Nose, Mouth, & Throat MUST USE PENLIGHT

Health History Nose & paranasal sinuses Discharge (color, amount, odor, clarity) Frequent colds Sinus pain Trauma Epistaxis Allergies Altered smell

Mouth & Throat Sores or lesions Sore throat Bleeding gums Toothache Hoarseness Altered taste Smoking Self-care behaviors – brushing, flossing, dental visits

Nose Inspect nose for deviations in shape, size, or color Flaring of nostrils Discharge Patency of nostrils Asymmetry of nasal septum is normal (abnormal if airflow is obstructed) Nasal mucosa is usually redder than oral mucosa Kiesselbach’s Triangle – site of most nosebleeds. Most vascular area of nose

Nasal Discharge/Drainage Allergic Rhinitis Clear drainage. Turbinates and M/M will be swollen, Boggy Pale under eyes Cold or Viral Infection White drainage

Sinusitis Copious, purulent drainage, with associated pain and tenderness over affected sinuses Unilateral drainage In children – suspect foreign body Bloody – suspect neoplasm Serosaingous – suspect CSF, head injury. With compression of the jugular vein, if it is CSF, you will see an increase in flow

Nosebleeds/Epistaxis Suspect hypertension, bleeding disorders or dryness of M/M Allergies Check history of nose sprays

Mouth & Oropharynx Inspect lips for symmetry, color, edema, or surface abnormalities Ask client to open and close mouth, palpate TMJ Oral mucosa is normally light pink and moist Inspect palate Inspect tonsils Inspect the buccal mucosa

Grading Tonsils 1+ Visible 2+ Halfway between tonsilar pillars and uvula 3+ Touching the uvula, Common in 4-9 year olds 4+ Touching each other

Tongue, Teeth, & Gums Assess for swelling, color, coating, or ulceration Test hypoglossal nerve – stick out tongue Inspect floor of mouth Inspect teeth for decay, missing teeth, and malocclusions Inspect gums for signs of inflammation and hemorrhage Assess CN IX and X (Glossopharyngeal and Vagal) Ahh, Uvula should move upward and midline Assess for mouth odors

Teeth Note number Note color – pearly white to yellow 20 Deciduous 32 Permanent Note color – pearly white to yellow Presence of plaque, tartar, cavities (brown spots) Eruption Deciduous - begins at 5-9 mos. Complete by 2 ½ years Permanent - begins at 6 years