“international health organizations and nursing organizations”

1. Health Assessment-I
Assessment of Nose, Mouth & Pharynx Unit# V
Amjad Ali
Assistant Professor
DIONAM, DUHS
06.05.2021
Objectives
By the end of the Unit, learners will be able to: 1. Describe the component of health history that should be elicited
during the assessment of nose, mouth and pharynx.
2. Identify the structural landmarks of the nose, mouth and pharynx.
3. Describe specific assessments to be made during the physical examination of the above systems.
4. Document findings.
Health History
• Nose
– Decreased ability to smell (elderly)
• Mouth and throat
– Tooth loss
– Gum disease
– Decreased taste
– Tonsilitis
– Sore throat/infection

2. • Nose
– Pain
– Drainage
– Blockage or congestion
– Bleeding (Epistaxis)
• Mouth and throat
– Halitosis
– Oral lesions
– Swelling
– Oral thrush
– Ulceration
– Pain
– Difficulty in swallowing
– Hoarseness of voice
Evaluation of Chief Complaint
• Quality
• Associated manifestations
• Aggravating factors
• Alleviating factors
• Frequency
• Timing
Past Health History
• Medical
– Otitis media or externa
– Nasal polyps, sinusitis, allergic rhinitis
– Tonsillitis, caries, upper respiratory infections
– Chronic diseases such as diabetes mellitus, renal disease, hypertension, immuno-suppression

3. – Dental pathology
– Nutritional disturbances
• Surgical
– Cosmetic surgery of head or neck
– Repair of deviated septum
– Oral surgery
– Tympanostomy tubes
• Medications
– Antibiotics
– Antihistamines
– Decongestants
– Steroids
– Chemotherapy
– Immunosuppressive drugs
• Allergies
– Signs and symptoms
– Pollen, insect stings, animal dander
• Injuries and accidents
– Foreign bodies
– Trauma
– Sports injuries
• Special needs
– Use of assistive devices (hearing aids)
– Speech disorders
• Childhood illnesses
– Frequent tonsillitis or ear infections
Social History

4. • Alcohol use
• Drug use
• Tobacco use
• Sexual practices
• Work and home environment
• Hobbies and leisure activities
• Stress
Health Maintenance Activities
• Sleep
• Diet
• Use of safety devices
• Health check-ups
General Approach to Assessment
• Greet patient
• Explain assessment techniques
• Quiet, well-lit environment
• Sitting position
• Compare right to left
• Systematic approach
Equipment
• Nasal speculum
• Penlight
• Tongue blade
• Watch
• Gauze square
• Cotton-tipped applicators
Structure and function : Nose, Mouth, and Throat

5. • Nose
– Function in the respiratory system
– External nose
– Nasal cavity
– Septum
– Turbinate
– Paranasal sinuses
• Frontal
• Maxillary
• Ethmoid
• Sphenoid
Paranasal Sinuses

6. • Mouth
– Function in the digestive and respiratory system
– Hard and soft palates
– Uvula
– Tongue
– Salivary glands
• Parotid
• Submandibular
• Sublingual
– Teeth
• Throat
– Oropharynx
– Tonsils
– Nasopharynx
Assessment of the Nose
• Take history of:
– Discharge
– Frequent colds
– Sinus pain

7. – Trauma
– Epistaxis
– Allergies
– Altered smell
Inspection and palpation of nose
• External nose
– Tenderness, discharge ,trauma, bleeding, lesions, masses, swelling, asymmetry
– Test patency of nostril
• Inspection of internal nose
– Speculum or otoscope with nasal speculum
– Nasal cavity
Nasal septum
Turbinates
– Sinus Areas- Palpate
Frontal and maxillary sinuses
Transillumination
• Normal findings
– Located in midline of face
– No swelling, bleeding, lesions, or masses
– Both nostrils patent
– Septum midline
– Nasal mucosa is pink or dull red
• Abnormal findings
– Broken, misshapen, swollen nose
– Occluded nasal passages
– Septum is deviated
– Nasal mucosa is red and swollen

8. – Purulent drainage
Assessment of the Sinuses
• Inspection (Sinus Transillumination)
• Palpation and percussion
• Normal findings
– No discomfort during palpation or percussion
– Resonance heard on percussion
Assessment of the Mouth
Inspect Mouth
– Lips
– Teeth and gums
– Tongue
– U-shaped areas under the tongue
– Buccal mucosa
– Uvula
– Hard and soft palate
Mouth inspection and palpation
• LIPS inspect for color, moisture, cracking, or lesions. Palpate lips, and face for mass and tenderness
• TEETH/gums note any diseased absent, loose teeth gums should be pink or coral, check for swelling,
retraction of gum margins spongy, bleeding discolored gums.
• TONGUE color pink and even dorsal side roughened, ventral smooth, glistening, shows veins Inspect
under tongue for nodules, lesions, ulcerations
• Buccal mucosa looks pink, smooth, moist, dark skinned people may have patchy hyperpigmentation
• Uvula fleshy pendant midline uvula and soft palate rise with “ahhh” sound. anterior hard palate is white
with irregular transverse rugae the posterior soft palate is pinker smooth, and upwardly movable.
• Normal findings of Mouth
• Breath is fresh
• Pink, moist lips

