Health- Nose Mouth Throat

Rhinorrhea

Nasal discharge

Rhinorrhea -nasal discharge

occurs with colds, allergies, sinus infection, trauma

About 90% to 98% of cases of rhinosinusitis

are viral and resolve without antibiotics.

Trauma may cause

deviated septum, which may cause nares to be obstructed.

Epistaxis occurs spontaneously

and with trauma, vigorous nose blowing, foreign body.

About 80%−90% of epistaxis cases occur

anteriorly in Kiesselbach plexus and are easy to control

Advise person to sit, lean forward, and digitally compress the lower soft part of nose for 15 to 20 minutes.

to control an epistaxis or nosebleed.

“Seasonal” rhinitis if caused by pollen;

“perennial” if allergen is dust.

Sense of smell diminishes occurs but is less likely with the new emerging variants of COVID-19 and also

cigarette smoking, chronic allergies, aging

Up to 90% of sore throats are viral and resolve in 3–5 days without antibiotics.

However, group A streptococcal (GAS) pharyngitis is more likely with fever over 100.4°F, absence of cough, tonsillar exudates, and cervical adenopathy

Dysphagiaa

occurs with pharyngitis, gastroesophageal reflux disease, stroke and neuromuscular diseases, esophageal cancer

OSA (obstructed sleep apnea) increases the risk of

cardiovascular and metabolic diseases.

snores very loudly so loud they wake up the bed partner

When they stop snoring, they’re not breathing

They feel sleepy during the day

Obese/overweight

High bp

OSA -obstructed sleep apnea

loose weight and c pack

Reverses OSA

Chronic tobacco use leads to tooth loss,

coronal and root caries, and periodontal disease in older adults.

Lesions may arise from ill-fitting dentures,

or the presence of dentures may mask the eruption of new lesions

Test the patency of the nostrils by pushing each nasal wing shut with your finger while asking the person to sniff inward through the other naris.

This reveals any obstruction, which later is explored with the nasal speculum.

Gently palpate and see if there’s a change

and check contour and tender area

Absence of sniff indicates obstruction

(e.g., common cold, nasal polyps, rhinitis).

Using a Nasal Speculum

Tilt head back

Take 1 finger and lift 1 nose

Be very careful putting on the otoscope

Avoid the nasal septum to prevent injury or discomfort.

nasal mucosa,

red color and smooth, moist surface

Note any swelling, discharge, bleeding, or foreign body.

A deviated septum is common and is not significant

unless air flow is obstructed

regardless of a deviated septum

If present in a hospitalized patient, document the deviated septum

in the event that the person needs nasal suctioning or a nasogastric tube.

A deviated septum look

a hump or shelf in one nasal cavity.

Perforation (hole) is seen as a spot of light from a penlight shining in the other naris

occurs with cocaine

Inspect the turbinates (the bony ridges curving down from the lateral walls).

The superior turbinate will not be in your view,

the middle and inferior turbinates appear the same light red color as the nasal mucosa.

Note any polyps (benign growths that accompany chronic allergy),

and distinguish them from the normal turbinates, which are pink, fixed, and vascular.

polyps

may grow to obstruct air passageways. NEED surgery asap

Symptoms are absence of sense of smell, disturbed sleep, postnasal drip, hoarseness and a “valve that moves” as the person breathes.

polyps look

smooth, grapelike, gray or yellow, non tender, mobile

using your thumbs, press the frontal sinuses

press firmly up and under the eyebrows

maxillary sinuses

below (not over) the cheekbones but under and not sideways

The person should feel firm pressure but no pain.

when touching sinuses

Inspect the Mouth

Begin with anterior structures and move posteriorly. Use a tongue blade to retract structures and a bright light for optimal visualization

lips

pink, moisture, no cracking, or lesions.

All racial groups have lips that are deeper or pinker than facial skin.

African Americans normally may have

bluish lips and a dark line on the gingival margin.

teeth

white, straight, evenly spaced, and clean and free of debris or decay.

Compare the number of teeth with the number expected for the person’s age.

Ask the person to bite as if chewing something and note alignment of upper and lower jaw.

Normal occlusion in the back is the upper teeth resting directly on the lower teeth;

in the front the upper incisors slightly override the lower incisors.

gums

pink

at the margins at the teeth are tight and well defined

tongue'

The color is pink and even.

The dorsal surface is normally roughened from the papillae.

A thin white coating =dehydrated

roof of the mouth.

Its ventral surface looks

smooth and glistening and shows veins

white patches or lesions; normally none are present.

if so, yeast infection

Oral precancerous, cancerous lesions, ulcer

The lateral and ventral tongue and the floor of the mouth are high-risk sites for oral squamous cell cancer.

U-shaped area under the tongue behind the teeth

older than 50 years, history of smoking or alcohol use

Note any induration/ hardened areas =mouth cancer

gutter of mouth

sides of tongue

ventral side of tongue

areas of mouth cancer

buccal mucosa

pink, smooth, and moist

Stensen duct

a small dimple

opening of the parotid salivary gland.

opposite the upper second molar

leukoedema

common in Black persons and East Indian persons

When it is mild, the patch disappears as you stretch the cheeks

a benign, milky, bluish-white, opaque area, bilateral

Fordyce granules

sebaceous cysts

small, isolated white or yellow papules on cheek, tongue, and lips are painless and not significant.

hard palate

white with irregular transverse rugae.

soft palate

pinker, smooth, and upwardly movable.

torus palatinus

nodular bony ridge down the middle of the hard palate

Native Americans, Inuits, and Asians; and is more common in female

mostly have torus palatinus

1+

Visible tonsils

2+

Halfway between tonsillar pillars and uvula

3+

Tonsils touching the uvula

4+

Tonsils touching one another

document tonsils

“grade +, ink with no exudate

tonsils

pink behind the anterior tonsillar pillar

Pharyngeal wall

pink, no exudate, no lesions

Gag reflex-

nerve 9 and 10

Stick out tongue-

nerve 12

light tight dynamite

breath odor

halitosis

aging

The tongue looks smoother as a result of papillary atrophy.

instead of pink and rough

The aging adult’s buccal mucosa is

thinned and may look shinier, as though it were “varnished.”

Old dental work deteriorates, especially at the gum margins.

The teeth loosen with bone resorption and may move with palpation.

The teeth may look longer

as the gum margins recede

The Aging Adult

Xerostomia

dry mouth because they take a lot of meds,

aging

some people add extra salt and sugar to enhance food when taste begins to wane.

Diminished smell also may decrease the person’s ability to detect food spoilage, natural gas leaks, or smoke from a fire.