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• Subjective data: focus questions about


  • Prior dental problems
  • Lip or oral lesions
  • Redness or swelling (location, occurrence)
  • Dysphagia
  • Sore throat
  • Hoarseness
  • Family Hx of mouth, nose or throat cancer
  • Smoking?
  • Dental care practices: (brushing)
• Mouth Assessment


  1. Subjective data: focus questions

  2. Objective Data: Inspection & Palpation
• Mouth Assessment (continue)


  1. Mouth open & close

  2. Lips (wearing gloves: inspect & palpate)

  3. Gums (retract client's lips to inspect & palpate)

  4. Teeth (wearing gloves: inspect & palpate)

  5. Tongue (wearing gloves: inspect & palpate)

  
• Mouth open & close


  • Asymmetrical mouth - Neurological condition (Bell's palsy, stroke), Tumors, Infections
  • Malocclusion of teeth, protrusion of upper or lower incisors
  • Symmetrical lips & surrounding, No lesion, swelling, drooping, Upper teeth resting on top of lower teeth

  
• Lips


  • Cyanotic - Shock, Carbon monoxide poisoning
  • Pale lips - Anemia
  • Dry, cracked, fissures, lesion
  • Pink (in white), Bluish (in black), Moist, smooth with no lesion
• Gums


  • Pale, markedly reddened
  • Swollen gums, bleeding - gingivitis
  • Bluish-black gum line - lead poisoning
  • Dry, edema, ulcers, bleeding, white patches, tenderness
  • Pink (white), Moist, clearly defined margins
• Teeth


  • Missing teeth
  • Loose or broken teeth, jagged edges, tooth decay
  • Darkened, brown, discoloration, Yellow brown - Excessive take of coffee, tea, tobacco
  • 32 teeth, Stable fixation, smooth surfaces & edges, White & shiny
• Tongue


  • Dry, nodules, ulcer & fissures absent
  • Red, shiny tongue - Vit B12 deficiency
  • Jerky, unilateral movement
  • Markedly reddened, white patches, pale
  • Moist, symmetrical, midline fissure smooth surfaces & edges, Stable fixation, Pink
• Nose, and Sinus Assessment


  1. Equipment: penlight, nasal speculum

  2. Subjective data: focus questions

  3. Objective data: Assess nose & sinus through Inspection &Palpation

  
• External Nose


  • Skin Appearance: Color as face, Consistency: smooth
  • Shape: Symmetrical
  • Nares: Symmetrical, no change in nares with respiration, dry no crust, septum midline
  • Nodules, lesion, erythema, visible vasculature
  • Asymmetry
  • Asymmetry, flaring nares, discharge crusting, displaced septum

  
• External Nose (Palpate for)


  • Firmness: Solid placement, No nodules, No masses, No pain with palpation
  • Unstable placement, Nodules, masses, pt verbalizes pain on palpation, Nasal tenderness
• Internal Nose (inspect for)


  • Appearance: Mucosa pink, Moist with uniform color, No lesion
  • Mucosa marked red, dry, cracked, discoloration, Swollen mucosa - upper respiratory infection, Ulcer - trauma, infection, cocaine use, nose-picking, Polyps - chronic allergies

  
• Internal Nose (inspect for)


  • Function of nose for patency (mouth closed & one naris occluded): Air is felt being exhaled through opposite naris, Noiseless
  • Obstructed exhalation when mouth is closed & one naris is occluded, Noisy
• Sinuses (Palpate for)


  • Frontal & maxillary sinuses: Non tender on palpation
  • pt verbalizes pain or discomfort on palpation - allergies & sinus infection
• The mouth is the opening to the digestive system.
• Functions of the Skin


  • Maintenance of Body Temperature
  • Production of Vitamin D
  • A Barrier (Prevents evaporative water loss, Protection for microorganisms, Protection from environment)
  • Sensations of touch, pressure and pain
  • Cosmetic Appearance
• Physical Assessment Equipment


  • Strong Direct Lighting
  • Small Centimeter ruler
  • Penlight
  • Gloves
  • Magnifying glass
• Techniques used in skin assessment

  Inspection and Palpation

  
• Principles of assessment


  • Exposed areas first
  • Compare
  • Fingertips for general differences/moisture
  • Dorsa (back) of hand, temperature
• Inspect and Palpate Skin


  • Color
  • Temperature
  • Moisture
  • Texture
  • Thickness
  • Edema
  • Mobility & Turgor
  • Vascularity or Bruising
  • Lesions

  
• Skin Assessment: Inspection


  1. Generalized Color (Normal, Pallor, Flushed, Bluish & cyanosis)

  2. Color variations in patches on body (Normal, Suntanned, White patches, Jaundice, Erythema, Ecchymosis, Petechiae)

  
• Skin Assessment: Palpation


  1. Texture (Normal, Rough, thick, dry)

  2. Temperature & moisture (Normal, Extremely cool, Extremely warm, Wet, oily)

  3. Turgor (Normal, Pinch up skin 30 sec or longer)

  4. Edema (Normal, Swollen, Shallow to deep pitting, Ascites)

  5. Skin Lesions (Primary lesion, Secondary lesion, Vascular lesion)

  
• Types of Skin Lesions


  • Macule
  • Vesicle
  • Nodule
  • Papule
  • Wheal
  • Pustule
  • Ulcer
  • Crust
  • Scale
  • Keloid
  • Scar
  • Atrophy
  • Spider Angioma
  • Cherry Angioma
  • Venous star

  
• Hair Inspection & Palpation


  1. Color

  2. Amount & distribution

  3. Texture

  4. Presence of parasites
• Nail inspection & palpation


  Nail Color (Normal, Pale or cyanotic, yellow discoloration, Splinter hemorrhage, Beau's lines)