1. Maria Carmela L. Domocmat, RN, MSN

2. Maria Carmela L. Domocmat, RN, MSN 3. Maria Carmela L. Domocmat, RN, MSN 4. Inspection and PalpitationInspect the lipsMaria Carmela L. Domocmat, RN, MSN 5. Lips are smooth and moist w/out lesionsor swelling. Pink lips are normal in ligth-skinned clients are bluish or freckled lipsin some dark-skinned clients, especiallythose of Mediterranean descent. Maria Carmela L. Domocmat, RN, MSN 6. Maria Carmela L. Domocmat, RN, MSN 7. Pallor around the lips( circumoral pallor)is seen in anemia and shock.Bluish(cyanotic) lips may result from cold orhypoxia. Reddish lips are seen in clientsw/ ketoacidosis, carbon monoxidepoisoning, and COPD w/ polycythemia.Swelling of the lips(edema) is common inlocal or systemic allergic or anaphylacticreactions. Maria Carmela L. Domocmat, RN, MSN 8. SWELLING LIPSMaria Carmela L. Domocmat, RN, MSN 9. Inspection and PalpitationInspect the teeth and gums.Maria Carmela L. Domocmat, RN, MSN 10. Thirty-two pearly whitish teeth w/ smooth surfaces and edges. Upper molar should rest directly on the lower molars and the front upper incisors should slightly override the lower incisors. Some clients normally have only 28 teeth if the 4 wisdom teeth do not erupt.No repaired or decayed areas ; no missing teeth or appliances.Maria Carmela L. Domocmat, RN, MSN 11. Maria Carmela L. Domocmat, RN, MSN 12. Clients who smoke, drink large quantitiesof coffee or tea or have an excessiveintake of fluoride may have yellow orbrownish teeth.Receding gums are abnormal in youngerclients;in elderly clients, the teeth mayappear longer because of age-relatedgingival recession, w/c is common.Red, swollen gums that bleed easily areseen in gingivitis, scurvy(vitamin Cdeficiency), and leukemia. Maria Carmela L. Domocmat, RN, MSN 13. Maria Carmela L. Domocmat, RN, MSN 14. BROWNISHYELLOWISH Maria Carmela L. Domocmat, RN, MSN 15. Inspection and PalpitationInspect the buccal mucosaMaria Carmela L. Domocmat, RN, MSN 16. Maria Carmela L. Domocmat, RN, MSN 17. It should appear pink in light-skinnedclients;tissue pigmentation typicallyincreases in dark-skinned clients.In both,tissue is smooth and moist w/out lesions Maria Carmela L. Domocmat, RN, MSN 18. Leukoplakia may be seen in chronicirritation and smoking.Maria Carmela L. Domocmat, RN, MSN 19. Maria Carmela L. Domocmat, RN, MSN 20. Inspection and PalpitationInspect and palpate the tongueMaria Carmela L. Domocmat, RN, MSN 21. Tongue should be pink, moist, amoderate size w/ papillae(littleprotuberances) present. A commonvariation is a fissured, topographic-map-like tongue, w/c is not unusual in olderclients. No lesions are present. Maria Carmela L. Domocmat, RN, MSN 22. Among possible abnormalities are deeplongitudinal fissures seen in dehydration;a black tongue indicative of bismuth(PeptoBismol)toxicity: black, hairytongue; a smooth ,reddish, shiny tonguew/out papillae indicative of niacin orvitamin B12 deficiencies, certainanemias, and antineoplastic therapy. Maria Carmela L. Domocmat, RN, MSN 23. Inspection and PalpitationAssess the ventral surface of the tongue Maria Carmela L. Domocmat, RN, MSN 24. The tongues ventral surface is smooth,shiny, pink or slightly pale w/ visibleveins and no lesions. Maria Carmela L. Domocmat, RN, MSN 25. Leukoplakia, persistent lesions, ulcers, ornodules may indicate cancer and shouldbe referred. Induration increases thelikelihood of cancer. Maria Carmela L. Domocmat, RN, MSN 26. Inspection and PalpitationInspect for Whartons ducts Maria Carmela L. Domocmat, RN, MSN 27. The frenulum is midline; Whartons ductsare visible w/ salivary flow or moistnessin the area. The client has no swelling,redness, or pain. Maria Carmela L. Domocmat, RN, MSN 28. Abnormal findings include