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NURS 252 > Nose, Sinuses, Mouth and Throat > Flashcards

Nose, Sinuses, Mouth and Throat Flashcards

1
Q

Mouth anatomy and physiology

A
  • lips, tongue, teeth, gums and salivary glands
  • roof consists of hard palate (anterior), and soft palate (posterior)
  • tongue has hundreds of papillae (taste buds)
  • dorsal surface has hundreds of papillae (taste buds) to distinguish sweet, sour, bitter and salty tastes
  • ventral surface is smooth and highly vascular
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2
Q

Assessment of the nose/sinuses: health history

A
  • OPQRSTU
  • discharge: Color, trauma, epistaxis (nosebleeds), infection, characteristic, smell, amount, differentiate etiology- cold, allergy, sinus infection, trauma
  • frequent colds (upper respiratory infections)
  • sinus pain
  • allergies: identify triggers and associated signs and symptoms (sneezing, itchy/runny/blocked nose, swollen lips and tongue, coughing)
  • altered smell
  • epistaxis: identify cause- trauma, vigorous nose blowing, foreign body, cocaine use, chronic high BP, high altitude
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3
Q

External nose: Inspect- expected

A

midline, symmetrical, proportional to other facial features, intact

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4
Q

External nose: Inspect- unexpected

A

deformity, deviated spetum, asymmetry, inflammation, lesions, drainage/discharge

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5
Q

Nasal mucosa: Color- expected

A

light red color or pink, smooth moist surface

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6
Q

Nasal mucosa: Color- unexpected

A
  • swollen and bright red with rhinitis and upper respiratory infection
  • discharge is common with rhinitis and sinusitis, varying from watery and copious to thick, purulent and green-yellow
  • with chronic allergy, mucosa looks swollen, boggy, pale and grey
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7
Q

Nose: Turbinate- expected

A

light red color, consistent with mucosa

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8
Q

Nose: Turbinate- unexpected

A

deviated, perforation

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9
Q

Nose: Palpate- expected

A

no pain or tenderness, patent (obvious) nostril, check by blocking a nostril and tell them to sniff (repeat on other nostril)

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10
Q

Nose: Palpate- unexpected

A

tenderness, swelling or mass

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11
Q

Mouth assessment: health history

A
  • tooth ache
  • bleeding gums: determine the cause
  • periodontal disease or clotting disorder
  • sores or lesions
  • bruxism (teeth grinding)- may not be aware bc usually hapepns when sleeping
  • dental problems, stress, TMJ
  • altered taste
  • self-care behaviors
  • oral care pattern
  • dentures
  • dental appliances
  • sugar consumption
  • alcohol consumption
  • tobacco consumption
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12
Q

Lips assessment: Expected

A
  • intact, pink/red and consistent with skin color
  • retract lips, and note their inner surfaces
  • individuals with darker complexions may normally have bluish lips and a dark line on the gingival marigin
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13
Q

Lips assessment: Unexpected

A
  • circumoral pallor: whiteness around the lips –> shock and anemia
  • cyanosis: bluish lips –> hypoxemia and chilling
  • cherry red lips –> CO poisoning
  • cheilitis (perleche): swollen patches and cracking at the corners –> herpes simplex
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14
Q

Mouth assessment: Inspect- unexpected

A
  • sores or lesions: determine if infectious, traumatic, immunological or malignant cause
  • bleeding gums: determine if periodontal disease or clotting disorder
  • bad smell: halitosis- poor oral hygiene, consumption of odoriferous foods, alcohol consumption, heavy smoking, or dental infection, could also indicate systemic disease
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15
Q

Mouth assessment: Palpate- unexpected

A
  • swelling or tenderness
  • canker sore
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16
Q

Teeth- expected condition

A
  • condition of the teeth is an index of the patient’s general health
  • white, straight, even spacing, no decay and free of debris
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17
Q

