Chapter 15—Nose, Sinuses, Mouth, and Throat

Structure and Function Nose: entry point of air; sense of smell Structure Nerve and blood supply Lymph drainage Sinuses: lighten weight of cranium; provide timbre, resonance to voice; produce mucus Major factors r/t normal function Sinus ostia patency; expected ciliary function; expected mucus quality/quantity Adenoids

Structure and Function—(cont.) Mouth: sense of taste; chewing; speech articulation Roof: contains hard, soft palates Hard and soft palates Floor of the mouth is highly vascular. Facilitates rapid absorption of sublingual medications Tongue: manipulates food during mastication; involved in sense of taste; speech production Taste buds (vallate papillae) One of the body’s most vascular muscles

Structure and Function—(cont.) Salivary glands: three drainage ducts within mouth Parotid; submandibular; sublingual Saliva: protects oral mucosa; transmits taste data; rinses oral cavity  maintain pH; provides lubrication Teeth, gums: food mastication Three layers: crown, neck, and root 32 permanent teeth; periodontium Throat (Oropharynx): common respiratory/digestive channel Tonsils/adenoids: immunological defense

Lifespan Considerations: Older Adults Age-related conditions Gustatory rhinitis: runny nose from smelling/tasting food Decreased: olfactory sensory fibers; saliva production; number of taste buds Cultural and environmental considerations Gingivitis: inflammation, bleeding of gums Cleft lip, palate; bifid uvula Oral and pharyngeal cancers Sleep-disordered breathing

Question In the clinic within an adult assisted-living complex, a 68- year-old retired detective reports his mouth is continually dry. This is problematic for him. What are the functions of saliva? A. Provides lubrication B. Protects oral mucosa C. Rinses oral cavity D. All of the above

Answer Rationale: Saliva begins the digestive process by releasing enzymes upon contact with food. Saliva protects the oral mucosa from heat, chemicals, and irritants. Saliva also transmits taste information, rinses the oral cavity to maintain pH, and provides lubrication for the movement of food.

Urgent Assessment Ludwig angina: edema pushing tongue up and back  airway obstruction Infection of the mouth floor Aspiration Abrupt loss of smell

Subjective Data Assessment of risk factors Personal history Medications, supplements Family history Risk factors Dental health Psychosocial history Environmental exposure

Risk Assessment and Health Promotion Health goals Risk factors Tobacco use Sleep disorders Cancer Oral health Hereditary hemorrhagic telangiectasia: chronic nosebleeds Prevention strategies

Common Symptoms Facial pressure, pain, headache Snoring, sleep apnea; obstructive breathing Nasal congestion; epistaxis Halitosis; anosmia Cough; pharyngitis Dysphagia; dental pain Voice changes; oral lesions Lifespan considerations: older adults Cultural considerations

Objective Data Collection Common specialty or advanced techniques Inspection; equipment Comprehensive physical assessment External nose: inspection; palpation Internal nose: inspection Sinuses: inspection; palpation, percussion Mouth: external, internal inspection; palpation Throat: inspection; palpation Swallowing evaluation

Lifespan Considerations: Older Adults Edentulous: toothless Teeth Discoloration; teeth loosening Gums: receding Tongue Smooth, shiny appearance Fissures Cultural considerations

Critical Thinking Common laboratory and diagnostic testing Lab studies; diagnostic testing; radiographs Biopsy; sleep studies Diagnostic reasoning Nursing diagnoses, outcomes, and interventions Outcomes (partial listing) Oral mucous membranes are pink, intact. Patient swallows with evidence of aspiration. Patient reports breathing is more comfortable.

Critical Thinking—(cont.) Diagnostic reasoning—(cont.) Nursing diagnoses, outcomes, and interventions—(cont.) Interventions (partial listing) Provide oral hygiene every 8 hours. Consult with speech pathologist to evaluate swallowing. Encourage fluid increase to 2 L daily to liquefy secretions.

NCLEX-Style Review Questions Which of the following is part of the upper gastrointestinal tract? Nasal septum Sinuses Throat Adenoids

NCLEX-Style Review Questions The nurse is assessing the nares to evaluate the site of epistaxis. The most common site of bleeding is which of the following? Ostiomeatal complex Nasal septum Kiesselbach plexus Woodruff plexus

NCLEX-Style Review Questions The nurse knows that the floor of the mouth is highly vascular and therefore a good location for which of the following? Absorption of sublingual medications Identification of malignancy in the pharyngeal fossa Infection with streptococcus Aspiration, even if the gag reflex is present

NCLEX-Style Review Questions Acute airway obstruction is a situation that should be reassessed during the next visit. evaluated within 8 hours. further assessed thoroughly. quickly assessed and treated.

NCLEX-Style Review Questions Risk factors for nose, sinus, mouth, and throat problems include topical decongestant use, smoking, and allergies. smoking, allergies, and high blood cholesterol. allergies, high blood cholesterol, and topical decongestant use. high blood cholesterol, topical decongestant use, and smoking

NCLEX-Style Review Questions The nurse has assessed the nose and documents expected findings as nose asymmetrical with clear drainage nose symmetrical and midline nose asymmetrical and proportional to facial features nose symmetrical with yellow drainage

NCLEX-Style Review Questions The nurse is assessing a patient who has been taking antibiotics for 10 days. Oral assessment is important because of the increased risk for which of the following? Fordyce granules Pharyngitis Anosmia C. albicans

NCLEX-Style Review Questions An adolescent male presents with complaints of nosebleeds. The nurse would further assess for hemangioma. nasal trauma. angiofibroma. cystic fibrosis

NCLEX-Style Review Questions The nurse assesses the child with purulent, unilateral nasal discharge. The nurse knows that the most likely causative factor is allergic rhinitis. choanal atresia. foreign body in nose. cystic fibrosis

NCLEX-Style Review Questions During a routine physical examination of a 20-year-old woman, the nurse notes a septal perforation. This finding may be significant for which of the following causes? Illicit drug use Nose picking Nasal trauma Bifid uvula