Mouth

• ASSESSMENT of mouth, throat, nose and sinuses

  • Review the structure and function of the mouth, throat, nose, and sinuses
  • Interview the client for an accurate nursing history of the mouth, throat, nose, and sinuses
  • Use correct techniques to assess the mouth, throat, nose, and sinuses
  • Differentiate between normal and abnormal findings of the mouth, throat, nose, and sinuses
  • Analyze the data from the interview and physical assessment of the mouth, throat, nose, and sinuses to formulate valid clinical judgments
  • Document and verbally report accurate assessment findings of the mouth, throat, nose, and sinuses
• OBJECTIVES

  • MOUTH
  • THROAT (PHARYNX)
  • Nose
  • SINUSES
• Mouth


  • The mouth—or oral cavity—is formed by the lips, cheeks, hard and soft palates, uvula, and the tongue and its muscles
  • The mouth is the beginning of the digestive tract and serves as an airway for the respiratory tract
  • The two main functions of the mouth are eating and speaking
• Permanent teeth


  • appears about age 6 and adulthood
  • there are 32 permanent pieces
  • 4 – incisors x 2
  • 2 – canines x 2
  • 4 premolars x 2
  • 6 molars x 2
  • 16 x 2 both upper and lower
• Deciduous teeth


  • erupt about 6 months with the incisors thereafter until the 20 are present
  • generally lost in the same sequence between 6 - 12 years of age
• Salivary Glands


  Saliva helps break down food and lubricates it
• Salivary Glands

  • PAROTID GLAND
  • SUBMANDIBULAR GLAND
  • SUBLINGUAL GLAND
• Throat (Pharynx)


  Located behind the mouth and nose, serves as a muscular passage for food and air
• Parts of the Throat (Pharynx)

  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
  • Tonsils
  • Palatine Tonsils
  • Lingual Tonsils
  • Pharyngeal Tonsils (Adenoids)
• Nose


  • 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
  • The front of the nasal septum contains a rich supply of blood vessels and is known as Kiesselbach area. This is a common site for nasal bleeding
  • The superior, middle, and inferior turbinates are bony lobes, sometimes calledconchae, that project from the lateral walls of the nasal cavity
• Paranasal Sinuses


  • Frontal – above the eyes
  • Maxillary – in the upper jaw
  • Ethmoidal
  • Sphenoidal
• Sinuses


  • These air-filled cavities decrease the weight of the skull and act as resonance chambers during speech
  • The paranasal sinuses are also lined with a ciliated mucous membrane that traps debris and propels it toward the outside
  • Often a primary site of infection
• Collecting Subjective Data: The Nursing Health History


  • Subjective data related to the mouth, throat, nose, and sinus can aid in detecting diseases and abnormalities that may affect the client's activities of daily living(ADLs)
  • This examination also allows the nurse to evaluate the client's health practices
• Collecting Objective Data: Physical Examination


  Examination of the mouth and throat can help the nurse to detect abnormalities ofthe lips, gums, teeth, oral mucosa, tonsils, and uvula
• Preparing the Client


  1. Ask the client to assume a sitting position with the head erect. It is best if the client's head is at your eye level

  2. Explain the specific structures you will be examining, and tell the client who wears dentures, a retainer, or rubber bands on braces that they will need to be removed for an adequate oral examination

  3. A gentle yet confident and matter-of-fact approach may help the client to feel more at ease
• Equipment/ Materials needed

  • Nonlatex gloves (wear gloves when examining any mucous membrane)
  • × 4-in. gauze pad
  • Penlight
  • Short, wide-tipped speculum attached to the head of an otoscope
  • Tongue depressor
  • Nasal speculum
• Assessment techniques

  • Inspection
  • Palpation
  • Percussion
• Inspection of the Mouth


  1. Inspect the lips - Observe lip consistency, moisture, and color. Check for lesions or ulcers

  2. Inspect the teeth - Note the number of teeth, color, and condition. Ask the client to bite down as though chewing on something and note the alignment of the lower and upper jaws

  3. Inspect the buccal mucosa - Use a penlight with your nondominant hand and tongue depressor with your dominant hand to retract the lips and cheeks to check color and consistency

