Nose, Mouth and Throat (HA)

Nasal Cavity

structure and function: nose

• first segment of respiratory system

• upper third made up of bone; rest is cartilage

• nasal cavity divided medially by septum into 2 slit -like air passages

• 3D sinus animation

  • olfactory receptors, hair cells, lie at roof of nasal cavity and upper third of septum

  • 2 pairs of sinuses are acceptable to examine

    • frontal sinus (above and medial to orbits)

    • maxillary sinuses in maxilla (cheek bone)

paranasal sinuses

Structure and function: mouth

first segment of digestive system and an airway for the respiratory system

Oral cavity: short passage bordered by lips, palate, cheeks and tongue

lips: anterior border of oral cavity, transition zone from outer skin to inner mucous membrane lining the oral cavity

• palate: arching roof of mouth divided into 2 parts

• hard palate: anterior part made up of bone

• soft palate: posterior part, an arch of muscle that is mobile

• uvula: free projection handing down from middle of soft palate

  • pink, moist and intact

anatomy of mouth

salivary glands

developmental competence: aging adult

natural tooth loss exacerbated by inadiquate dental care, poor oral hygiene and tabacco use

• can lead to malocclusion leading to further tooth loss and pain

dimdinished sense of taste and smell

aging persons interest in food diminishes

trouble with mastication can lead to dietary pattern changes which may place the older adult at risk for nutritional deficits (protein, vitamins and minerals)

gradual loss of subcutaneous fat starts during later middle adult years, making the nose appear more prominent

atrophic tissues ulcerate easily

• increasing risk for older people for infections, such as oral moniliasis and malginant lesions

culture and genetics

increased incidence of oral cancers

• linked to HPV

dental caries

• infectious process leading to tooth decay due to interaction of bacteria is on the rise

increased risk for dental disease

• due to socioeconomic status, lack of access

complications related to periodontal disease

• linked to type 2 diabetes

subjective data: nose

• discharge

• frequent colds

• sinus pain

• trauma

• epistaxis (nosebleeds)

• allergies

• altered smell

subjective data: mouth and throat

• sores or lesions

• sore throat

• bleeding gums

• toothache

• hoarseness (how they are talking)

  • aneurism that changes your voice

• dysphagia (trouble swallowing)

• altered state

• smoking, alcohol consumption

• patient care pattern

  • dental care pattern

  • dentures or appliances

additional history for aging adult

any dryness in the mouth? meds?

have you had any loss of teeth? can you chew all types of food?

are you able to care for your own teeth or dentures?

have you noticed a change in your sense of taste or smell?

objective data

preparation

• position a person sitting up straight with their head at your eye level

• if they wear dentures put them in a napkin

equipment

• otoscope with short, wide-tipped nasal speculum

• penlight

• 2 tongue blades

• cotton gauze pad, 4 by 4 inches

• gloves

Inspection and palpation: nose

external nose

nasal septum

• observe for deviation

• note any bleeding or perforation

nasal cavity

• attach short wide-tipped speculum to otoscope head and insert apparatus into nasal cavity

  • inspect nasal mucosa, noting its normal red color and smooth moist surface

  • note any swelling, discharge, bleeding or foreign body

• normally nose is symmetric, in midline, and in proportion to other facial features

• test patency of nostrils

• sense of smell, mediated by cranial nerve I, is usually not tested in a routine examination

• inspect for any deformity, asymmetry, inflammation or skin lesions

  • if an injury is reported or suspected, palpate gently for any pain or break in contour

nasal turbinates

• inspect

• superior turbinate may not be in view

• middle and inferior turbinates appear the same light red color as nasal mucosa; note any swelling but do not try to push speculum past it

• turbinates are quite vascular and tender if touched

• note any polyps

palpation of sinus area

using thumbs, press frontal sinuses by pressing up and under the eyebrows and over maxillary sinuses below cheekbones

Inspection of the mouth

begin with anterior structures and move posteriorly; use tongue blade to retract structures and bright light for optimal visualization

inspect lips: color, moisture, cracking or lesions; retract lips and note inner surface

• african americans normally may have bluish lips and a dark line gingival margin

inspection of teeth and gums

• condition of teeth is an index of the persons general health

• note any diseased, absent, loose o abnormally positioned teeth

• compare number of teeth with number expected for the persons age

• ask the person to bite as if chewing something and note alignment of upper and lower jaw

inspection of tongue

• check tongue for color, surface, characteristics and moisture

• ask the person to touch tongue and roof of mouth

  • ventral surface looks smooth, glistening and shows veins

• with glove, hold tongue with cotton gauze pad for traction and swing tongue out and to each side; inspect for white patches or lesions

• inspect entire U-shaped area under tongue behind teeth

  • oral malignancies are most likely there

• note any white patches, nodules or ulcerations

inspection of palate

anterior hard palate white with irregular transverse rugae

• closer to teeth

posterior soft palate is pinker, smooth and upwardly moveable

• closer to throat

observe uvula

• should be midline

• ask person to say “ahh”

• CN 10, vagus nerve

Inspection of throat

observe oval, rough -surfaced tonsils

pink and their surface has indentations; no exudate on tonsils

tonsils graded in size:

• 1+ visible

• 2+ halfway between tonsillar pillars and uvula

• 3+ touching uvula

• 4+ touching each other

1+ or 2+ is normal and healthy

developmental competence: aging adult

nose may appear more prominent on face from loss of subcutaneous fat

teeth may look slightly yellowed, but color is uniform

surface of incisors may show vertical cracks from a lifetime of exposure to extreme temps

teeth may look longer as gums recede

• teeth loosen with bone resorption

• tongue looks smoother as a result of papillary atrophy

• aging buccal mucosa is thinned and may look shiner

nose abnormalities

• choanal atresia

• epistaxis (gum bleeding)

• sinusitis (sinus inflammation)

• seasonal allergies

• acute rhinitis (nonallergic)

• foreign body

• perforated septum

• nasal polyps

lip abnormalities

cleft lip

herpes simplex 1 (HSV-1)

carcinoma

teeth and gum abnormalities

dental caries

tooth avulsion

gingivitis

meth mouth

buccal mucosa abnormalities

koplik spots (HIV and AIDs)

leukoplakia

candidiasis in adult

herpes simplex 1

tongue abnormalities

smooth glossy tongue

black hair tongue

• poor nutrition

• drug use

carcinoma

• smoking and vaping

fissured tongue