1. Nose, Mouth, and Throat Dr. Zyad Saleh

2. Mouth and Throat The mouth and throat: - make up the first part of the digestive system - are responsible for receiving food (ingestion), taste, preparing food for digestion, - and aiding in speech.

3. Nose The nose and paranasal sinuses constitute the first part of the respiratory system: - are responsible for receiving, filtering, warming, and moistening air to be transported to the lungs. - the sense of smell. - A site of speech resonance

4. MOUTH the lips, cheeks, Hard and soft palates, uvula, and the tongue and its muscles

5. MOUTH The roof of the oral cavity is formed by the anterior hard palate the posterior soft palate. An extension of the soft palate is the uvula

6. MOUTH Cheeks form the lateral walls of the mouth the tongue and its muscles form the floor of the mouth.

7. MOUTH within the mouth: - Tongue (connected to the floor of the mouth by a fold of tissue called frenulum). - Small bumps called papillae cover the dorsal surface of the tongue. - Taste buds, scattered over the tongue’s surface, carry sensory impulses to the brain.

8. MOUTH - Teeth (normally hold 32 permanent teeth) - gums, (gingiva) are covered by mucous membrane - the salivary glands

9. THROAT The throat (pharynx), located behind the mouth and nose, serves as a muscular passage for food and air. nasopharynx. oropharynx, laryngopharynx.

10. the palatine tonsils are located on both sides of the oropharynx The lingual tonsils lie at the base of the tongue. Pharyngeal tonsils, or adenoids, are found high in the nasopharynx.

11. NOSE The nose consists: - external portion covered with skin - Internal nasal cavity composed of bone and cartilage, and is lined with mucous membrane.

12. NOSE The external nose consists: - bridge - two oval openings called nares. The nasal cavity is located between the roof of the mouth and the cranium. Nasal septum separates the cavity into two halves.

13. SINUSES Four pairs of paranasal sinuses (frontal, maxillary, ethmoidal, and sphenoidal) Air-filled cavities within the bones of the skull. Make the skull lighter and add to speech resonance. Lined with mucous membranes.

14. SINUSES The frontal sinuses (above the eyes) and the maxillary sinuses (in the upper jaw) are accessible to examination. The ethmoidal and sphenoidal sinuses are smaller, located deeper in the skull, and are not accessible for examination.

15. COLLECTING SUBJECTIVE DATA: THE NURSING HEALTH HISTORY Data collected regarding the client’s risk factors may form the basis for preventive teaching. - Use of tobacco and heavy alcohol consumption - Malnutrition - Sinus infections and headaches - improper use of nasal decongestants - improper oral hygiene practices

16. Do you experience tongue or mouth sores or lesions? explore the symptoms using OLDCART.

17. Do you experience redness, swelling, bleeding, or pain of the gums or mouth? - Gingivitis Do you have any toothache? Have you lost any permanent teeth? - Dental caries, abscesses, or sensitive teeth.

18. Nose and Sinuses Do you have pain over your sinuses (cavities around nasal passages)? - acute sinusitis Do you experience nosebleeds? Describe the amount and color of bleeding Do you experience frequent clear or mucous drainage from your nose? - Thin, watery, clear nasal drainage-rhinorrhea

19. Can you breathe through both of your nostrils? Do you have a stuffy nose at times during the day or night? - sinus congestion, obstruction, or a deviated septum. Have you experienced a change in your ability to smell or taste?

20. Throat Do you have difficulty swallowing or painful swallowing? - Dysphagia (difficulty swallowing) or odynophagia (painful swallowing) Do you have a sore throat? Do you experience hoarseness?

21. Personal Health History Surgery Infections Allergies regularly use any treatments or medications for conditions

22. Family History Is there a history of mouth, throat, nose, or sinus cancer in your family?

23. Lifestyle and Health Practices Do you smoke or use smokeless tobacco? If so, how much? Do you drink alcohol? How much and how often? Do you grind your teeth? Describe how you care for your teeth or dentures. How often do you brush and use dental floss? When was your last dental examination?

24. If the client wears braces: How do you care for your braces? Do you avoid any specific types of foods? If the client wears dentures: How do your dentures fit? Do you brush your tongue? How often are you in the sun? Describe your usual dietary intake for a day.

