Chapter 18 HA

• Mouth


  Also known as the oral cavity
• Structure of the Mouth

  • Formed by the lips, cheeks, hard and soft palates, uvula, and the tongue and its muscles
  • Oral cavity contains tongue, teeth, gums, and the openings of the salivary glands
• Throat


  Also known as the pharynx
• Structure of the Throat

  • Located behind the mouth and nose, serves as a muscular passage for food and air
  • Nasopharynx, oropharynx, and laryngopharynx
  • Masses of lymphoid tissue: palatine tonsils, lingual tonsils, pharyngeal tonsils (adenoids)
• Structure of the 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 turbinates
• Structure of the Sinuses


  • Four pairs of paranasal sinuses—frontal, maxillary, ethmoidal, and sphenoidal—are located in the skull
  • Sinuses decrease the weight of the skull and act as resonance chambers during speech
• The sinuses decrease the weight of the skull and act as resonance chambers during speech.
• Risk Factors for Cancer of the Oral Cavity

  • Using tobacco products
  • Heavy alcohol use
  • Drinking alcohol and smoking together
  • Being infected with a certain types of HPV
  • Being exposed to sunlight (lip cancer only)
  • Male gender
  • Age over 55
  • Fair skin
  • Poor oral hygiene
  • Poor diet/nutrition
  • Weakened immune system
  • Graft-versus-host disease
  • Genetic syndromes such as Fanconi anemia, dyskeratosis congenita
  • Lichen planus
  • Use of mouthwash with high alcohol content
  • Irritation from dentures
• Most cases of oral cancer occur in people who are heavy users of tobacco (smoking and smokeless) and alcohol. Excessive caffeine intake is not linked to oral cancer. Men are more prone to oral cancer than women. Vitamin D deficiency may lead to oral cancer.
• 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
• Equipment for Assessment of Mouth, Nose, Throat, and Sinuses

  • Gloves
  • Cotton gauze pads
  • Penlight
  • Nasal speculum attached to otoscope
  • Tongue blade
• Physical Assessment Techniques


  • Inspection
  • Palpation
• Assessment of the Mouth

  • Distinctive odors
  • Inspect and palpate lips, buccal mucosa, gums, and tongue for color variations or lesions, Stensen and Wharton ducts
  • Inspect gums for hyperplasia, blue-black line
  • Inspect teeth for number and shape, color, occlusion
  • Inspect and palpate tongue for color, texture and consistency, moisture, and size
• Throat and Tonsils


  • Inspect throat for color, consistency, torus palatinus, uvula
  • Inspect the tonsils for color and consistency; grading scale (1+, 2+, 3+, 4+)
• Assessment of the Nose

  • Inspect and palpate the external nose for color, shape, consistency, tenderness, and patency of airflow
  • Inspect the internal nose for color, swelling, exudate, bleeding, ulcers, perforated septum, or polyps
• Assessment of the Sinuses

  • Palpation for tenderness
  • Percussion and transillumination for air versus fluid or pus
• Abnormal Findings of the Mouth and Throat

  • Herpes simplex type I
  • Cheilosis of lips
  • Carcinoma of lip
  • Leukoplakia
  • Hairy leukoplakia
  • Smooth, reddish, shiny tongue without papillae due to vitamin B12 deficiency
  • Black, hairy tongue
  • Carcinoma of the tongue
  • Canker sore
  • Gingivitis
  • Receding gums
  • Periodontitis
  • Kaposi sarcoma lesions
  • Acute tonsillitis and streptococcal pharyngitis
• Abnormal Findings of the Sinuses

  • Nasal polyp
  • Perforated septum
• 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
  • Talon cusps on incisors and circular cusps on molars in Asian, Pacific Islanders, and Native Americans
  • Torus palatinus in female Eskimos, Native Americans, and Asians
  • Bifid uvula 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