Nose, Mouth, Throat and Neck

58
NOSE, MOUTH AND THROAT ASSESSMENT

Transcript of Nose, Mouth, Throat and Neck

Page 1: Nose, Mouth, Throat and Neck

NOSE, MOUTH AND THROAT ASSESSMENT

Page 2: Nose, Mouth, Throat and Neck

Structure and Function Subjective Data—Health

History Questions Objective Data—The Physical

Exam Abnormal Findings

Nose, Mouth, and Throat

Page 3: Nose, Mouth, Throat and Neck

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

Page 4: Nose, Mouth, Throat and Neck

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.

Page 5: Nose, Mouth, Throat and Neck

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

Page 6: Nose, Mouth, Throat and Neck

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

Page 7: Nose, Mouth, Throat and Neck

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.

Page 8: Nose, Mouth, Throat and Neck

SINUSES

FrontalMaxillaryEthmoidSphenoid

Page 9: Nose, Mouth, Throat and Neck
Page 10: Nose, Mouth, Throat and Neck

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

Page 11: Nose, Mouth, Throat and Neck

Three pairs of salivary glands- Parotid- Submandibular- Sublingual

32 permanent teeth

Page 12: Nose, Mouth, Throat and Neck

THROAT ASSESSMENT

OropharynxNasopharynx- continuous with oropharynx

Pharyngeal tonsils and eustaschian tube openings located here

Rich in lymphatics

Page 13: Nose, Mouth, Throat and Neck

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

Page 14: Nose, Mouth, Throat and Neck

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

Page 15: Nose, Mouth, Throat and Neck

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)

Page 16: Nose, Mouth, Throat and Neck

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

Page 17: Nose, Mouth, Throat and Neck

Determine the patency of both nasal cavities

Air moves freely as the client breathes through the nares

Page 18: Nose, Mouth, Throat and Neck

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

Page 19: Nose, Mouth, Throat and Neck

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

Page 20: Nose, Mouth, Throat and Neck

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

Page 21: Nose, Mouth, Throat and Neck

ASSESSING THE NOSE Inspect the nasal

cavities using a flashlight or a nasal speculum

Observe for the presence of redness, swelling, growths and discharge

Page 22: Nose, Mouth, Throat and Neck

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.

Page 23: Nose, Mouth, Throat and Neck

FRONTAL MAXILLARY

PALPATION

Page 24: Nose, Mouth, Throat and Neck

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.

Page 25: Nose, Mouth, Throat and Neck

ASSESSING THE MOUTH

Page 26: Nose, Mouth, Throat and Neck

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

Page 27: Nose, Mouth, Throat and Neck

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

Page 28: Nose, Mouth, Throat and Neck

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

Page 29: Nose, Mouth, Throat and Neck

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

Page 30: Nose, Mouth, Throat and Neck

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)

Page 31: Nose, Mouth, Throat and Neck

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

Page 32: Nose, Mouth, Throat and Neck

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

Page 33: Nose, Mouth, Throat and Neck

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

Page 34: Nose, Mouth, Throat and Neck

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

Page 35: Nose, Mouth, Throat and Neck

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.

Page 36: Nose, Mouth, Throat and Neck

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

Page 37: Nose, Mouth, Throat and Neck

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.

Page 38: Nose, Mouth, Throat and Neck

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

Page 39: Nose, Mouth, Throat and Neck

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

Page 40: Nose, Mouth, Throat and Neck

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

Page 41: Nose, Mouth, Throat and Neck

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

Page 42: Nose, Mouth, Throat and Neck

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

Page 43: Nose, Mouth, Throat and Neck

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

Page 44: Nose, Mouth, Throat and Neck

ASSESSING THE NECK

Examination includes the muscles, lymph nodes, trachea, thyroid gland, carotid arteries and jugular veins

Page 45: Nose, Mouth, Throat and Neck

ANATOMY OF THE NECK

• Anterior Triangle– Medial Border of

Sternocleidomastoid Muscle and Mastoid

• Posterior Triangle– Formed by Trapezius

and Sternocleidomastoid (SCM) Muscles and Clavicle

Page 46: Nose, Mouth, Throat and Neck

ANATOMY OF THE NECK

Includes:

• Trachea

•Thyroid glands

Page 47: Nose, Mouth, Throat and Neck

ANATOMY OF THE NECK

Page 48: Nose, Mouth, Throat and 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

Page 49: Nose, Mouth, Throat and Neck

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.

Page 50: Nose, Mouth, Throat and Neck

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

Page 51: Nose, Mouth, Throat and Neck

LYMPH NODES

3) Submental

4) Submandibular

5) Tonsillar

6) Anterior Cervical

7) Posterior Cervical

8) Supraclavicular

Page 52: Nose, Mouth, Throat and Neck

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

Page 53: Nose, Mouth, Throat and Neck

THYROID GLAND

Inspect the thyroid gland:

Posterior Approach Anterior Approach

Page 54: Nose, Mouth, Throat and Neck

Posterior approach

Page 55: Nose, Mouth, Throat and Neck

Anterior approach

Page 56: Nose, Mouth, Throat and Neck

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

Page 57: Nose, Mouth, Throat and Neck

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

Page 58: Nose, Mouth, Throat and Neck

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