MOUTH

Cards (36)

  • Mouth and Throat
    First part of digestive system, responsible for receiving food, taste, preparing food for digestion and aiding speech
  • Nose and Paranasal Sinuses
    First part of the respiratory system, responsible for receiving, filtering, warming, and moistening air to be transported to the lungs
  • Mouth
    • Formed by the lips, cheeks, hard and soft palates, uvula, and the tongue and its muscles
    • Contains tongue, teeth, gums, and the openings of the salivary glands
  • Throat
    • Also known as the pharynx
    • Located behind the mouth and nose, serves as a muscular passage for food and air
    • Consists of nasopharynx, oropharynx, and laryngopharynx
    • Contains masses of lymphoid tissue: palatine tonsils, lingual tonsils, and pharyngeal tonsils (adenoids)
  • Nasopharynx
    • Lies behind the nose, connects nasal passages to the rest of the respiratory system, allows passage of air to get from nose to lungs
  • Oropharynx
    • Middle part includes back of tongue, tonsils, soft-palate and pharyngeal wall, allows air and food to pass through, serves as both respiratory and digestive system
  • Laryngopharynx
    • Crucial connection point through which food, water, and air pass, where pharynx divides anteriorly into the larynx and posteriorly into esophagus
  • Nose
    • Consists of an external portion covered with skin and an internal nasal cavity
    • External nose: a bridge, tip, and two oval openings called nares
    • Internal nose: nasal cavity, nasal septum, Kiesselbach area, superior, middle, and inferior turbinate
  • Kiesselbach area
    Located at anterior inferior quadrant of nasal septum where several arteries anastomose, common site of nose bleeding (epistaxis)
  • Turbinate
    Bony structures inside the nose covered by soft tissue (mucosa) that regulates airflow, warm and humidify the air you inhale
  • Paranasal Sinuses
    • Group of 4 paired air-filled spaces that surround the nasal cavity: frontal, maxillary, ethmoid, and sphenoid
    • Sinuses decrease the weight of the skull and act as resonance chambers during speech
  • Risk Factors for Oral Cancer
    • Heavy users of tobacco (smoking and smokeless)
    • Alcohol
    • Men are more prone than women
    • Vitamin D deficiency
  • Risk Reduction Tips for Cancer of the Oral Cavity
    • Stop smoking
    • Limit alcohol consumption
    • Balanced diet
    • Precautionary measures at workplace
    • Practice regular oral hygiene
    • Avoid excessive exposure to ultraviolet light
    • Avoid sources of oral irritation
  • Collecting Subjective Data
    • History of present health concern
    • Past health history
    • Family history
    • Lifestyle and health practices
  • Tongue and Mouth
    • Determine if lesions are related to medications, stress, infection, trauma or malignancy
    • Red swollen gums that bleed easily occur in early gum disease (gingivitis)
  • Nose and Sinuses
    • Pain, swelling, tenderness and pressure around eyes, cheeks, nose or forehead are seen in acute sinusitis/infection of the sinuses
    • Epistaxis can be local or systemic cause, refer client who experiences frequent nosebleeds for further evaluation
    • Thin, watery nasal discharge (rhinorrhea) can indicate a chronic allergy, yellow mucus drainage is typical of a cold
    • Inability to breathe through both nostrils may indicate sinus congestion, obstruction, or deviated septum
  • Throat
    • Dysphagia and odynophagia may be seen with tumors of the pharynx, esophagus, or surrounding structures, narrowing of esophagus, GERD, anxiety, poorly fitting dentures or neuromuscular disorders
    • Sore throat are commonly seen with viral infections, hoarseness may be present
  • Personal Health History
    • Present symptoms may be related to past problems or surgery
    • Pollens cause seasonal rhinitis, dust may cause rhinitis year-round
  • Family History
    There is a genetic risk factor for mouth, throat, nose, and sinus cancers
  • Lifestyles and Health Practices
    • Smoking and excessive use of alcohol increase a person's risk for oral cancer
    • Brushing teeth twice a day with soft bristle toothbrush, flossing and oral hygiene prevent dental caries and gum disease
  • Equipment for Assessment of Mouth, Nose, Throat, and Sinuses
    • Gloves
    • Cotton gauze pads
    • Penlight
    • Nasal speculum attached to otoscope
    • Tongue Depressor
  • Mouth Inspection
    • Lips are smooth, moist and no swelling or lesions
    • 32 pearly white teeth with smooth surfaces and edges, no decayed areas, no missing teeth
    • Buccal mucosa should appear pink in light skinned clients, in all clients is smooth and moist without lesions
    • Tongue should be pink, moist, a moderate size with papillae present and no lesions
    • Lingual frenulum is midline, Wharton ducts or submandibular ducts are visible, with salivary flow or moistness in the area, no lesions, ulcers or nodules present
    • The tongue offers strong resistance and can distinguish between sweet and salty
    • Hard palate is pale or whitish with firm wrinkle-folds, soft palate should be pinkish, spongy, and smooth, no foul odor, uvula hangs freely in the midline, no redness exudate
    • Tonsils may be present or absent, normally pink and symmetric and may be enlarged to 1+ in healthy clients, no exudate, swelling, or lesions, throat is normally pink, without exudate or lesions
  • Grading of Tonsils
    Tonsils can be graded from 0 to 4+ based on their size
  • External Nose Inspection
    • Color is the same as the face, structure is symmetric, no tenderness, client can sniff through each nostril while other is occluded
  • Internal Nose Inspection
    • Nasal mucosa is dark pink, moist, and free of exudate, nasal septum is intact, no ulcers or perforations, turbinate are dark pink, moist and free of lesions
  • Sinuses Palpation
    Frontal and maxillary sinuses are nontender to palpation and percussion and no crepitus is evident
  • A deviated septum may appear to be an overgrowth of tissue, this is a normal finding as long as breathing is not obstructed
  • Cultural Variations
    • Pink lips are normal in light-skinned clients, as are bluish or freckled lips in some dark-skinned clients, especially those of Mediterranean descent
    • Torus palatinus (bony growth in roof of the mouth) in female Eskimos, Native Americans, and Asians
    • Bifid uvula (cleft uvula or split in two) in Native Americans and Asians
  • Age-Related Changes in the Mouth, Nose, Throat, and Sinuses
    • Gums recede, ischemic, and undergo fibrotic changes
    • Tooth surfaces worn down
    • Decreased ability to smell and taste
    • Oral mucosa drier and more fragile
    • Varicose veins in ventral surface of tongue
  • Nursing Process
    • Validating and documenting findings
    • Diagnostic reasoning
    • Nursing diagnoses
    • Collaborative problems
  • Resources
    • Weber, J., & Kelley, J.(2018). Health Assessment in Nursing, Sixth edition
    • Weber, J., & Kelley, J.(2014). Health Assessment in Nursing, Fifth edition
    • Berman A., Snyder, S. & Frandsen, G.(2016). Kozier & Erb's Fundamentals of Nursing, Concept, Process, and Practice, Tenth edition
  • lingual frenulum attaches to mandible
  • tongue has taste buds, papillae, lingual frenulum, and lingual tonsils
  • tongue has taste buds, papillae, lingual frenulum (frenum), and lingual tonsils
  • the tongue is the most mobile organ
  • The lingual frenulum can cause difficulty with speech if it is too tight.