Nose, Mouth

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Nose, Mouth Throat

• N1037

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Nose A P

• Review structure and function of External nose,
  nasal fossa, internal nose (p 377)

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Nose A P
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Nasal Cavity

• Extends over the roof of the mouth
• Lined with coarse nasal hairs
• Mucous blanket filters out dust and bacteria
• Divided by the septum
• 3 parallel bony projections superior, middle
  and inferior turbinates.
• Olfactory receptors lie at the roof of the nasal
  cavity

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Nose Sinuses

• 4 pairs of Sinuses air-filled within the
  cranium, serve as resonators for sound
  production, lighten the weight of skull bone,
  provide mucous and drain into the nasal cavity.
• Ethmoid between the orbits (smaller and deeper)
• Sphenoid deep within the skull in the sphenoid
  bone (post. to nasal cavity).
• These are non-palpable

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Nose - Sinuses These are Palpable

• Frontal in frontal bone, above and medial to
  the orbits.
• Maxillary in the maxilla (cheekbone) along the
  side walls of the nasal cavity.

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Mouth

• Structure and Function
• Exterior and Interior

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• Exterior structures

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Head-Salivary Glands

• 3 pairs of Salivary glands
• parotid, submandibular and sublingual
• Parotid ant. and below the ear in cheeks,
  normally not palpable, secret amylase-rich fluid
  through Stensens Ducts located near upper 2nd
  molars
• Submandibular beneath the mandible, size of
  walnuts, opens at either side of the tongue
  frenulum
• Sublingual lie in the floor of the mouth, has
  many small openings along the sublingual fold
  under the tongue.

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Throat

• Structure and Function

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Throat (Pharynx)

• Area behind the mouth and the nose
• Oropharynx
• Tonsils mass of lymphoid tissue, deep crypts
• Nasopharynx
• above and continuous with oropharynx, behind the
  nasal cavity
• Pharyngeal tonsils (adenoids) and eustachian tube
  openings here

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Nose Mouth Throat

• Health History - Subjective Data

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Nose Mouth ThroatHealth Hx

• Nose
• Discharge
• Frequent colds (Upper Resp Infection)
• Sinus pain
• Trauma (cause a deviated septum)
• Epistaxis (nosebleeds)
• Allergies
• Altered smell

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Nose Mouth ThroatHealth Hx

• Mouth Throat
• Sores or lesions
• Sore throat
• Bleeding gums
• Toothaches
• Hoarseness
• Dysphagia
• Altered taste
• Smoking, alcohol consumption
• Self-care behaviours (dental care, dentures or
  appliances

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Nose Mouth Throat

• Objective Data
• Preparation and Equipment Needed

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Nose, Mouth Throat

• Preparation
• Client sitting up straight
• Head at your eye level
• Remove dentures

• Equipment
• Otoscope (nasal speculum with light)
• Tongue blade
• Cotton gauze pad (4x4)
• gloves

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Nose, Mouth Throat

• Objective Data
• Inspection and Palpation

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Assessment of Nose

• External Inspection
• Symmetric
• Midline
• Proportionate to other facial features
• Deformity, asymmetry
• Inflammation
• Skin lesions

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Assessment of Nose

• Inspect and palpate external nose
• Inspect external nose for symmetry
• Palpate external nose noting any tenderness - may
  indicate inflammation
• Patency
• Occlude one nostril at a time with a finger and
  ask pt to breath in out through the nose.
• Internal Inspection
• Extend pts head, place non dominant hand on pts
  head and use thumb to lift the tip of the nose ,
  insert nasal speculum or otoscope and inspect
  nasal septum, turbinates

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Nasal Cavity Inspection

• (short, wide tipped speculum to otoscope)
• N- nasal mucosa should be pink or dull red
  colour, smooth, moist surface with small amount
  of clear watery discharge.
• Nasal septum deviations, perforations or
  bleeding (airflow must not be obstructed)
• Note polyps, (benign growths that sometimes
  accompany chronic allergy)
• Note swelling, discharge (watery, copious to
  thick, purulent, green-yellow)
• Bleeding or foreign body