  4. Inspect Stensen ducts (parotid ducts) - openings of the parotid salivary glands—located on the buccal mucosa across from the second upper molar
• Common abnormalities of the lips and mouth

  • Common abnormalities of the lips and mouth
  • Common abnormalities of the lips and mouth
• Inspect and palpate the tongue


  1. Ask client to stick out the tongue. Inspect for color, moisture, size, and texture. Observe for fasciculations (fine tremors), and check for midline protrusion

  2. Palpate any lesions present for induration (hardness)

  3. Assess the ventral surface of the tongue - Ask the client to touch the tongue to the roof of mouth, and use a penlight to inspect the ventral surface of the tongue, frenulum, and area under the tongue

  4. Inspect for Wharton ducts —openings from the submandibular salivary glands—located on either side of the frenulum on the floor of the mouth

  5. Observe the sides of the tongue - Use a square gauze pad to hold the client's tongue to each side

  6. Check the strength of the tongue - Place your fingers on the external surface of the client's cheek. Ask the client to press the tongue's tip against the inside of the cheek to resist pressure from your fingers

  7. Check the anterior tongue's ability to taste- Place drops of sugar and salty water on the tip and sides of tongue with a tongue depressor
• Hard and Soft Palate


  1. Inspect the hard (anterior) and soft (posterior) palates and uvula - Ask the client to open the mouth wide while you use a penlight to look at the roof. Observe color and integrity

  2. Note odor - While the mouth is wide open, note any unusual or foul odor
• Uvula


  Assess the uvula - Apply a tongue depressor to the tongue (halfway between the tip and back of the tongue) and shine a penlight into the client's wide-open mouth. Note the characteristics and positioning of the uvula. Ask the client to say "aaah" and watch for the uvula and soft palate to move
• Bifid uvula - Native Americans and Asians may have a split (or bifid) uvula
• Tonsils


  Inspect the tonsils -Using the tongue depressor to keep the mouth open wide, inspect the tonsils for color, size, and the presence of exudate or lesions. Grade the tonsils.
• Tonsillitis (Detecting and Grading)


  • In a client who has both tonsils and a sore throat, tonsillitis can be identified and ranked with a grading scale from 1 to 4 as follows:
  • 1+ Tonsils are visible.
  • 2+ Tonsils are midway between tonsillar pillars and uvula.
  • 3+ Tonsils touch the uvula.
  • 4+ Tonsils touch each other.
• Pharynx


  Inspect the posterior pharyngeal wall - Keeping the tongue depressor in place, shine the penlight on the back of the throat. Observe the color of the throat, and note any exudate or lesions.
• Nose

  1. Inspect and palpate the external nose - Note nasal color, shape, consistency, and tenderness.

  2. Check patency of air flow through the nostrils by occluding one nostril at a time and asking client to sniff or exhale.

  3. Inspect the internal nose - To inspect the internal nose, use an otoscope with a short wide-tip attachment or you can also use a nasal speculum and penlight. Use your nondominant hand to stabilize and gently tilt the client's head back. Insert the short wide tip of the otoscope into the client's nostril without touching the sensitive nasal septum.
• Sinuses

  1. Palpate the sinuses - When an infection is suspected, the nurse can examine the sinuses through palpation and percussion. Palpate the frontal sinuses by using your thumbs to press up on the brow on each side of nose.

  2. Palpate the maxillary sinuses - by pressing with thumbs up on the maxillary sinuses.

  3. Percuss the sinuses - Lightly tap (percuss) over the frontal sinuses and over the maxillary sinuses for tenderness.
• Validating and Documenting Findings


  Validate the mouth, throat, nose, and sinus assessment data that you have collected (by asking additional questions, verifying data with another health care professional, or comparing objective with subjective findings). This is necessary to verify that thedata are reliable and accurate.
• Analyzing Data to Make Informed Clinical Judgments


  After collecting subjective and objective data pertaining to the mouth, throat, nose, and sinuses, identify abnormal cues and supportive cues (client strengths). Then cluster the cues to reveal any significant patterns or abnormalities. These cues may be used to make clinical judgments about the status of the client's mouth, throat, nose, and sinuses.