1. Chapter 15—Nose, Sinuses, Mouth, and Throat

2. Structure and Function
Nose: entry point of air; sense of smell
Structure
Nerve and blood supply
Lymph drainage
Sinuses: lighten weight of cranium; provide timbre, resonance to voice; produce mucus
Major factors r/t normal function
Sinus ostia patency; expected ciliary function; expected mucus quality/quantity
Adenoids

3. Structure and Function—(cont.)
Mouth: sense of taste; chewing; speech articulation
Roof: contains hard, soft palates
Hard and soft palates
Floor of the mouth is highly vascular.
Facilitates rapid absorption of sublingual medications
Tongue: manipulates food during mastication; involved in sense of taste; speech production
Taste buds (vallate papillae)
One of the body’s most vascular muscles

4. Structure and Function—(cont.)
Salivary glands: three drainage ducts within mouth
Parotid; submandibular; sublingual
Saliva: protects oral mucosa; transmits taste data; rinses oral cavity  maintain pH; provides lubrication
Teeth, gums: food mastication
Three layers: crown, neck, and root
32 permanent teeth; periodontium
Throat (Oropharynx): common respiratory/digestive channel
Tonsils/adenoids: immunological defense

5. Lifespan Considerations: Older Adults
Age-related conditions
Gustatory rhinitis: runny nose from smelling/tasting food
Decreased: olfactory sensory fibers; saliva production; number of taste buds
Cultural and environmental considerations
Gingivitis: inflammation, bleeding of gums
Cleft lip, palate; bifid uvula
Oral and pharyngeal cancers
Sleep-disordered breathing

6. Question
In the clinic within an adult assisted-living complex, a 68- year-old retired detective reports his mouth is continually dry. This is problematic for him. What are the functions of saliva?
A. Provides lubrication
B. Protects oral mucosa
C. Rinses oral cavity
D. All of the above

7. Answer
Rationale: Saliva begins the digestive process by releasing enzymes upon contact with food. Saliva protects the oral mucosa from heat, chemicals, and irritants. Saliva also transmits taste information, rinses the oral cavity to maintain pH, and provides lubrication for the movement of food.

8. Urgent Assessment
Ludwig angina: edema pushing tongue up and back  airway obstruction
Infection of the mouth floor
Aspiration
Abrupt loss of smell

9. Subjective Data Assessment of risk factors Personal history
Medications, supplements
Family history
Risk factors
Dental health
Psychosocial history
Environmental exposure

10. Risk Assessment and Health Promotion
Health goals
Risk factors
Tobacco use
Sleep disorders
Cancer
Oral health
Hereditary hemorrhagic telangiectasia: chronic nosebleeds
Prevention strategies

11. Common Symptoms Facial pressure, pain, headache
Snoring, sleep apnea; obstructive breathing
Nasal congestion; epistaxis
Halitosis; anosmia
Cough; pharyngitis
Dysphagia; dental pain
Voice changes; oral lesions
Lifespan considerations: older adults
Cultural considerations

12. Objective Data Collection
Common specialty or advanced techniques
Inspection; equipment
Comprehensive physical assessment
External nose: inspection; palpation
Internal nose: inspection
Sinuses: inspection; palpation, percussion
Mouth: external, internal inspection; palpation
Throat: inspection; palpation
Swallowing evaluation

13. Lifespan Considerations: Older Adults
Edentulous: toothless
Teeth
Discoloration; teeth loosening
Gums: receding
Tongue
Smooth, shiny appearance
Fissures
Cultural considerations

14. Critical Thinking Common laboratory and diagnostic testing
Lab studies; diagnostic testing; radiographs
Biopsy; sleep studies
Diagnostic reasoning
Nursing diagnoses, outcomes, and interventions
Outcomes (partial listing)
Oral mucous membranes are pink, intact.
Patient swallows with evidence of aspiration.
Patient reports breathing is more comfortable.

15. Critical Thinking—(cont.)
Diagnostic reasoning—(cont.)
Nursing diagnoses, outcomes, and interventions—(cont.)
Interventions (partial listing)
Provide oral hygiene every 8 hours.
Consult with speech pathologist to evaluate swallowing.
Encourage fluid increase to 2 L daily to liquefy secretions.

16. NCLEX-Style Review Questions
Which of the following is part of the upper gastrointestinal tract?
Nasal septum
Sinuses
Throat
Adenoids

17. NCLEX-Style Review Questions
The nurse is assessing the nares to evaluate the site of epistaxis. The most common site of bleeding is which of the following?
Ostiomeatal complex
Nasal septum
Kiesselbach plexus
Woodruff plexus

18. NCLEX-Style Review Questions
The nurse knows that the floor of the mouth is highly vascular and therefore a good location for which of the following?
Absorption of sublingual medications
Identification of malignancy in the pharyngeal fossa
Infection with streptococcus
Aspiration, even if the gag reflex is present

19. NCLEX-Style Review Questions
Acute airway obstruction is a situation that should be
reassessed during the next visit.
evaluated within 8 hours.
further assessed thoroughly.
quickly assessed and treated.

20. NCLEX-Style Review Questions
Risk factors for nose, sinus, mouth, and throat problems include
topical decongestant use, smoking, and allergies.
smoking, allergies, and high blood cholesterol.
allergies, high blood cholesterol, and topical decongestant use.
high blood cholesterol, topical decongestant use, and smoking

21. NCLEX-Style Review Questions
The nurse has assessed the nose and documents expected findings as
nose asymmetrical with clear drainage
nose symmetrical and midline
nose asymmetrical and proportional to facial features
nose symmetrical with yellow drainage

22. NCLEX-Style Review Questions
The nurse is assessing a patient who has been taking antibiotics for 10 days. Oral assessment is important because of the increased risk for which of the following?
Fordyce granules
Pharyngitis
Anosmia
C. albicans

23. NCLEX-Style Review Questions
An adolescent male presents with complaints of nosebleeds. The nurse would further assess for
hemangioma.
nasal trauma.
angiofibroma.
cystic fibrosis

24. NCLEX-Style Review Questions
The nurse assesses the child with purulent, unilateral nasal discharge. The nurse knows that the most likely causative factor is
allergic rhinitis.
choanal atresia.
foreign body in nose.
cystic fibrosis

25. NCLEX-Style Review Questions
During a routine physical examination of a 20-year-old woman, the nurse notes a septal perforation. This finding may be significant for which of the following causes?
Illicit drug use
Nose picking
Nasal trauma
Bifid uvula