9. • Tongue midline, symmetrical, with adequate movement
• No pockets between gums and teeth
• No bleeding
• Smooth, white teeth; proper alignment, no dental caries
• Abnormal findings of Mouth
• Lesions, growths
• Dry, cracked lips
• Vesicles or blisters
• Red, tender, inflamed tongue, gums, buccal mucosa
• Thrush
• Coating on tongue
• Red, tender, swollen gingiva
• Bleeding gums
Inspection of the Throat
• Position, size, color,and general appearance of tonsils and uvula
• Gag reflex
• Color of oropharynx
• Presence of swelling, exudate, lesions
Assessment of tonsils
– Enlarged tonsils are graded
• Grade 1 – wnl
• Grade 2 – tonsils b/w pillars and uvula
• Grade 3 – tonsils touching uvula
• Grade 4 – tonsils touching each other (kissing tonsils)

10. Neck assessment usually done with Thorax
• Normal findings
– Soft palate and uvula rise when patient says “ah”
– Uvula is midline

11. – Throat is pink and vascular
– No swelling, exudate, or lesions
– Gag reflex is present
• Abnormal findings
– Posterior pharynx is red with white patches
– Tonsils and uvula are red and swollen
– Hoarse voice
– Grayish membrane covering tonsils, uvula, soft palate
Nose and Mouth
ROS Nose and Mouth PE
 History question (Review of systems)
 Pain / discomfort in Nose mouth and pharynx, cheeks forehead
 Drainage
 Seasonal allergies
 Condition of teeth, gums, dentures, Dental check up and hygiene
 Bleeding from mouth and gums

12.  Chewing abilities
 Ability to smell or unusual odor
 Ability to taste or decrease taste
 Injury, surgery, bleeding
 Family history of Cancer,
 Smoking, exposure to fumes, dust etc
PE of Nose
Inspection
 Inspect for shape, size, color, Check both the nares for patency and flaring by cotton wisp or paper
Palpation
 Palpate the bridge for deviation, deformity tenderness and masses
 Sense of smell (CN I)
Findings: the nasal structure is smooth and symmetric. No tenderness observed
PE of Nose
Palpate Sinuses
◦ Frontal and maxillary
◦ For Tenderness

13. ◦ Transillumination ( If tenderness present)
Findings: frontal and maxillary sinuses are non palpable and no crepitus is evident.
PE of Nose
Palpating frontal & Maxillary Sinuses

17. Common Abnormalities…..Cont
Esophagus and Stomach
– Dysphagia

18. • Difficulty swallowing
– Sensation of food sticking in the esophagus
– Hematemesis
• Vomiting of blood
– Pyrosis
• Heartburn
– Dyspepsia
• Burning pain
– Eructation
– Belching
– Nausea/Vomiting
– Feeling of or expulsion of gastric contents through the mouth
– Achalasia
inability of the esophagus to move food toward the stomach. Symptoms: Backflow (regurgitation) of food;
PE of Mouth & Pharynx
Inspect Gums with opening of mouth
Color, Inflammation, Swelling, Bleeding, Retraction, Discoloration
(Gingivitis, Pyorrhea, receding gums, pain, hyperplasia, Kaposi’s lesions in AIDS, Lead line in Chronic lead
poisoning).
Inspect and palpate Tongue using gauze:
◦ Size & Color (big sized, myxedema, beefy)
◦ Texture-papillae, abnormal smoothness.
◦ Movement- symmetry, tremor (movement or protrusion of tongue)
(CN12)
◦ Nodules, ulcers, growth
◦ Sublingual-Frenulum, veins, moist. Instruct pt to touch tongue on roof of mouth.

19. • Number 32 (Loose, Missing, dentures)
• Position, shape, color
• Condition (caries)
• Buccal Mucosa
• Color
• Pigmentation
• Ulcers, nodules spots, thrush
• Hard & Soft Palates
• Color & Architecture (Cleft palate)
Ulcer at buccal mucosa

20. Findings
• Lips are smooth and moist without lesions or swallowing.
• Thirty two pearly whitish/ yellowish teeth with smooth surfaces and edges. Gums are pink, moist and
firm with tight margins to the tooth. No lesions and masses observed.

21. • Tongue is pink, moist and moderate in size with little papillae present. Ventral surface of the tongue is
smooth, shinny.
• Wharton's ducts are visible with salivary flow or moistness in the area. Client is able to difference
between salty and sweet.
• The hard palate is pale, firm and have transverse rugae. The ulva symmetric elevation from soft palate is
a fleshy solid structure that hangs freely in the midline
References / Photographs
 Bates, B., Bickley, L.S. & Hoekelman, R.A. (1995). A guide to
Physical examination and history taking Philadelphia: Lippincott
 Bickley, L.S. (2007). Bates’ guide to physical examination and history taking (9th
ed.). Philadelphia:J.B.
Lippincott.
 Fuller, J. & Schaller - Ayers, J. (2000). Health assessment: A nursing approach. (3rd
ed.). Philadelphia:J.B.
Lippincott.
 Jarvis, C. (2008). Physical Examination and Health Assessment (5th
ed). Philadelphia: W.B. Saunders
Company
 Weber, J., & Kelley, J. (2007). Health Assessment in Nursing (3nd
ed.). Philadelphia: Lippincott