nose, sinuses, mouth and throat VB

throat

oropharynx, common channel for respiratory and digestive enzymes

tonsils

at back of throat between anterior and posterior pillars, more granular and less smooth tissues, contribute to immunologica defense, help filter germs

adenoids

contribute to immunological defense

older population

increased risk of ulcerations, infections, oral cancers, decrease in production of saliva and number of taste buds, edentulous

health disparaties

oral health in vulnerable populations, smokers, cogenital defects in children, sleep-disordered breathing

priority urget assessment

nose bleeds, ludwig angina aspiration, abrupt loss of smell (brain tumor, covid 19 infection)

ludwig angina

edema pushing tounge up and back → airway obstruction; result of infection of the mouth floor

common nose, sinus and mouth symptoms

facial pressure, pain, headache, snoring sleep apnea; obstructive breathing, nasal congestion; epistaxis, halitosis, anosmia (loss of smell), cough; pharyngitis, dysphagia; dental aching/pain, hoarsness/voice changes; oral lesions, older adults, cultural considerations

inspect nouse,mouth,throat

nose with otoscope and nasal speculum, inspect sinuses, inspect/evaluate swalloing, assess for inspiration

palpate nose

perform smell testing to determine patency, palpate sinuses, palpapte lips and mouth

nose mouth throat exam and equipment

tounge blades, cotton gauze 4×4s, gloves, penlight or flashlight, otoscope

external nose

inspection, palpation

internal nose

inspection, palpation

sinuses

inspection, palpation, and percussion

mouth

external inspection, internal inspection: buccal mucosa; uvula; hard and soft palates; tounge, submandibular ducts, palpation

throat

inspection, palpation, swallowing evaluation

nasal cavity check

check for color and integrity of mucosa

check septum

for deviation, perforation, bleeding

check tubinante

for color, exudate, swelling, polyps, foreign body

documentation

normal - external nose is symmetrical with no discoloration, swelling or maiformation

beign your assessment by palpating for

sinus tenderness

frontal sinuses

place your thumbs just under the bony brows of your patient’s eyes. Press upward, being careful not to put pressure on the eyes

ethmoid sinuses

use your thumbs to press on each side of the nose

maxillary sinuses

press up under the zygomatic processes using your thumbs or index and middle fingers

transillumination

a decrease in the amount of light passing through the sinus indicates that fluid has filled the sinus and indicates a possible sinusitis. The test is regarded as negative if the sinuses transilluminate equally and well; if one or both sinuses show impaired transmissiblity of light.

lips

symmetry, color, edema, mositure, cracking, lesions

teeth and gums

dental repair, hygeine, bleeding, swelling, missing teeth

tongue

color, geographic, swelling, ulcers/lesions; patches, odor CNXIII

CN XIII

hypoglossal, stick tounge out

buccal mucosa

inspect and palapte

throat inspection

inspect soft & hard palpate, shape & posistion of uvula, check CN X, with CN IX, check tonsils and pillars for size, shape color lesoions & exudate

CN X

vagus

CN IX

gag reflex (glossopharyngeal)

Check CN X with CN IX

have patient say “ahhh” uvula should rise

health promotion

misuse of OTC nasal medications, smoking cessation, chewing tobacco, skin cancer, dental hygiene / exams, prolonged thumb sucking, medication side effects such as dry mouth, nasal irrigation hygeine