25. Mouth: INSPECTION AND PALPATION: Inspect the lips. - Observe lip consistency and color. - Lips are smooth and moist without lesions or swelling. - Pallor around the lips (circumoral pallor) is seen in anemia - Bluish (cyanotic)  hypoxia. - Reddish lips  polycythemia. - Swelling of the lips (edema)  allergic

26. Inspect the teeth and gums. - Thirty-two pearly whitish teeth with smooth surfaces and edges. - No decayed areas; no missing teeth. - Tooth decay (caries)  brown dots - Red, swollen gums that bleed easily are seen in gingivitis,

27. Inspect the buccal mucosa. - smooth and moist without lesions. - salivary ducts are visible with flow of saliva and with no redness, swelling, pain, or moistness in area.

28. Inspect and palpate the tongue. - Tongue should be pink, moist, a moderate size with papillae - No lesions are present. - Deep longitudinal fissures  dehydration - enlarged tongue  hypothyroidism, acromegaly - small tongue  malnutrition.

29. Assess the ventral surface of the tongue. - smooth, shiny, pink, or slightly pale, with visible veins and no lesions. - persistent lesions, ulcers, or nodules may indicate cancer

30. Inspect for Wharton’s ducts—openings from the submandibular salivary glands— located on either side of the frenulum on the floor of the mouth.

31. The frenulum is midline Wharton’s ducts are visible, with salivary flow or moistness in the area. The client has no swelling, redness, or pain. lesions, ulcers, nodules, or hypertrophied duct

32. Observe the sides of the tongue. - No lesions, ulcers, or nodules are apparent.

33. Check the strength of the tongue. - The tongue offers strong resistance. - Decreased tongue strength  defect of the twelfth cranial nerve—hypoglossal— - with a shortened frenulum that limits motion.

34. Check the anterior tongue’s ability to taste. - The client can distinguish between sweet and salty. - a seventh cranial nerve (facial) defect, chronic sinus infections, and certain medication use

35. Inspect the hard (anterior) and soft (posterior) palates and uvula. - The hard palate is pale or whitish with firm, transverse rugae (wrinkle-like folds). - the soft palate should be pinkish, movable, spongy, and smooth. - An opening in the hard palate is known as a cleft palate.

36. Note odor - No unusual or foul odor - Fruity or acetone breath - An ammonia odor - Foul odors

37. Assess the uvula. - The uvula is a fleshy, solid structure that hangs freely in the midline. - No redness of or exudate from uvula or soft palate. - Midline elevation of uvula and symmetric elevation of the soft palate. - Asymmetric movement or loss of movement  neurological disorders

38. Inspect the tonsils. - Tonsils may be present or absent. - They are normally pink and symmetric and may be enlarged to 1+ in healthy clients - No exudate, swelling, or lesions - Tonsils are red, enlarged (to 2+, 3+, or 4+), and covered with exudate in tonsillitis.

40. Inspect the posterior pharyngeal wall. - Throat is normally pink, without exudate or lesions - A bright red throat with white or yellow exudate indicates pharyngitis.

41. Nose Inspect and palpate the external nose. - Color is the same as the rest of the face; - The nasal structure is smooth and symmetric; - The client reports no tenderness.

42. Check patency of air flow through the nostrils - Client is able to sniff through each nostril - sign of swelling, rhinitis, or a foreign object obstructing

43. Foreign Body Furun cle

44. Inspect the internal nose. - The nasal mucosa is dark pink, moist, and free of exudate. - The nasal septum is intact and free of ulcers or perforations. - A deviated septum may appear to be an overgrowth of tissue

45. Turbinates are dark pink (redder than oral mucosa), moist, and free of lesions. The superior turbinate will not be visible

46. Sinuses: PALPATION Frontal and maxillary sinuses are nontender to palpation, and no crepitus is evident. are tender  allergies or acute rhinosinusitis.

47. PERCUSSION The sinuses are not tender on percussion.

48. TRANSILLUMINATION transillumination will let you see if the sinuses are filled with fluid or pus.

49. A red glow transilluminates the frontal sinuses  a normal, air-filled sinus. A red glow transilluminates the maxillary sinuses. The red glow will be seen on the hard palate.

50. Absence of a red glow usually indicates a sinus filled with fluid or pus.