MOUTH AND PHARYNX AND NECK

Using a penlight: Inspect lips, buccal mucosa, gums, hard and soft palates, floor of the mouth for color and surface characteristics/dentition, oropharynx: uvula, tonsils, posterior pharynx, mouth odor (halitosis)

Gums, tongue and oral mucosa are pink, moist and intact

Teeth are intact and in good condition

Tonsils of normal size and no halitosis

• *Use your penlight and ask client to swallow, open their mouth and say “ah”

*(CN IX – glossopharyngeal – taste posterior 1/3 of tongue/tonsil & pharynx/swallowing)

With “ah”, there is symmetrical rise of the soft palate and uvula.

• *Have client stick out tongue straight and then move from side to side 

*(CN XII - hypoglossal)

Tongue is midline with no deviation and full tongue mobility

• *(CN X – vagus – gag and swallowing reflexes)

• *Inspect for symmetry and smoothness of neck and thyroid and palpate thyroid, ask client to swallow

Neck should be smooth and no obvious nodules on thyroid as the client swallows and the thyroid moves up and down. Client can swallow without difficulty and has intact gag reflex (if tested with a tongue depressor)

Test strength of head and neck and shoulder shrug with resistance (CN XI – spinal accessory nerve – controls shoulder and neck movements)

Client can push head in all directions against resistance and shrug shoulders against resistance

Inspect for right internal jugular venous distention with client laying at 45° angle with head turned to the left

No distention of the right internal jugular vein

*Palpate carotid pulses; only one side at a time!

Pulses are strong and equal bilaterally

*Auscultate carotid arteries for bruits with bell of stethoscope

No bruits (pronounced brew-eee)

Palpate tracheal position

Trachea is midline