NOSE

• The nose consists of an external portion covered with skin and an internal nasal cavity. It is composed of bone and cartilage, and is lined with mucous membrane.
• The external nose consists of a bridge (upper portion), tip, and two oval openings called nares.
• The nasal cavity is located between the roof of the mouth and the cranium. It extends from the anterior nares (nostrils) to the posterior nares, which open into the nasopharynx.
• The nasal septum separates the cavity into two halves. The front of the nasal septum contains a rich supply of blood vessels and is known as Kiesselbach’s area. This is a common site for nasal bleeding.
• The superior, middle, and inferior turbinates are bony lobes, sometimes called conchae, that project from the lateral walls of the nasal cavity. These three turbinates increase the surface area that is exposed to incoming air.
• As the person inspires air, nasal hairs (vibrissae) filter large particles from the air. Ciliated mucosal cells then capture and propel debris toward the throat, where it is swallowed.
• The rich blood supply of the nose warms the inspired air as it is moistened by the mucous membrane.
• A meatus underlies each turbinate and receives drainage from the paranasal sinuses and the nasolacrimal duct.Receptors for the first cranial nerve (olfactory) are located in the upper part of the nasal cavity and septum.
• Four pairs of paranasal sinuses (frontal, maxillary, ethmoidal, and sphenoidal) are located in the skull.
• These air-filled cavities (sinuses) decrease the weight of the skull and act as resonance chambers during speech.
• The paranasal sinuses are lined with ciliated mucous membrane that traps debris and propels it toward the outside.
• The sinuses are often a primary site of infection because they can easily become blocked.
• The frontal sinuses (above the eyes) and the maxillary sinuses (in the upper jaw) are accessible to examination by the nurse.
• The ethmoidal and sphenoidal sinuses are smaller, located deeper in the skull, and are not accessible for examination.
• Pain, tenderness, swelling and pressure around the eyes, cheeks, nose or forehead is seen in acute sinusitis, which is a temporary infection of the sinuses.
• In chronic sinusitis, the sinuses become inflamed and swollen, but symptoms last 12 weeks or longer even with treatment.
• Nosebleeds are most commonly due to dry nasal membranes and nose picking.
• Thin, watery, clear nasal drainage (rhinorrhea) can indicate a chronic allergy or, in a client with a past head injury, a cerebrospinal fluid leak.
• Mucous drainage, especially yellow, is typical of a cold, rhinitis, or a sinus infection.
• Inability to breathe through both nostrils may indicate sinus congestion, obstruction, or a deviated septum.
• A decrease in the ability to smell may occur with acute and chronic upper respiratory infections, smoking, cocaine use, or a neurologic lesion or tumor in the frontal lobe of the brain or in the olfactory bulb or tract.
• A decreased ability to taste may be reported by clients with chronic upper respiratory infections or lesions of the facial nerve (VII).
• Changes in perception of smell also occur from a zinc deficiency and from menopause in some women.
• The ability to smell and taste decreases with age. Medications can also decrease sense of smell and taste in older people.
• Nasal mucosa is swollen and pale pink or bluish gray in clients with allergies.
• Nasal mucosa is red and swollen with upper respiratory infection.
• Exudate is common with infection and may range from large amounts of watery discharge to thick yellow-green, purulent discharge.
• Purulent nasal discharge is seen with acute bacterial rhinosinusitis.
• Bleeding (epistaxis) or crusting may be noted on the lower anterior part of the nasal septum with local irritation.
• Ulcers of the nasal mucosa or a perforated septum may be seen with use of cocaine, trauma, chronic infection, or chronic nose picking.
• Small, pale, round, firm overgrowths or masses on mucosa (polyps) are seen in clients with chronic allergies
• Frontal or maxillary sinuses are tender to palpation in clients with allergies or acute bacterial rhinosinusitis.
• If the client has a large amount of exudate, you may feel crepitus upon palpation over the maxillary sinuses.
• The normal findings for sinuses should not be tender on percussion.
• A red glow transilluminates the frontal sinuses. This indicates a normal, air-filled sinus.
• Check patency of air flow through the nostrils by occluding one nostril at a time and asking client to sniff