MOUTH, THROAT, NOSE AND SINUSES

• Bachelor of Science in Nursing

  Health Assessment Course Module
• Course Unit


  Week 9
• Adult Physical Assessment


  Mouth & Throat, Nose & Sinuses

  
• Learning activities


  1. Read course and unit objectives

  2. Read and comprehend study guide prior to class attendance

  3. Read and comprehend required learning resources

  4. Engage in classroom discussions

  5. Participate in weekly discussion board (Canvas)

  6. Answer and submit course unit tasks
• Lips


  • Muscular folds that surround the mouth
  • Contain sensory receptors and are very sensitive
  • Lips assist with eating, expression, and speech
• Teeth


  • 20 deciduous, 32 permanent
  • Needed for chewing
  • Also have esthetic value
  • DECIDUOUS – primary, milk, temporary or baby teeth
  • PERMANENT – 28 if molars did not erupt
• Tongue


  • Muscle controlled by CN XII – hypoglossal
  • Needed for chewing, swallowing, and speech
  • Sensory (taste) CN VII and CN IX (facial & glossopharyngeal)
• Hard Palate

  Forms the floor of the nasal cavity
• Soft Palate

  • Posterior to hard palate
  • Elevates during swallowing to prevent food and saliva from entering the nasopharynx
• Uvula

  • Fleshy conelike structure in the center of the soft palate
  • Prevents food from entering nasal passages
• Salivary Glands

  • Secrete saliva which contains amylase to convert starch to maltose
  • 3 major salivary glands (produce saliva): Parotid gland, Submandibular gland, Sublingual gland
  • Helps in digestion
  • Oral health
  • In the absence of saliva we cannot taste the food we eat
• Inspection of the Lips

  • Inspect color, condition, lesions, odor
• Normal lips

  • Midline
  • Symmetrical
  • Skin intact
  • Pink, and moist
  • Coloring consistent with ethnic group/race
  • No unusual odors
• Inspection of the Teeth & Bite

  • Have patient open and close mouth
  • Note occlusion and number, color, condition of teeth
• Normal teeth


  • Most adults have 28 teeth, or 32 if the four third molars, or wisdom teeth, are erupted
• Deviations from normal teeth


  • Loose, poorly anchored teeth
  • Malalignment
  • Dental caries
  • Discoloration of teeth
  • Mottled enamel
• Inspection of the Oral Mucosa & Gums


  • Inspect color, condition, lesions of mucosa
  • Note condition of gingiva, bleeding, retraction, or hypertrophy
• Normal oral mucosa and gums

  • Pink, moist, intact mucosa
  • Gums consistent in color with other mucosa
  • Gums intact
  • No bleeding
  • Color variants acceptable if consistent with patient's ethnic group/race
• Deviations from normal oral mucosa and gums

  • Gum hyperplasia / Gingival hyperplasia
  • Gum recession
  • Pale or gray gingivae
  • Abrasions, erosion of underlying mucosa
  • Inflamed, bleeding gingivae
  • Allergic stomatitis
  • Aphthous ulcer
  • Cancers
  • Leukoplakia
• Inspection of the Tongue


  • Inspect color, texture, moisture, and mobility
• Normal tongue


  • Pink and moist
  • Papillae intact
  • Mucosa intact with no lesions or discolorations
  • Freely and symmetrically mobile
  • CN XII intact – hypoglossal
  • Geographic tongue

  
• Deviations from normal tongue

  • Absence of Papillae
  • Color changes
  • Black, hairy tongue
  • Hypertrophy and discoloration of papillae
  • Cancers
• Inspection of the Oropharynx


  • Inspect oropharynx for color, lesions, and drainage
• Normal oropharynx


  • Mucosa is pink, moist, intact
  • The lymphpid - rich posterior wall may have a slightly irregular surface
  • No lesions, erythema, swellings, exudate, or discharge
• Deviations from normal oropharynx

  • Postnasal drainage
  • Gray membrane / adherent material
  • White or pale patches of exudates with erythemic mucosa
  • Exudative pharyngitis
  • Erythema
  • Scattered vesicles/ulcerations
• Causes of changes to papillae

  • Poor oral hygiene
  • Dry mouth
  • Dehydration
  • Smoking or other oral tobacco use
• Cancers


  Abnormal growth of cells
• Inspection of the Oropharynx


  • Inspect oropharynx for color, lesions, and drainage
  • Mucosa is pink, moist, intact
  • The lymphpid - rich posterior wall may have a slightly irregular surface
  • No lesions, erythema, swellings, exudate, or discharge
• Inspection of the Tonsils


  • Note color, size, and exudate
  • Symmetrical, pink, clean crypts
  • Crypts may have normal variation of small food particles
• Tonsil grading


  • 1+
  • 2+
  • 3+
  • 4+
• Palpation of the Lips


  • Lightly palpate lips for consistency and tenderness
  • Soft, nontender, no masses
• Palpation of the Tongue


  • Lightly palpate tongue for consistency and tenderness
  • Tissue is soft, supple, without nodules, thickenings, masses, or tenderness
  • Sublingual glands may be palpable under the tongue but should be nontender, soft, and supple
• Palpation of the Parotid Glands


  • Palpate in front of ears
  • Glands are nonpalpable and nontender
• Palpation of the Submandibular / Sublingual Glands


  • Palpate under the mandible
  • Submandibular and sublingual glands may be palpable but should be nontender, supple, and soft
• Anatomy of the Nose

  • Nares (Nostrils) / Vestibules (provide access to the nasopharynx through structured lines with mucous membranes, rich with blood vessels, covered with CILIA)
  • Nasal Mucosa (Ciliated epithelium cells with goblet cells produce mucus, which traps bacteria and air pollutants)
  • Nasal Septum (Composed of the ethmoid bone and vomer, divides the nasal cavities)
  • Cilia (Small hairs that filter air)
  • Turbinates (Bony conchae (folds) of the internal nasal walls that increase the surface area for air to be filtered, warmed, and humidified before entering the lungs)
  • Olfactory Nerve (CN I) (Controls sense of smell. Stimulated by olfactory receptor cells located in upper nasal cavities)
• Inspection of the External Nose

  • Note size, shape, and symmetry
  • Midline placement
  • Shape symmetrical and consistent with age, gender, and race/ethnic group
  • No nasal flaring
  • No drainage

  
• Inspection of the Internal Nose

  • Pink, variations consistent with ethnic group/race and with oral mucosa
  • Moist, with only clear, scant mucus present
  • Intact, with no lesions or perforations
  • No crusting or polyps
  • Septum located midline
• Palpation of the Nose

  • Cartilaginous portion is slightly mobile
  • Nontender, no masses
  • Nares patent