Teeth- unexpected condition

A
  • loose, absent, abnormal position, discoloration, decay
  • periodontal disease is linked to CV disease, diabetes, pulmonary infections, kidney disease, and osteoporosis
  • discoloured teeth appear brown with excessive fluoride use, and yellow with tobacco use
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18
Q

Teeth- expected number and alignment

A

adult (32), upper teeth rest on lower teeth

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19
Q

Teeth- unexpected number and alignment

A

malocclusion- bad bites, protrusion of upper or lower incisors:
- stress of chewing with misaligned teeth causes further problems (a) excessive bone resorption, resulting in further tooth loss, (b) muscle imbalance resulting from misalignment of the mandible and maxilla, producing muscle spasms, tenderness of muscles of mastication and chronic headaches, (c) increased stress on the temporomandibular joint leading to osteoarthritis, pain and inability to fuly open the mouth

  • caries: decay
  • enamel erosion: eating disorder
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20
Q

Gums- expected findings

A

pink or coral with a stippled (dotted) surface, gum margins at the teeth are tight and well defined. Darker-skinned patients may normally have a dark melanotic line along the gingival margin

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21
Q

Gums- unexpected findings

A
  • swelling, retraction, discolouration
  • bleeding of gums with slight pressure indicates gingivitis
  • dark line on gingival margins occurs with lead and bismuth poisoning
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22
Q

Tongue- Dorsal: expected findings

A
  • color is pink and even
  • roughened from the papillae
  • thin white coating may be present
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23
Q

Tongue- Dorsal: unexpected findings

A
  • beefy red, swollen
  • macroglossia- enlargement of the tongue (allergic and anaphylactic reactions, hypothyroidism and acromegaly)
  • tongue may be small with malnutrition
  • dry mouth occurs with dehydration, fever, tongue has deep vertical fissures
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24
Q

Tongue- Ventral: expected findings

A

smooth, glistening veins

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25
Q

Saliva: unexpected findings

A
  • Excess: neurological dysfunction and gingivostomatitis
  • Deficit: anticholinergic medications
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26
Q

Oral cavity: Buccal Mucosa- expected findings

A
  • pink, smooth, moist
  • dark skin- patchy hyperpigmentation, dark pigmentation
  • Stensen’s duct: the opening of the parotid salivary gland. It looks like a small dimple opposite the upper second molar
  • raised occlusion line on the buccal mucosa parallel with the level at which the teeth meet, caused by the teeth closing against the cheek
  • Leukoedema: benign greyish opaque area that may be present along the buccal mucosa- more common in people of African or South Asian descent
  • Fordyce’s granules: small, isolated white or yellow papule on the mucosa of the cheeks, tongue and lips. Little sebaceous cysts- painless and not significant
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27
Q

Oral cavity: Floor

A

no lesions, firm, moist

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28
Q

Oral cavity: hard palate- expected findings

A

anterior, white with irregular transverse rugae

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29
Q

Oral cavity: hard palate- unexpected findings

A

yellow/green/brown- jaundice

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30
Q

Oral cavity: soft palate- expected

A

posterior, pinker, upwardly movable

31
Q

Oral cavity: soft palate- unexpected

A

asymmetrical movement

32
Q

Oral cavity: uvula- expected

A

midline, soft palate and uvula rise in the midline when patient says “aah”- test of the function of cranial nerve X (vagus nerve)

33
Q

Oral cavity: uvula- unexpected

A
  • deviation or absence of movement indicates nerve damage, which also occurs with poliomyelitis and diphtheria
  • bifid uvula looks as if its split in 2- more common in Indigenous people
34
Q

Developmental considerations: Older adults- Nose

A
  • more prominent from loss of subcutaneous fat
  • nasal hairs grow coarser and stiffer and may not filter the air as well- the hairs protrude and may cause itching and sneezing (do not clip them because this may cause infection)
  • sense of smell may diminish because of a decreased number of olfactory nerve fibers - decreases progressively after 60
35
Q

