Nose, Mouth, Throat and Neck
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Transcript of Nose, Mouth, Throat and Neck
NOSE, MOUTH AND THROAT ASSESSMENT
Structure and Function Subjective Data—Health
History Questions Objective Data—The Physical
Exam Abnormal Findings
Nose, Mouth, and Throat
NOSE - SENSORY ORGAN FOR SMELL Functions:
o The nose humidifies, filters and warms air before it enters the lungs.
o Conserves heat and moisture during exhalation.
o Identifying odorso Giving resonance to
laryngeal sounds
External Parts:- Bridge- Tip- Nares- Columnella- Ala
Internal Structures: NASAL CAVITY- Vibrissae-The hairs growing in the vestibule of the nose. Cilia- Microscopic hair like projection from certain
epithelial cells. Membranes containing such cells are known as ciliated
membranes. Nasal Mucosa- appears redder than oral mucosa
because of the rich blood supply present to warm the inhaled air.
SEPTUM- divide the nasal cavity medially into two slit like air passages.
KIESSELBACH”S PLEXUS- the anterior part of the septum hold a rich vascular network. The most common site of nosebleeds.
Extends back over the roof of the mouth- Increase the surface area, more blood vessels and mucous membranes are available to humidify and filter inhaled air.
TURBINATES Line the lateral walls of the nasal cavity, providing a
large surface area of nasal mucosa. For heat and water exchange as air passes through the nose.
Three Turbinates Inferior Middle Superior
Middle meatus The space between the inferior and middle
turbinates Serves as an outlet for drainage from frontal,
maxillary and anterior ethmoid sinuses. The inferior meatus- just below the inferior
turbinates-outlet of drainage from the nasolacrimal ducts.
Middle and superior meatus- serves as an outlet of drainage from posterior ethmoid sinuses
NASAL PARTS
Olfactory receptors – responsible for smell and merge into the olfactory nerve, cranial nerve I.
Paranasal sinuses- communicate with the nasal cavity, lined with ciliated mucous membrane. - Provide mucous and serve as resonators for sound production.
SINUSES
FrontalMaxillaryEthmoidSphenoid
Slide 16-3
Nose, Mouth, and ThroatSTRUCTURE AND FUNCTION OF THE MOUTH
First segment of digestive system
Airway for respiratorySTRUCTURES:
Hard and soft palates
Uvula
Tongue
Three pairs of salivary glands- Parotid- Submandibular- Sublingual
32 permanent teeth
THROAT ASSESSMENT
OropharynxNasopharynx- continuous with oropharynx
Pharyngeal tonsils and eustaschian tube openings located here
Rich in lymphatics
Slide 16-4
Nose, Mouth, and Throat
SUBJECTIVE DATA—HEALTH HISTORY QUESTIONS
Nose Discharge Frequent colds (upper respiratory infections) Sinus pain Trauma Epistaxis (nosebleeds) Allergies Altered smell
Slide 16-5
Nose, Mouth, and ThroatSUBJECTIVE DATA—HEALTH HISTORY QUESTIONS
Mouth and throat Sores or lesions Sore throat Bleeding gums Toothache Hoarseness Dysphagia Altered taste Smoking and/or alcohol consumption Self-care behaviors Dental care pattern Dentures or appliances
Slide 16-6
Nose, Mouth, and ThroatOBJECTIVE DATA—THE PHYSICAL EXAM
Preparation Positioning
Position the person in sitting up straight with his or her had at your eye level. if the person wears dentures, offer a paper towel and ask the person to remove them
Equipment needed Otoscope with short, wide-tipped nasal speculum attachment
Pen light
Two tongue blades
Cotton gauze pad (4 x 4 inches)
Gloves
Long-stem light attachment for otoscope (occasionally)
NoseNose NORMAL FINDINGSNORMAL FINDINGS DEVIATION FROM DEVIATION FROM NORMALNORMAL
Inspect for any deviations in shape, size, or color and flaring or discharge from nares
Symmetric and Straight;No discharge or flaring;Uniform color;
Asymmetric;Discharge from nares;Localized area of redness/skin lesions;
Lightly palpate the external nose to determine any areas of tenderness, masses, or displacements of bone and cartilage
Not tender, no lesions Tenderness on palpation; presence of lesions
Determine patency of both nasal cavities
Air moves freely as client breathes through the nares
Air movement is restricted to one or both nares
Assessing The Nose And SinusesAssessing The Nose And Sinuses
Determine the patency of both nasal cavities
Air moves freely as the client breathes through the nares
NoseNose NORMAL FINDINGSNORMAL FINDINGS DEVIATION FROM DEVIATION FROM NORMALNORMAL
Observe for the presence of redness, swelling, growths and discharge, using the flashlight
Mucosa pinkClear, watery dischargeNo lesions
Mucosa red, edematousAbnormal dischargePresence of lesions
Inspect the nasal septum between nasal chambers
Intact and in midline Deviated to the left or to the right
SinusesSinuses
Palpate the maxillary and frontal
sinuses for tenderness
Not tender Tenderness in one or more sinuses
Assessing The Nose And SinusesAssessing The Nose And Sinuses
CRANIAL NERVE 1- OLFACTORY NERVE
Test the sense of smell in those who reports loss of smell. Those with trauma, and those with abnormal mental status. And when presence of intracranial lesion is suspected.
