ASSESSMENT OF

NOSE
MOUTH & THROAT
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 Objective
s Unit, learners will be able to:
By the end of the
1. Describe the component of health
history that should be elicited during the
assessment of nose, mouth and pharynx.
2. Identify the structural landmarks of the
nose, mouth and pharynx.
3. Describe specif ic assessments to be
made during the physical examination
2
of the above systems.
4. Document findings.
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 Equipment
Gloves
4X4 inch gauze pad
Penlight
 Short, wide- tipped speculum
attached to the head of an otoscope
Tounge depressor
Nasal Speculum
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Examination of Face:
• Proportion/Contour ( Nose Midline)

• Cranial Nerves : Cranial Nerve 5

Trigeminal
Sensory, Carries Sensory Impulses
of pain, touch and temperature
from the face to the brain
Motor, Inf luences Clenching and
4
lateral jaw movements( bitting,
chewing)
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 Examination of
•Face
Cranial Nerve 7:
Sensory: Contains sensory f ibers for
taste on anterior 2/3rd of tongue and
stimulate secretion of salivary glands
and tears from lacrimal glands
Motor: Supplies the facial muscles and
facial expressions
• Lymph Nodes 5
• Edema/Lesions/Masses.
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 •ASSESSMENT
OF
NOSE:
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 History
Nose and Sinuses
• Nasal discharge or postnasal
drip
• Epistaxis
• Obstruction of airf low
• Sinus pain and localized
headache
• Itching
• Anosmia (cranial nerve 1) 7

• Nasal trauma
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• Sneezing
• Watery eyes
 History
• Do you experience tongue or mouth sores or lesions? Are they
painful? How long have you had them? Do they recur? Is it single
or do you have many?
• Do you experience redness, swelling, bleeding, or pain of the
gums or mouth? How long has this been happening? Do you
have any toothache? Have you lost any permanent teeth?
Throat
• Do you have dif ficulty chewing or swallowing food? How long
have you had this? Do you have any pain?
• Do you have a sore throat? How long have you had it? Describe.
• How often do you get sore throats?
• Do you experience hoarseness? How long?
• Have you ever had any oral, nasal, or sinus surgery?
• Do you have a history of sinus infections? Describe your
symptoms. 8
• Do you use nasal sprays? (What type? How much? How
• often?)
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9
 The external portion of the nose is
inspected for the following:
1. Placement and symmetry.
2. Patency of nares (done by
occluding nosetril one at a time,
and noting for dif ficulty in
breathing)
3. Flaring at alae nasi
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4. Discharge
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 The external nares
are palpated for:
1. Displacement of
bone and cartilage.

2. For tenderness
and masses

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 • The internal nares are inspected
by hyperextending the neck of the
client
Inspect for the following:

1. Position of the septum.

2.
3. Check septum
The nasal for perforation
mucosa (turbinates) for
swelling, exudates and change in
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color.
Paranasal Sinuses
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 Turbinate
Provide
largest
surface area
for
• Temperat
ure control
• Purif ication

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4
1
 Paranasal
Sinuses
• Only frontal and maxillary sinuses are
accessible for examination.
• By palpating both cheeks
simultaneously, one can determine
tenderness of the maxillary sinusitis.
• Pressing the thumb just below the
eyebrows, we can determine
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tenderness of the frontal sinuses.
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 Transillumination

1
6
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 Normal
1. Nose in the midline
Findings:
2. No Discharges.
3. No f laring alae nasi.
4. Both nares are patent.
5. No bone and cartilage deviation noted on
palpation.
6. No tenderness noted on palpation.
7. Nasal septum in the mid line and not
perforated.
8. The nasal mucosa is pinkish to red in color.
(Increased redness turbinates are typical of
allergy). 17

9. No tenderness noted on palpation of the

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paranasal sinuses.
 ASSESSMENT
OF MOUTH:

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 h
11/28/2024 Mout 19
9
1
 Ducts of
the
Salivery
Glands
Parotid:
Stenson
Sublingual
and
submandib
ul ar :
Wharton
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Parts Normal f indings Abnormal f indings
Lips symmetrical, asymmetrical, cyanotic,
pink, smooth and cherry red, Reddish lips are
moist. seen in clients with
ketoacidosis, carbon 17
20
/
monoxide poisoning, and 25/10
COPD with polycythemia.
Swelling of the lips (edema) is
common in local or systemic
allergic or anaphylactic
reactions, pale or dry.