Developmental considerations: Older adults- Teeth

A
  • may be slightly yellow
  • color uniform (worn enamel)
  • longer appearance as gums recede
  • teeth may loosen with bone resorption (osteoporosis)
  • if tooth loss occurs, the remaining teeth drift, causing upper or lower incisors to protrude= malocclusion
36
Q

Developmental considerations: Older adults- Tongue

A
  • smoother appearance due to papillary atrophy
  • impairments in taste because of decreased salivary secretion, which is needed to dissolve flavouring agents, and the presence of upper dentures, which cover secondary taste sites
  • diminished senses of taste and smell decrease older adults’ appetite and may contribute to malnutrition
  • decreased saliva also reduces the mouth’s self-cleaning property
37
Q

Developmental considerations: Older adults- Buccal Mucosa

A
  • thinned and shinier appearance
  • atrophic tissues ulcerate easily, increasing older adults’ risk for oral yeast infections, also known as thrush or candidiasis
  • risk of malignant oral lesions is also increased
38
Q

Nose

A
  • first segment of the respiratory effect
  • warms, moistens, and filters inhaled air
39
Q

Nasal cavity

A
  • much larger than the external size of the nose would indicate
  • extends back over the roof of the mouth
  • the anterior edge is lined with numerous coarse nasal hairs (vibrissae), the rest of the cavity is lined with a blanket of cilitated mucous membrane
  • nasal hairs filter coarse matter from inhaled air, whereas the mucous blanket filters out dust and bacteria
  • nasal mucosa appears redder than oral mucosa because of the rich blood supply present to warm the inhaled air
40
Q

Turbinates

A
  • lateral walls of each nasal cavity contain 3 parallel bony projections: the (a) superior, (b) middle and (c) inferior turbinates
  • they increase the SA so that more blood vessels and mucous membranes are available to warm, humidify, and filter inhaled air
41
Q

Mouth/ oral cavity

A
  • first segment of the digestive system and an airway for the respiratory system
  • lips: anterior border of the oral cavity, transition zone from the outer skin to the inner mucous membrane lining the oral cavity
  • palate: arching roof of the mouth and is divided into 2 parts- anterior hard palate (made up of bone and is a whitish color) and posterior soft palate (pinker and mobile arch of muscle)
  • uvula: free projection hanging down from the middle of the soft palate
  • cheeks: side walls of the oral cavity
42
Q

Tongue

A
  • mass of striated muscle arranged in a crosswise pattern so it can change shape and position
  • papillae: rough, bumpy elevations on its dorsal surface
  • underneath, the ventral surface of the tongue is smooth, shiny and has prominent veins
  • frenulum: midline fold of tissue connecting the tongue to the mouth floor
  • its ability to change shape and position enhances its functions in mastication, swallowing, cleansing the teeth and speech
  • also functions in taste sensation
43
Q

Teeth

A
  • adults have 32 permanent teeth
  • each tooth has 3 parts: the crown, the neck and the root
44
Q

Gums (gingivae)

A
  • collar the teeth
  • thick fibrous tissues covered with mucous membrane
  • different from the rest of the oral mucosa because of their pale pink colour and stippled surface
45
Q

Throat/pharynx

A
  • area behind the mouth and nose
  • oropharynx (middle part of throat): separated from the mouth by the anterior tonsillar pillars- 2 folds of tissue, 1 on each side
  • tonsils: mass of lymphoid tissue
  • nasopharynx: continuous with the oropharynx, above the oropharynx and behind the nasal cavity
  • have rich lymphatic network
46
Q

Developmental considerations: Infants and children (teeth)

A
  • salivation starts at 3 months
  • babies drool periodically for a few months before learning to swallow the saliva (drooling does not herald the eruption of teeth, as many parents believe)
  • both sets of teeth begin development in utero
  • children have 20 temporary deciduous teeth (first set of teeth)- these erupt between 6-24 months of age
  • all 20 teeth should appear by 2 1/2 years of age
47
Q

