Nose, Mouth, and Throat

Chapter 17

Structure and Function - Nose

 External nose

 Nasal cavity

 Septum

 Turbinates

 Meatus

Structure and Function – Paranasal

Sinuses

 Frontal

 Maxillary

 Ethmoid

 Sphenoid

Structure and Function – Mouth

 Oral cavity

 Hard and soft palates

 Uvula

 Tongue

Structure and Function – Salivary

Glands

 Parotid

 Submandibular

 Sublingual

 Teeth and gums

Throat (pharynx)

 Oropharynx

 Tonsils

 Nasopharynx

Structure and Function – Throat

 Infants and children

 Salivation

 Deciduous teeth

 Nose

 Pregnant women

 Nasal stuffiness

 Epistaxis

 Hyperemic gums

Developmental Considerations (1 of 2)

 Older adults

 Diminished smell

and taste

 Atrophic tissues

 Dental changes

• Malocclusion

 Malnutrition

 Infants and children

 Positioning

 Nose: obligate nose breathers

 Mouth and throat: sucking tubercle

 Tonsils

 Pregnant women

 Pregnancy-related gingivitis

 Older adults

 “Purse string” appearance of mouth

 Yellow teeth

Developmental Considerations (2 of 2)

 Incidence of cleft lip and palate

 Leukoedema

 Oral hyperpigmentation

 Increased incidence of dental disease in

Indigenous peoples

 Changes from traditional diets

 Lack of access to fluoridated water and dental

health services

 Correlation between socioeconomic variables

and dental disease

 32% of Canadians lack adequate dental insurance

Cultural and Social Considerations

 Discharge

 Frequent colds (upper respiratory infections)

 Sinus pain

 Trauma

 Epistaxis (nosebleeds)

 Allergies

 Altered sense of smell

Subjective Data: Health History – Nose

 Sores or lesions

 Sore throat

 Bleeding gums

 Toothache

 Hoarseness

 Dysphagia

 Altered taste

 Smoking, alcohol consumption

 Self-care behaviours

Subjective Data: Health History –

Mouth and Throat

Infants and children

 Mouth disease

 Throat disease

 Tooth development

 Self-care behaviours

Additional Health History Questions

For the older adult

 Mouth dryness

 Teeth

 Mouth care

 Taste and smell

 Chewing tobacco and snuff (dry or moist) used in Canada

 Using SLT can lead to oral, esophageal, or pancreatic cancer

 Early signs of oral cancer include:

 Ulcers or sores that do not heal

 White or red patches

 Prolonged sore throat or feeling that something is in the throat

 Difficulty chewing

 Unexplained bleeding

 Numbness or tingling

 Restricted movement of the tongue or jaw

 A small lump or thickening in the lip, tongue, floor or roof, cheeks, gums,

tonsil

Promoting Health: Smokeless

Tobacco (SLT) and Cancer Risk

 Preparation

 Positioning

 Equipment

 Otoscope with short, wide-tipped nasal speculum

attachment

 Penlight

 Two tongue blades

 Cotton gauze pad (10 × 10 cm)

 Gloves

 Occasionally: long-stem light attachment for otoscope

Objective Data: Physical Exam

Physical Exam – Nose

 Inspect and palpate

 External nose

 Nasal cavity

• Holding the otoscope

• Nasal septum

• Turbinates

Physical Exam – Sinus Areas

 Palpate

 Frontal and maxillary

sinuses

Physical Exam – Mouth

 Inspect

 Lips

 Teeth and gums

 Tongue (test cranial

nerve XII)

 Buccal mucosa

 Palate and uvula

 Inspect

 Tonsils—grading from 1+ to 4+

 Use of tongue blade

 Posterior pharyngeal wall

Physical Exam – Throat

Nose

 Choanal atresia

 Epistaxis

 Foreign body

 Perforated septum

 Furuncle

 Acute rhinitis

 Allergic rhinitis

 Sinusitis

 Nasal polyps

Lips

 Cleft lip

 Herpes simplex I

 Angular cheilitis

(stomatitis, perlèche)

 Carcinoma

 Retention “cyst”

(mucocele)

Abnormal Findings (1 of 3)

Teeth and Gum

 “Baby bottle” tooth decay

 Malocclusion

 Dental caries

 Epulis

 Gingival hyperplasia

 Gingivitis

 “Meth mouth”

Buccal mucosa

 Aphthous ulcers

 Koplik’s spots

 Leukoplakia

 Candidiasis or monilial

infection

 Herpes simplex I

Abnormal Findings (2 of 3)

Tongue

 Anklyoglossia

 Fissured or scrotal tongue

 Geographical tongue

(migratory glossitis)

 Smooth, glossy tongue

(atrophic glossitis)

 Black hairy tongue

 Enlarged tongue

(macroglossia)

 Carcinoma

Oropharynx

 Cleft palate

 Bifid uvula

 Oral Kaposi’s sarcoma

 Acute tonsillitis and

pharyngitis

Abnormal Findings (3 of 3)

A. How often do you brush your teeth?

B. Has your sense of taste changed?

C. What is your daily dental care routine?

D. Do you have any problems with your

dentures?

1. Which of the following questions is

likely to elicit the most information?

A. Circumoral pallor

B. Dappled brown patches on the buccal

mucosa

C. Bluish lips

D. A chalky white raised patch on the mucosa

of the tongue

2. Which of the following is an

expected finding in dark-skinned

people?

1. The nurse is assessing a patient of African descent for signs of

hypoxia. Which of the following assessments would provide the

most accurate result?

1. Assess skin turgor and colour for bluish pallor.

2. Assess the inside of the patient’s mouth for

discoloration and pallor.

3. Assess the nail beds of the hands and feet and the

ears for blanching.

4. Inspect the sclera of the eyes for yellowish tint.

2. The nurse is assessing a patient for sinus

tenderness. How should the nurse perform

this examination?

1. Palpate behind the ears and along side of

the throat and clavicles, noting edema.

2. Press firmly around the orbit of the eyes, and

palpate the nose, noting pain.

3. Tap above the eyes and nose, noting

tenderness or pain.

4. Auscultate the neck bilaterally with the bell of

the stethoscope.