lesions,ulcers, nodules, or hypertrophied ductopenings on either side of frenulum. Maria Carmela L. Domocmat, RN, MSN 29. Inspection and Palpitation.Observe the sides of the tongueMaria Carmela L. Domocmat, RN, MSN 30. No lesions,ulcers,or nodules areapparent. Maria Carmela L. Domocmat, RN, MSN 31. Cancer sores may be seen on the sides ofthe tongue in clients receiving certainkinds of chemotherapy. Leukoplakia ,persistent lesions, ulcers, or nodules mayindicate cancer and should be furtherevaluated medically. Maria Carmela L. Domocmat, RN, MSN 32. Inspection and Palpitation.Check the strength of the tongueMaria Carmela L. Domocmat, RN, MSN 33. The tongue offers strong resistance Maria Carmela L. Domocmat, RN, MSN 34. Decreased tongue strength may occur w/a defect of the twelfth cranial nerve-hypoglossal-or w/ a short-ened frenulumthat limits motion.Maria Carmela L. Domocmat, RN, MSN 35. Inspection and PalpitationCheck the anterior tongues ability to taste Maria Carmela L. Domocmat, RN, MSN 36. The client can distinguish between sweetand salty.Maria Carmela L. Domocmat, RN, MSN 37. Loss of taste discrimination occurs w/zinc deficiency. A seventh cranialnerve(facial)defect, and certainmedication use. Maria Carmela L. Domocmat, RN, MSN 38. Inspection and PalpitationInspect the hard(anterior)andsoft(posterio)palates and uvula.Maria Carmela L. Domocmat, RN, MSN 39. The hard palate is pale or whitish w/ firm,trasverse rugae(wrinklelike folds). Maria Carmela L. Domocmat, RN, MSN 40. A candidal infection may appear as thickwhite plaques on the hard palate.Deeppurple, raised, or flat lesions mayindicate a Kaposis sarcoma.A yellow tint to the hard palate mayindicate jaundice because bilirubinadheres to elastic tissue(collagen). Anopening in the hard palate is known as acleft palate.Maria Carmela L. Domocmat, RN, MSN 41. Inspection and PalpitationNote odorMaria Carmela L. Domocmat, RN, MSN 42. No unusual or foul odor is noted. Maria Carmela L. Domocmat, RN, MSN 43. Fruity or acetone breath is associated w/diabetic ketoacidosis.An ammonia odor is often associated w/kidney disease.Foul odor may indicate an oral or respiratoryinfection, or tooth decay.Alcohol or tobacco use may be identified bybreath odor.Fecal breath odor occurs in bowelobstruction;sulfur odor(fetor hepaticus) occurs in end-stage liver disease. Maria Carmela L. Domocmat, RN, MSN 44. Inspection and PalpitationAssess the uvulaMaria Carmela L. Domocmat, RN, MSN 45. The uvula is a fleshy, solid structure thathangs freely in the midline. No redness ofor exudate from uvula or soft palate.Midline elevation of the soft palate. Maria Carmela L. Domocmat, RN, MSN 46. A bifit uvula looks like it is split in two orpartially severed.Clients w/ a bifit uvulamay have a submucous cleft palate.Maria Carmela L. Domocmat, RN, MSN 47. Inspection and PalpitationInspect the tonsils Maria Carmela L. Domocmat, RN, MSN 48. Tonsils may be present or absent.Theyare normally pink and symmetric andmay be enlarge to 1+ in healthyclients.No exudate, swelling, or lesionsshould be present. Maria Carmela L. Domocmat, RN, MSN 49. Tonsils are red,enlarge(to 2+, 3+, or4+),and covered w/ exudate intonsilitis.Abnormal findings 15-2 depictsgrading of tonsils.They also may beindurated w/ patches of white or yellowexudate. Maria Carmela L. Domocmat, RN, MSN 50. Maria Carmela L. Domocmat, RN, MSN 51. Inspection and PalpitationInspect the posterior pharyngeal wall. Maria Carmela L. Domocmat, RN, MSN 52. Throat is normally pink w/out excudateor lesions.Maria Carmela L. Domocmat, RN, MSN 53. A bright red throat w/ white or yellowexudate indicates pharyngitis. Yellowishmucus on throat may be seen w/postnasal sinus drainage. Maria Carmela L. Domocmat, RN, MSN 54. Maria Carmela L. Domocmat, RN, MSN