1. Assess patency by occluding one nostrils at a time and ask the person to sniff.
2. Then with the person’s eyes closed, occlude one nostrils and present an aromatic substance.
3. Use familiar, conveniently obtainable, and non- noxious smells such as coffee, toothpaste, orange , vanilla, soap or peppermint
One cannot test smell when passage are occluded with upper respiratory infection or with sinusitis
Anosmia- decreases or loss of smell occurs bilaterally with tobacco smoking, allergic rhinitis, and cocaine users
ASSESSING THE NOSE Inspect the nasal
cavities using a flashlight or a nasal speculum
Observe for the presence of redness, swelling, growths and discharge
View each nasal cavity with the person’s head erect, then with the head tilted back.. Inspect the nasal mucosa. Noting each normal red color and smooth moist surface. Note any swelling, discharge, bleeding and foreign bodies.
RHINITIS- Nasal mucosa is swollen and bright red with an Upper respiratory infection.
FRONTAL MAXILLARY
PALPATION
The frontal sinuses are palpated by gently pressing upward on the bony prominences above each eye.
The maxillary sinuses are palpated by applying gentle pressure on the bony prominences of the upper cheek.
ASSESSING THE MOUTH
LipsLips NORMAL FINDINGSNORMAL FINDINGS DEVIATION FROM DEVIATION FROM NORMALNORMAL
Inspect for symmetry of contour, color, and texture
Uniform pink color; Soft, moist, smooth texture;Symmetry of contour;Ability to purse lips
Pallor; cyanosisBlisters; generalized or loc. Swelling; fissures, crusts or scalesInability to purse lips
Buccal MucosaBuccal Mucosa
Inspect and palpate the inner lips and buccal mucosa for color, moisture, texture and presence of lesions.
Uniform pink colorMoist, smooth, soft, glistening, and elastic texture
Pallor; white patches (Leukoplakia)Excessive drynessMucosal cysts; irritations from dentures; abrasions, ulcerations; nodules
Assessing The Mouth And OropharynxAssessing The Mouth And Oropharynx
NORMAL FINDINGSNORMAL FINDINGS DEVIATION FROM DEVIATION FROM NORMALNORMAL
Teeth & Gums Teeth & Gums Inspect the teeth and the gums while examining the inner lips and buccal mucosa.
32 adult teeth Smooth, white, shiny tooth enamelPink gums
Moist, firm texture to gumsNo retraction of gums (pulling away from teeth)
Missing teeth; ill-fitting denturesBrown or black discoloration of the enamel (may indicate staining or presence of caries)Excessively red gumsSpongy texture; bleeding; tenderness (may indicate periodontal disease.Receding; atrophied gums, swelling that partially covers the teeth
Inspect the dentures. Smooth intact dentures Ill-fitting dentures, irritated and excoriated area under dentures
Assessing The Mouth And OropharynxAssessing The Mouth And Oropharynx
Tongue/Floor of the Tongue/Floor of the MouthMouth NORMAL FINDINGSNORMAL FINDINGS DEVIATIONS FROM DEVIATIONS FROM
NORMALNORMALInspect the surface of the tongue for position, color, and texture.
