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

2. Structure and Function
Nose: entry point of air; sense of smell CN1
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- lymphoid tissue in the roof of the nasopharynx and laterally in the eustachian tube orifice.

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 CN 5,7
Taste buds (vallate papillae) CN 9, 10, 12
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. Abnormal Mouth and Throat
Dry tongue
Glossitis
Peritonsillar abcess

7. Abnormal nose
Perforated septum
Nasal polyp

8. 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

9. Answer D. All of the above
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.

10. Urgent Assessment
Ludwig angina: edema pushing tongue up and back  airway obstruction
Infection of the mouth floor
Aspiration- assessing risk begins in upper respiratory tract, focus on laryngeal airway competency and presence of dental prostheses or loose teeth.
Abrupt loss of smell- may indicate a brain tumor and warrants MRI, hard fixed lymph nodes should be evaluated by biopsy.

11. Subjective Data Assessment of risk factors Personal history-
Medications, supplements- HTN, hormones, anticoagulants, antihistamines, analgesics, CNS agents, decongestants, antidepressants = nasal congestion, dry mouth, or epistaxis.
Family history
Risk factors
Dental health
Psychosocial history- including drug and alcohol exposure and consumption
Environmental exposure

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

13. 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

14. 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

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

16. 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.

17. 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.