Nose, Mouth & Throat

1. Nose, Mouth & Throat N1037

2. Nose A & P Review structure and function of External nose, nasal fossa, internal nose (p 377)

3. Nose A & P

4. 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

6. 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

7. 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.

10. Mouth Structure and Function Exterior and Interior

11. Exterior structures

14. 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 Stensen’s 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.*

16. Throat Structure and Function

17. 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

19. Nose Mouth & Throat Health History - Subjective Data

20. Nose Mouth & ThroatHealth Hx Nose • Discharge • Frequent colds (Upper Resp Infection) • Sinus pain • Trauma (cause a deviated septum) • Epistaxis (nosebleeds) • Allergies • Altered smell

21. 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

22. Nose Mouth & Throat Objective Data Preparation and Equipment Needed

23. 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 Nose, Mouth & Throat

24. Nose, Mouth & Throat Objective Data Inspection and Palpation

25. Assessment of Nose External Inspection • Symmetric • Midline • Proportionate to other facial features • Deformity, asymmetry • Inflammation • Skin lesions

26. 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 pt’s 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

28. 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

29. Assessment of Sinuses • Inspection • Observe patients face for any swelling around nose and eyes • N= no evidence of swelling

30. 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

32. 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

33. 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

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

36. Tongue Pink and even, roughened White coating may be present Ventral suface smooth, shows veins Saliva present Note *induration on palpation 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) Mouth – Inspection

37. 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

39. 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)

40. 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

41. 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 Throat - Inspection

44. 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