Developmental considerations: Pregnant women (nose, teeth, gums)

A
  • nasal stuffiness and nosebleeds or epistaxis may occur during pregnancy as a result of increased vascularity in the upper respiratory tract
  • gums may be hyperemic and softened and may bleed with normal tooth brushing- as a result of increased hormone production, which causes increased vascularity and fragility
  • no evidence shows that pregnancy causes tooth decay or loss
48
Q

SDOH for nose, sinuses, mouth and throat

A
  • incidence of cleft palate is similar across ethnic groups, but Indigenous people have a higher occurence of cleft lip and combined cleft lip/clef palate
  • torus palatinus, a bony ridge running down the middle of the hard palate, is also more common in Indigenous people and people of Asian descent
  • leukoedema, a greyish-white benign lesion occuring on the buccal mucosa, may be present in people of African descent
  • oral hyperpigmentation- more common among people of African descent
  • Indigenous people and individuals living in remote communities reported worse oral health status and greater frequency of oral pain as compared with non-Indigenous or people living in urban areas
  • For Indigenous people, higher rates of dental disease are also the result of a change from a traditional diet to one higher in processed and sugary foods and the lack of access to fluoridated water
  • recent refugees and immigrants also face obstacles accessing oral health care because of limited financial resources, poor language skills, a fear of dentists, history of inadequate care, embarrassment about their oral condition, and differences in cultural approaches and concepts for oral health care prevention and treatment
  • Individuals from lower income households have a greater prevalence of edentulism, periodontal disease, dental pain, and chewing difficulties
  • people with disabilities may experience challenges in maintaining oral health, preventing disease, and accessing oral health care- barriers include physical and equipment limitations, personal social challenges (fear, anxiety, embarrassment, stigma, or discrimination) and cost
49
Q

Collecting health history on discharge and rationale

A

Questions: Any nasal discharge or runny nose? Continuously? Is the discharge watery, purulent, mucoid, bloody?

Rationale: Rhinorrhea (nasal discharge) occurs with colds, allergies, sinus infection, or trauma

50
Q

Collecting health history on frequent colds (upper respiratory infections) and rationale

A
  • Question 1 : Any unusually frequent or severe colds? How often do these occur?
  • Question 2: Any sinus pain or sinusitis? How is this treated? How did you respond to treatment?
  • Rationale: Most people have occasional colds; asking this more precise question yields more meaningful data
51
Q

Collecting health history on nose trauma and rationale

A
  • Questions: Ever had any trauma or a blow to the nose? Can you breathe through your nose? Is either side obstructed?
  • Rationale: Trauma and cocaine use may cause a deviated septum, which may cause nares to be obstructed
52
Q

Collected health history on epistaxis (nosebleeds) and rationale

A
  • Questions: Any nosebleeds? How often? How much bleeding- a teaspoonful, or does it pour out? Colour of the blood- red or brown? Clots? From one nostril or both? Aggravated by nose picking or scratching?
  • Rationale: Epistaxis occurs with trauma, vigorous nose blowing, foreign body, or cocaine use
53
Q

Collecting health history on allergies and rationale

A
  • Questions: Any allergies or hay fever? To what are you allergic? How was this determined?
  • Rationale: Allergic rhinitis is “seasonal” if caused by pollen and “perennial” if the allergen is dust. Common oral symptoms include sneezing, itchy/runny/blocked nose, and swollen lips and tongue
54
Q

Collecting health history on smell and rationale

A

Question: Any change in sense of smell?

Rationale: Sense of smell diminishes with cigarette smoking, chronic allergies and aging

55
Q

Collecting health history on mouth and throat sores or lesions and rationale

A

Questions: Noticed any sores or lesions in the mouth or on the tongue or gums? How long have you had it?
Ever had this lesion before? Is it single or multiple? Is it associated with stress, season change, food? Is it single or multiple? How have you treated the sore? How did you respond to treatment?