Tongue in central positionPink color, moist, slightly rough; thin whitish coating; Smooth, lateral margins, no lesionsRaised papillae (taste buds)
Deviated from centerSmooth red tongueDry, furry tongueNodes, ulcerations, discolorations; areas of tenderness
Inspect tongue movement Ask the client to protrude the tongue and move it from side to side
Move freely, no tenderness
Restricted mobility
Inspect the base of the tongue, the mouth floor, and the frenulum. Ask client to place the tip of the tongue against the roof of the mouth
Smooth tongue base with prominent veins
Swelling, ulceration
Tongue/Floor of the Tongue/Floor of the MouthMouth
NORMAL FINDINGSNORMAL FINDINGS DEVIATIONS FROM DEVIATIONS FROM NORMALNORMAL
Palpate the tongue and floor of the mouth for any nodules, lumps or excoriated areas
Smooth with no palpable nodules
Swelling, nodules
Palates and UvulaPalates and Uvula
Inspect the hard and soft palate for color, shape, texture and the presence of bony prominences
Light pink, smooth, soft palate;Lighter pink hard palate, more irregular texture
Discoloration Palates the same colorIrritationsBony growths (Exostoses) growing from hard palate
Inspect the uvula for position and mobility while examining the palates
Positioned in midline of soft palate
Deviation to one side from tumor or trauma; immobility
Oropharynx and Oropharynx and TonsilsTonsils NORMAL FINDINGSNORMAL FINDINGS DEVIATIONS FROM DEVIATIONS FROM
NORMALNORMAL
Inspect the oropharynx for color, and texture (one side at a time to avoid eliciting gag reflex)
Pink and smooth posterior wall
Reddened or edematous; presence of lesions, plaques, or drainage
Inspect the tonsils for color and discharge, and size.
Pink and smoothNo dischargeOf normal size or not visible
InflamedPresence of dischargeSwollen
Elicit the gag reflex by pressing the posterior tongue with a tongue blade.
Present Absent – may indicate problems with glossopharyngeal (9th CN) & vagus (10th CN)
Grading System for TonsilitisGrading System for Tonsilitis
Grade 1 – The tonsils are behind the tonsillar pillars (Normal)
Grade 2 – between the pillars and the uvula
Grade 3 – tonsils touch the uvula Grade 4 – one or both tonsils extend to
the midline of the oropharynx
ASSESSMENT OF THE NOSE
Normal findings Located in midline of face No swelling, bleeding, lesions, or masses Both nostrils patent Septum midline Nasal mucosa is pink or dull red
Copyright 2002, Delmar, A division of Thomson Learning
ASSESSMENT OF THE NOSE
Abnormal findings Broken, misshapen, swollen nose Occluded nasal passages Septum is deviated Nasal mucosa is red and swollen Purulent drainage
Copyright 2002, Delmar, A division of Thomson Learning
ASSESSMENT OF THE SINUSES
Inspection Palpation and percussion Normal findings
No evidence of swelling Resonance heard on percussion No discomfort during palpation or percussion
ASSESSMENT OF THE MOUTH Inspection• Lips- Inspect the lips for color, moisture, cracking
or lesions. Retract the lips and note the inner surface as well
• Teeth and Gums ( The condition of the teeth is an index of the persons general health. Note the any diseased, absent ,loose, or abnormally positioned teeth , The teeth normally look white, straight and evenly spaced and clean and free from debris or decay.
• Compare the number of teeth with the number expected for the person’s age.
• Ask the persons to bite as if chewing something and note the alignment of the upper and lower jaw.
Normal occlusion in the back is the upper teeth resting directly on the lower , infront , the upper incisors slightly override the lower incisors
TONGUE Check the tongue for color, surface
characteristics and moisture. The color is pink and even. The dorsal surface is normally roughened from the papillae. A thin white coating maybe present. Ask the client to touched the tongue to the roof of the mouth. Its ventral surface looks smooth, glistening and shows vein. Saliva is present
With te gloves hold the tongue using cotton gauze pad for traction and swing the tongue out and to each side. Inspect for any white patches or lesions- Normally none are present. If any occur palpate these for indurations
Inspect carefully the entire U- shape area under the tongue. Oral malignancies are most likely to develop here.Note any white patches, nodules, or ulcerations. If lesions are present, or with any persons over 50 or with a positive history of smoking of alcohol use. Use your glove hands to palpate the area.Place your other hand under the jaw to stabilize the tissue and to capture any abnormality.