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Assessment of Sinuses

• Inspection
• Observe patients face for any swelling around
  nose and eyes
• N no evidence of swelling

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Sinuses Palpation

• Client feels pressure but no pain
• Press frontal sinuses (below eyebrows)
• Press maxillary sinuses ( below cheekbones)
• Chronic allergies and acute infections
  (sinusitus) tenderness to sinuses

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Perscussion of Sinuses

• Gently percuss frontal and maxillary sinuses
  using direct percussion technique
• N elicits a resonant sound indicating air
  filled cavity
• If a dull sound is heard fluid in cavity
• note any signs of tenderness or pain which may
  indicate sinusitis due to infection, allergies

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Transillumination of the Sinuses

• Turn lights off in room
• Place strong light under bony ridge of upper
  orbits
• Observe red glow
• Place strong light under each eye just above the
  infraorbital ridge
• Ask pt to open mouth
• Observe red glow on hard palate
• N glow on each side is equal indicating air
  filled frontal and maxillary sinuses

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Mouth Inspection

• Teeth, Buccal mucosa Gums
• White, straight, evenly spaced, clean and free of
  debris or decay
• Note absent, loose, abnormally positioned
• Gums are pink with margins tight and well
  defined.
• Note swelling, retractions, spongy or bleeding
  gingivae.

• Breath
• Should smell fresh
• Lips
• Observe colour, moisture, swelling cracking or
  lesions
• Inner surface pinkish-red.

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Mouth Inspection

• Mucous membranes
• Pink, smooth and moist
• Palate hard (anterior) and soft (posterior)
• Anterior white with irregular transverse rugae
• Posterior pink, smooth and movable
• Say ahhh, soft palate and uvula rise (may be
  split in two)

• Tongue
• Pink and even, roughened
• White coating may be present
• Ventral suface smooth, shows veins
• Saliva present
• Note induration on palpation

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Mouth - Palpation

• Don gloves
• LIPS Pull pts lower lip with thumb and index
  finger
• N lips should be flaccid and without lesions
• Tongue ask pt to stick out tongue (CNXII)
• Move tongue from side to side, and up and down
• Press tongue against cheek on each side
• Using gauze and gloves hold tongue and inspect
  ventral surface for Whartons ducts, frenulum,
  color, hydration, lesions, inflammation and
  vasculature
• N tongue is midline, dorsum is pink, moist with
  taste buds (rough) and without lesions. Tongue
  strength is equal. Ventral surface has visible
  vasculature. Lateral aspect is pink, moist and
  free of lesions

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Salivary and Parotid GlandInspect and palpate

• Note for enlargement of salivary gland as the
  client moves their head back and forth
• Note swollen parotid gland with head extended (
  below the angle of the jaw)

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Throat - Inspection

• Ask pt to stick tongue out
• Place tongue depressor on middle third of tongue
• Shine light at back of pt throat
• Ask pt to say ah observe uvula
• Observe tonsillar pillars
• Touch posterior third of tongue observe for gag
  reflex
• N soft palate, uvula is midline and rises
  symmetrically (CN IX X), gag reflex is present,
  tonsils are not enlarged

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Throat - Inspection

• Tonsils
• pink, peppered with indentations or crypts.
• No exudate present
• Graded

• Tonsil - Grade
• 1 visible
• 2 halfway pillars/uvula
• 3 touching uvula
• 4 touching each other

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Developmental Considerations

• Infant and children
• Drool before they swallow
• Milia on nose
• No nasal flaring present
• Note of teeth 20 temporary (by 2 ½)
• Lost between 6 and 12
• Pregnant
• Gingivitis
• Stuffiness and epistaxis
• Aging Adult
• Mouth and lips fold in
• Changes to appearance of teeth, gums recede
• Mucosa is shinier, thinner, less vascular
• Tongue is smoother (atrophy)
• Sense of smell diminishes