Rationale: The patient’s history helps determine whether oral lesions have infectious, traumatic, immunological or malignant causes

56
Q

Collecting health history on bleeding gums and rationale

A
  • Questions: Any bleeding gums? How long have you had this?
  • Rationale: A little bleeding is normal if a patient is just starting to floss. More frequent bleeding from brushing or flossing indicate periodontal disease or a clotting disorder
57
Q

Collecting health history on bruxism (teeth grinding) and rationale

A
  • Questions: Has a family member or bed partner informed you that you grind your teeth at night? If yes, do you wear a mouthguard when sleeping? Do you have jaw pain or tenderness?
  • Rationale: Teeth grinding occurs when upper and lower teeth are clenched together and then forcefully move in a forward backward motion. Usually caused by dental problems or stress, it happens more frequently at night during sleep. Grinding may result in fractured or flattened teeth, and pain or tenderness in TMJ, face or ear
58
Q

Collecting health history on hoarseness and rationale

A
  • Questions: Any hoarsness, voice change? For how long? Do you feel like you have to clear your throat? Or have a “lump in your throat”? Do you use your voice a lot at work, recreation? Does the hoarseness seem associated with a cold or a sore throat?
  • Rationale: Hoarseness of the larynx has many causes: overuse of the voice, upper respiratory infection, chronic inflammation, lesions or neoplasm, enlarged thyroid gland
59
Q

Collecting health history on swallowing and rationale

A
  • Questions: Any difficulty swallowing? How long have you had it? Do you feel as if food gets stopped at a certain point? Do you cough while drinking or eating? Does your voice sound “wet” or hoarse when you eat or drink? Any drooling or leakage of food or liquid while eating? Pocketing (food get stuck in your mouth/throat)? Any pain with this?
  • Rationale 1: Dysphagia- dificulty in safe transfer of liquid or food bolus from mouth to esophagus, Odynophagia- pain upon swallowing, may be burning or sharp, indicating mucosal inflammation or a cramping, squeezing pain that suggests a muscular cause
60
Q

Collecting health history on smoking and alcohol consumption and rationale (throat and mouth)

A
  • Question 1: Do you smoke? Pipe or cigs? How many packs a day? How many years? Do you currently want to quit smoking? Have you tried quitting?
  • Rationale 1: Chronic tobacco use can lead to tooth loss, coronal and root caries, periodontal disease and oral and pharyngeal cancers
  • Question 2: When was your last alcoholic drink? How much alcohol did you drink that time? How much do you usually drink?
  • Rationale 2: Chronic heavy alcohol consumption increases risk for oral and pharyngeal cancers
61
Q

Collecting health history on tooth development and rationale

A
  • Question 1: Is the child using a bottle? How often during the day? Does the child go to sleep with a bottle at night?
  • Rationale 1: Prolonged bottle use increases the risk for tooth decay and middle ear infections
  • Question 2: Have you noticed any thumb-sucking after the child’s secondary teeth came in?
  • Rationale 2: Prolonged thumb-sucking (after age 6-7 years) may affect occlusion
62
Q

Collecting health history for older adults (mouth) and rationale

A
  • Question 1: Any dryness in the mouth? How do you treat the dryness? Are you taking any medications?
  • Rationale 1: Xerostomia (dry mouth) is an adverse effect of many medications: antidepressants, anticholinergics, antihypertensives, antipsychotics and bronchodilators
  • Question 2: Are you able to care for your own teeth or dentures?
  • Rationale 2: Self-care may be decreased by physical disability (arthritis), vision loss, confusion or depression
63
Q