ASSESSMENT OF THE MOUTH
Abnormal findings Lesions, growths Dry, cracked lips Vesicles or blisters Red, tender, inflamed tongue, gums,
buccal mucosa Thrush- a disease associated with white
spots on the mucous membrane Coating on tongue Bleeding gums
INSPECTION OF THE THROAT Using your light, observe the oval, rough-
surfaced tonsils behind the anterior tonsillar pillar. Their color is the same as the oral mucosa. And their surfaced is peppered with indentation.In some people the crypts collects small plugs of whitish cellular debris. This does not indicate infection. However, there should be no exudates on the tonsils
Gag reflex- touching the posterior wall with the tongue blade elicits the gag reflex.. This test the cranial nerve IX and X the glossopharyngeal and vagus
To test the Cranial nerve XII or the hypoglossal nerve- by asking the person to stick out the tongue. It should protrude in the midline
Copyright 2002, Delmar, A division of Thomson Learning
(continues)
INSPECTION OF THE THROAT
Normal findings Soft palate and uvula rise when patient says,
“ah” Uvula is midline No swelling, exudate, or lesions Gag reflex is present
Copyright 2002, Delmar, A division of Thomson Learning
INSPECTION OF THE THROAT
Abnormal findings Posterior pharynx is red with white patches Tonsils and uvula are red and swollen Hoarse voice Grayish membrane covering tonsils, uvula, soft
palate
Copyright 2002, Delmar, A division of Thomson Learning
GERONTOLOGICAL VARIATIONS
Diminished sense of smell and taste Periodontal disease- a chronic inflammatory
condition that attacks the supporting structures of the teeth, including the ligaments , and destroys the bones.
Oral alterations due to disease or side effects of medications
Tooth loss
AGING ADULT
Sense of smell and taste diminishes
Soft tissue atrophies, epithelium thins
Salivary secretion decreasesDental changes- dentures, malocclusion, absence of teeth
Medications cause dry mouth
ASSESSING THE NECK
Examination includes the muscles, lymph nodes, trachea, thyroid gland, carotid arteries and jugular veins
ANATOMY OF THE NECK
• Anterior Triangle– Medial Border of
Sternocleidomastoid Muscle and Mastoid
• Posterior Triangle– Formed by Trapezius
and Sternocleidomastoid (SCM) Muscles and Clavicle
ANATOMY OF THE NECK
Includes:
• Trachea
•Thyroid glands
ANATOMY OF THE NECK
ASSESSING THE NECK
Inquire if the client has any history of the following:• Problems with neck lumps• Neck pain or stiffness• When and how any lumps occur• Previous diagnosis of thyroid problems• Other treatment provided
NECK MUSCLES
• Inspect the neck muscles for abnormal swellings or masses
• Observe the head movement• Move the chin to the chest• Move the head back so that the chin points
upward• Move the head so that the ear is moved toward
the shoulder on each side• Turn the head to the right and to the left
Assess the muscle strength.
LYMPH NODES Palpate the entire neck
for enlarged lymph nodes• Face the client, bend
the head slightly forward, toward the side being examined
• Palpate the nodes using the pads of the fingers in a gentle rotating motion
1) Preauricular
2) Postauricular
LYMPH NODES
3) Submental
4) Submandibular
5) Tonsillar
6) Anterior Cervical
7) Posterior Cervical
8) Supraclavicular
TRACHEA
Palpate the trachea for lateral deviation• Place fingertip or thumb on the trachea in the
suprasternal notch• Move finger laterally to the left and the right in
spaces bordered by the clavicle, the anterior aspect of the sternocleidomastoid muscle, and the trachea
THYROID GLAND
Inspect the thyroid gland:
Posterior Approach Anterior Approach
Posterior approach
Anterior approach
THYROID GLAND
Palpation of Thyroid Size — R>L. Normally does not
Extend above Thyroid Cartilage Shape — Butterfly Consistency — Firm but not Hard Sensation — Non-Tender Surface — Normally Smooth.
Nodules may Occur with Age or Cancer of Thyroid.
Movement — Rises with Swallowing
THYROID GLAND
If enlargement of the gland is suspected:• Auscultate over the thyroid area for bruit ( a soft
rushing sound created by turbulent blood flow)• Use the bell of the stethoscope
LIFESPAN CONSIDERATIONS
Examine the neck while the infant or child is lying supine
An infant’s neck is normally short, lengthening by about age 3 years. This makes the palpation of the trachea difficult