Exam 1 / Week 5 HEENT (Nose & Mouth)

Question 1

NOSE: Which cranial nerve affects this area?

Answer 1

CN I S (olfactory) > smell

Question 2

NOSE: What questions would you ask to assess this area?

Answer 2

Have you had any injuries to your nose? Do you ever have pain, stuffiness, or fluid draining from your nose? Do you ever have nosebleeds? Do you use nasal sprays? Do you snore?

Question 3

NOSE: When inspecting and palpating this area, what do you expect to find?

Answer 3

1. The nose is midline, symmetrical, and the same color as the face.
2. Each naris (nostril) is patent without excessive flaring. The structure of the nose is firm and stable.
3. To examine internal structures, insert a nasal speculum just barely into each naris as the pt tips his head back. Check that the septum is midline and intact. Check that the mucous membranes are deep pink and moist with no discharge or lesions.
4. Assess cmell (CN I) by asking the pt to close eyes, occlude one naris at a time, and identify a familiar smell (mint or coffee, for example)

Question 4

NOSE: Describe how to palpate the sinuses.

Answer 4

1. Palpate the frontal sinuses by pressing upward with the thumbs from just below the eyebrows on either side of the bridge of the nose.
2. Palpate the maxillary sinuses by pressing upward at the skin crevices that run from the sides of the nose to the corner of the mouth.
3. Expect that they are nontender.

Question 5

MOUTH: Which cranial nerves affect this area?

Answer 5

CN VII (facial) > taste
CN IX (glossopharyngeal) > taste
CN IX (glossopharyngeal) &  CNN X (vagus) > movement of soft palate & gag reflex and swallowing & speech

Question 6

MOUTH: What questions would you ask to assess this area?

Answer 6

Have you noticed any change in your sens of taste? How often do you go to the dentist? Do you have dentures? Retainers? Do you have any problems with your gums? Do you have any difficulty swallowing? Do you have a hoarse or sore throat?

Question 7

MOUTH: When inspecting and palpating this area, what do you expect to find? (part 1, the front-ish bits)

Answer 7

1. Lips are darker pigmented than the face. They are moist, symmetric, smooth, nontender, and soft with no lesions.
2. Gums are coral pink. They are tight against the teeth with no bleeding - even after you palpate with a gloved finger).
3. Teeth are shiny, white and smooth. Check for malocclusions by asking the pt to clench her teeth; note any missing or loose teeth as well as discoloration.
4. Mucous membranes are pink and moist with no lesions.

Question 8

MOUTH: When inspecting and palpating this area, what do you expect to find? (part 2, the back-ish bits)

Answer 8

5. The hard palate is whitish, intact, symmetric, firm and concave.
6. The soft palate is light pink, intact, smooth, symmetric, and moves with vocalization (CN IX, X)
7. The uvula is pink, midline, intact, and move with vocalization.
8. Tonsils are the same color as the surrounding mucosa and vary in size and visibility (+1 is barely visible; +2 is halfway to uvula; +3 is touching uvula; and +4 is touching each other or midline)

Question 9

MOUTH: When inspecting and palpating this area, what do you expect to find? (part 3, the tongue bit)

Answer 9

9. Use a gauze pad to hold the tip of the tongue from side to side. The dorsal surface is pink and symmetric with presence of papillae. The tongue is midline, moist, free of lesions and moves freely.
10. The underside of tongue is smooth with symmetric vascular pattern.
11. Assess taste (CN VII, CN IX) by having the pt close eyes and identify foods (like a mint)
12. Ask the client to move tongue up, down, and side to side. Test strength (CN XII) by applying resistance against each cheek while the pt sticks tongue into each cheek.
13. Elicit the gag reflex by using a tongue blade to stimulate the back of the throat (CN IX, CN X). Explain the procedure to the pt prior to this assessment!
14. Speech is clear & articulate.