Nose, Mouth, & Throat

Health History

Nose & paranasal sinuses Discharge (color, amount, odor, clarity) Frequent colds Sinus pain Trauma Epistaxis Allergies Altered smell

Mouth & Throat

Sores or lesions Sore throat Bleeding gums Toothache Hoarseness Altered taste Smoking Self-care behaviors – brushing, flossing, dental

visits

Nose

Inspect nose for deviations in shape, size, or color Flaring of nostrils Discharge Patency of nostrils Asymmetry of nasal septum is normal (abnormal if

airflow is obstructed) Nasal mucosa is usually redder than oral mucosa

Kiesselbach’s Triangle – site of most nosebleeds. Most vascular area of nose

Nasal Discharge/Drainage

Allergic Rhinitis Clear drainage. Turbinates and M/M will be swollen, Boggy Pale under eyes

Cold or Viral Infection White drainage

Sinusitis Copious, purulent drainage, with

associated pain and tenderness over affected sinuses

Unilateral drainage In children – suspect foreign body Bloody – suspect neoplasm Serosaingous – suspect CSF, head injury.

With compression of the jugular vein, if it is CSF, you will see an increase in flow

Nosebleeds/Epistaxis

Suspect hypertension, bleeding disorders or dryness of M/M

Allergies Check history of nose sprays

Mouth & Oropharynx

Inspect lips for symmetry, color, edema, or surface abnormalities

Ask client to open and close mouth, palpate TMJ Oral mucosa is normally light pink and moist Inspect palate Inspect tonsils Inspect the buccal mucosa

Grading Tonsils

1+ Visible 2+ Halfway between tonsilar pillars

and uvula 3+ Touching the uvula,

Common in 4-9 year olds 4+ Touching each other

Tongue, Teeth, & Gums

Assess for swelling, color, coating, or ulceration Test hypoglossal nerve – stick out tongue Inspect floor of mouth Inspect teeth for decay, missing teeth, and

malocclusions Inspect gums for signs of inflammation and

hemorrhage Assess CN IX and X (Glossopharyngeal and Vagal)

Ahh, Uvula should move upward and midline Assess for mouth odors

Teeth

Note number 20 Deciduous 32 Permanent

Note color – pearly white to yellow Presence of plaque, tartar, cavities (brown spots) Eruption

Deciduous - begins at 5-9 mos. Complete by 2 ½ years Permanent - begins at 6 years