Inspecting nasal cavity

A
  • attach the short wide-tipped speculum to the otoscope head and insert this combined apparatus into the nasal vestibule, avoiding pressure on the nasal septum
  • gently life up the tip of the nose with your finger before inserting
  • view each nasal cavity with the patient’s head erect and then tilted back
64
Q

Inspecting septum

A
  • observe for deviation- common and only significant if air flow is obstructed
  • not any perforation or bleeding in the septum
  • a deviated septum looks like a hump or shelf in one nasal cavity
65
Q

Palpating sinus areas

A
  • using your thumbs, press over the sinuses below the eyebrows and over the maxillary sinuses below the cheekbones
  • take care not to palpate below the bony orbitals (eye sockets) to avoid pressing the eyeballs
  • the patient should feel firm pressure but no pain
  • sinus areas are tender to palpation with chronic allergies and acute infection (sinusitis)
66
Q

Palpating tongue

A
  • with a glove and a cotton gauze pad for traction, gently pull out the tongue and move it to each side
  • inspect for white patches or lesions; normally, none are present. If any are present, palpate these lesions for firmness or induration (thickening)
  • inspect carefully the entire U-shaped area under the tongue behind the teeth. Oral malignancies are most likely to develop there. Note any white patches, nodules, or ulcerations
  • If lesions are present, or in any patient older than 50 years of age or with a positive history of smoking or alcohol use, use your gloved hand to palpate the area. Place your other hand under the jaw to stabilize the tissue and detect any abnormality
67
Q

Oral cavity: Buccal Mucosa- unexpected findings

A
  • Koplik’s spots: early prodromal (early warning) sign of measles
  • Leukoplakia: a chalky white raised patch
68
Q

Breath- unexpected finding

A
  • Diabetic ketoacidosis produces a sweet, fruity breath odour
  • acetone smell also occurs in children with malnutrition or dehydration
  • ammonia- uraemia
  • musty odour- liver disease
69
Q

Tonsils- expected findings

A
  • oval, rough-surfaced behind the anterior tonsillar pillar
  • colour is the same pink as the oral mucosa
  • surface is peppered with indentations or crypts
  • in some people the crypts collect small plugs of whitish cellular debris- does NOT indicate infection
  • graded in size as follows: 1+: visible, 2+: halfway between tonsillar pillars and uvula, 3+: touching the uvula, 4+: touching each other
70
Q

Tonsils- unexpected findings

A
  • with acute infection, tonsils are bright red and swollen and may have exudates or large white spots
  • tonsils are enlarged to 2+, 3+ or 4+ with an acute infection (3+/4+- chronic tonsilitis)
  • a white membrane covering the tonsils may accompany infectious mononucleosis, leukemia, and diphtheria
71
Q

Testing cranial nerve XII, hypoglossal nerve

A
  • asking the patient to stick out the tongue
  • should protrude in the midline
  • with cranial nerve XII damage, the tongue deviates toward the paralyzed side
  • a fine tremor of the tongue occurs with hyperthyroidism; a coarse tremor, with cerebral palsy and alcoholism
72
Q

Developmental considerations for inspection of mouth: infants and children

A
  • because the oral examination is intrusive for infants or young children, timing is best toward the end of the complete examination, along with the ear examination
  • older infants and toddlers may sit on the parent’s lap, with one of the parent’s hands holding the arms down and the other securing the child’s head against the parent’s chest
  • use a game to help prepare the young child
  • maybe avoid the tongue blade- just ask the child to open the mouth “as big as a lion” and to move tongue in different directions
73
Q

Developmental considerations for inspection of nose: newborns

A
  • no nasal flaring or narrowing with breathing- nasal flaring indicates respiratory distress
  • essential to determine patency of the nares in the immediate newborn period because most newborns are obligate nose breathers
  • palpate the sinus areas in children older than 8, younger children sinus areas are too small
74
Q

Tongue- Ventral: unexpected findings

A

cancer lesions/malignancies most often occur here

NURS 252 (5 decks)

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