Nose, Mouth, Throat Nose Divided by septum Olfactory receptors (CN 1) Hair cells (cilia) Sinuses : air-filled pockets Using thumbs, press frontal sinuses by pressing up and under the eyebrows and over maxillary sinuses below cheekbones. Transillumination You may use this technique when you suspect sinus inflammation, although it is of limited usefulness. Darken room; affix strong narrow light to end of otoscope and hold it deep under superior orbital ridge against location of frontal sinus area; cover with your hand. A diffuse red glow is a normal response; it comes from light shining through air in the healthy sinus. Lighten weight of skull bone, resonate sounds, provide mucus When inflamed results in sinusitis Nose PQRST Discharge Rhinorrhea: runny nose Clear, yellow, green, bloody? Frequent URI’s Sinus pain Trauma Epistaxis Nose bleed Allergies Altered smell Nose: Objective Data Inspect symmetry, deformity, proportion, inflammation, sin lesions Palpate if necessary Assess patency of nostrils Assess CN 1 (sense of smell) Palpate sinuses Nose Abnormalities Nasal Polyps Smooth, pale grey, avascular, mobile, non-tender Deviated septum Looks like a hump in nasal cavity Perforated septum Hole in the septum Cocaine, chronic infection Sinusitis Acute, infected, inflamed sinus Typically following upper respiratory infection Eptaxisis Nose bleed Forceful coughing/sneezing, nose picking Allergic Rhinitis(Hay Fever) Abnormal immune response to antigens Rhinorrhea Itching of eyes and nose Lacrimation(watery eyes) Nasal congestion, sneezing Allergic shiners Dark circle around the eyes Nasal crease Horizontal crease across the lower bridge of nose Caused by the repeated upward rubbing of the tip of the nose with the palm of the hand, known as the Allergic Salute Throat AKA Pharynx Observe tonsils: Color, moisture, are there crypts or exudate Abnormal: Tonsillitis Bright, red, swollen, white or yellow exudate on tonsils, and pharynx. Tonsil grading +1 visible +2 Halfway between tonsillar pillars and uvula 3+ Touching the uvula +4 Touching one another Depress tongue with blade: Gag reflex CN IX & X Can stick out tongue and move side to side, coordinated speech? CN XII Breath Oropharynx/Throat abnormalities Bifid uvula Looks partly severed May indicate cleft palate May effect speech Peritonsillar abscess Occurs for untreated strep infection Pus filled pocket May require drainaige Pharyngitis Inflammation of the pharynx Sore throat Cleft Palate Congenital defect Failure of fusion of the maxillary process Environmental factors Lack of folic acid in or before pregnancy The Aging Adult Nose may appear prominent Teeth may be slightly yellow Gum margins may be receded Dental deterioration/ loss of teeth Diminished taste Decreased salivation Trouble with mastication Culture and genetics Bifid Uvulua: American indians Cleft lip/palate: Asians, whites and least in Blacks Dental caries: Low socioeconomic status Lack of access to healthcare Periodontal disease: Type 2 DM Oral cancer: HPV, tobacco use Mouth Abnormalities Cleft lip Maxillaryfacial cleft common with congenital deformities Family history, drug use, alcohol Herpes Simplex (HSV 1) Virus Common cold sore Clear vesicles, evolve to pustules, and crust Highly contagious Precipitated by infection, cold, allergies, sunlight Ginigvitis Gum margins red and swollen Bleed easily Diabetes, pregnancy, poor oral hygiene Gingival hyperplasia Painless enlargement of the gums Puberty, pregnancy, leukemia Ulcers Canker sores Painful Last 1-2 weeks Candidiasis White, cheesy, curd, like Thrush An opportunist infection more common in immunocompromised such as HIV Ankyloglossia Short lingual frenulum Tongue tie Effects speech, and limits mobility Black hairy tongue Overgrowth of mycelial threads from fungus infection Can occur after use of antibiotics Heavy smoking may be a contributing factor Carcinoma Ulcer with rolled edges Indurated (hard) Risk for metastasis Tabaco and alcohol use increase risk Mouth: Objective Data Inspection: Lips for color, moisture, cracking, lesions Teeth and gums: missing teeth and gum health is indicative of general health Tongue: color, surface, moisture, not patches/lesions Uvula: midline and moves (CN 10) Mouth: PQRST Sores/Lesions Sore throat Bleeding gums Toothache Hoarseness Dysphagia Altered taste Smoking/alcohol use PCC: dental care and Mouth
