuses are air-filled pockets within cranium  Two pairs of sinuses are accessible to examination:frontal & maxillary  The other two sets are smaller & deeper (ethmoid & sphenoid)  Mouth Mouth is first segment of digestive system & an airway for respiratory system Oral cavity is a short passage bordered by lips, palate, cheeks, and tongue. It contains teeth, gums, tongue & salivary glands  Adults have 32 permanent teeth—16 in each arch  Mouth (Cont….)  Arching roof of mouth is palate; it is divided into two parts: i. Hard palate (anterior) ii. Soft palate (posterior) Uvula is free projection hanging down from middle of soft palate  Frenulum is a midline fold of tissue that connects tongue floor of mouth  Throat Throat, or pharynx, is area behind mouth & nose  Oropharynx is separated from mouth by a fold of tissue on each side (anterior tonsillar pillar)  Tonsils (four types), each a mass of lymphoid tissue Subjective Data: Nose Rhinorrhea  Objective Data: Nose  To assess noes, use inspection, palpation and percussion Inspection  Inspect for position , symmetry, nasal discharge, flaring, inflammation, or skin lesions  Normally, symmetric, in the midline & no lesions/signs of infection Patency test of nostrils  This reveals any obstruction i. Occluding one nostril and asking client to breathe in through the other nostril ii. Repeat on the other side  Objective Data: Nose (Cont….)  Inspect the nasal cavity  Use otoscope with a large speculum, lift up tip of nose before inserting  View each nasal cavity with client's head erect and then with head tilted back  Normally, red with smooth & moist surface, no swelling, discharge, bleeding, or foreign body. No polyps  Objective Data: Nose (Cont….) Palpate and percussion the sinuses i. Stand facing the client ii. Using your thumbs, press frontal sinuses by pressing firmly up and under eyebrows and over maxillary sinuses below (not over) cheekbones iii.Take care not to press directly on the eyeballs iv.Percuss the areas using middle or index finger of dominant hand (direct percussion)  Normally, client will feel pressure but no pain with palpation. Non-tender to percussion  Nose Abnormalities  Epistaxis (nosebleed) Sinusitis  Seasonal allergic rhinitis  Nasal Polyps  Subjective Data: Mouth and Throat  Sores or lesions. Noticed any sores or lesions in the mouth, tongue, or gums?  Sore throat. How about sore throats? How frequently do you get them? Have a sore throat now? When did it start?  Bleeding gums. Any bleeding gums? How long have you had them?  Toothache. Any toothache? Do your teeth seem sensitive to hot, cold? Have you lost any teeth?  Subjective Data: Mouth and Throat (Cont….)  Dysphagia. Any difficulty swallowing? How long have you had it?  Altered taste. Any change in sense of taste?  Smoking, alcohol consumption. Do you smoke? Pipe or cigarettes? Smokeless tobacco? How many packs per day? For how many years?  Objective Data: Mouth and Throat Inspect the mouth Use a tongue blade 1) Lips to retract structures  Inspect for color, moisture, cracking, and a bright light for optimal visualization lesions  Retract lips and note their inner surface  Normally, pink, no cracking or lesion Objective Data:Mouth and Throat (Cont….)  Inspect the mouth (Cont….) 2) Teeth  Note any absent, loose, caries or abnormally positioned teeth  Normally, look white, straight, evenly spaced, clean & free of caries 3) Gums  Inspect gums for color, bleeding, inflammation, ulcerations & lesions  Normally, look pink, gum margins at teeth are tight & well defined Objective Data:Mouth and Throat (Cont….)  Inspect the mouth (Cont….) 4) Tongue  Check tongue for color, size, surface characteristics & moisture  Normally, color is pink and even o A thin white coating may be present (Fig. A) o Ventral surface looks smooth & shows veins (Fig. B) Objective Data:Mouth and Throat (Cont….)  Palpate the mouth 4) Tongue  With a glove, a hold tongue with a cotton gauze pad for traction and swing it out and to each side  Use your gloved hand to palpate the area and rest of oral mucosa  Note any nodules or ulcerations Objective Data:Mouth and Throat (Cont….)  Inspect the mouth (Cont….) 5) Buccal mucosa  Hold the cheek open with a tongue blade and check for color, nodules, or lesions  Normally, pink, smooth and moist with no lesions 6) Palate  Shine your light up to the roof of mouth  Normally, anterior hard palate is white, posterior soft palate is pinker, smooth, and upwardly movable  Objective Data: Mouth and Throat (Cont….) Inspect the throat  Observe oval, rough-surfaced tonsils behind anterior tonsillar pillar  Notice any breath odor (halitosis)  Normally, color is same pink as oral mucosa & no exudate on tonsils  Tonsils are graded in size as follows: i. 1+ Visible ii. 2+ Halfway between tonsillar pillars & uvula iii. 3+ Touching the uvula Tonsils are enlarged to 2+, 3+, or 4+ with an acute infection iv. 4+ Touching one another Tonsils Graded  Mouth Abnormalities  Lip colors  Cleft Lip  Circumoral pallor: with shock & anemia  Cyanosis: with hypoxemia & chilling  Cherry red lips: carbon monoxide poisoning  Cheilitis  Herpes Simplex 1 (HSV-1)  Mouth Abnormalities (Cont…..)  Dental Caries Koplik Spots Gingival Hyperplasia  Mouth Abnormalities (Cont…..) Ankyloglossia (tongue tie) Cleft Palate  Throat Abnormalities Tonsillitis  Sample Charting: Subjective Data  No history of discharge, sinus problems, obstruction, epistaxis, or allergy. Fractured nose during high school sports. No lesions, bleeding gums, toothache, dysphagia. Occasional sore throat with colds. Tonsillectomy, age 8. Smokes cigarettes 1 PPD × 9 years. Visits dentist annually, flosses daily Sample Charting: Objective Data  Nose: Symmetric, no deformity or skin lesions. Nares patent. No discharge, lesions, or polyps; no septal deviation or perforation. Sinuses-no tenderness to palpation  Mouth: Mucosa and gingivae pink, no masses or lesions. Teeth all present, straight, and in good repair. Tongue smooth, pink, no lesions, protrudes in midline, no tremor  Throat: Mucosa pink, no lesions or exudate. Uvula rises in midline on phonation. Tonsils 3+; exudate on tonsils