2
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1
Parts Normal findings Abnormal findings
Teeth clean with no decay, Clients who smoke, drink large
appear white and quantities of coffee or tea or have an
shiny enamel with excessive intake of f luoride may have
smooth surfaces and yellow or brownish teeth. Tooth decay
edges. (caries) may appear as brown dots or 17 20
/
25
cover more extensive areas of chewing/10
surfaces.
Missing teeth can affect chewing
as well as self-image. A chalky white
area in the tooth surface is a cavity that
will turn darker with time.
Malocclusion of teeth is seen when
upper or lower incisors protrude. Poor
occlusion of teeth can affect chewing,
wearing down of teeth, speech, and self-
image. White spots on teeth may result 2
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from antibiotic therapy. 2
Part Normal findings Abnormal findings
s
Gums symmetrical, Receding gums are abnormal in
moist, pink with younger clients; in elderly clients,
tight well def ined the teeth may appear longer
because of
margins.
age-related gingival recession, 17 20
/
which is common. 25
/
10
Red, swollen gums that bleed easily
are seen in gingivitis, scurvy
(vitamin C deficiency), and
leukemia. Receding red gums with
loss of teeth are seen in
periodontitis. Enlarged reddened
gums (hyperplasia) that may cover
some of the normally exposed
11/28/2024 teeth may be seen in pregnancy, 23
2
3
puberty, leukemia, and use of some
medications, such as phenytoin.A
bluish-black or grey-white line
along the gum line is seen in lead
poisoning
Parts Normal Abnormal findings
findings
Buccal Pink , smooth Leukoplakia is a precancerous
Mucosa and moist. lesion, and the client should be
referred for evaluation. Whitish, 17
20
/
curdlike patches that scrape off 25
/
10
over reddened mucosa
and bleed easily indicate “thrush”
(Candida albicans) infection.
Koplik’s spots (tiny whitish spots
that lie over reddened mucosa)
are an early sign of the measles.
Canker sores may be seen
2
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4
cheeks of clients with
adrenocortical insuf ficiency.
Part Normal Abnormal
s Finding Findings
Tongu s
Pink, moist Among possible abnormalities are
e with a deep longitudinal f issures seen in
slightly dehydration; a black tongue
indicative of bismuth toxicity:
rough
black, hairy tongue; a smooth,
surface reddish, shiny tongue without
from the papillae indicative of niacin or
papillae. vitamin B12 def iciencies, certain
anemias, and antineoplastic
therapy. An enlarged tongue
suggests hypothyroidism,
acromegaly, or Down’s syndrome,
and angioneurotic edema of 2
5
anaphylaxis. A very small tongue
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suggests malnutrition.
An atrophied tongue or
fasciculations point to cranial
nerve (hypoglossal,
Parts Normal Abnormal Findings
Findings
Check the strength of The tongue Decreased tongue strength may
the tongue. Place your offers occur with a defect of the twelfth
fingers on the external strong cranial nerve hypoglossal or with a
surface of resistance. shortened frenulum that limits
the client’s cheek. Ask motion.
the client to press the
tongue’s tip against
the inside of
the cheek to resist
pressure from your
fingers.
Repeat on the
2
opposite cheek. 6
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Parts Normal Abnormal Findings
Findings
Check the anterior The client Loss of taste
tongue’s ability to can discrimination occurs with
taste by placing distinguish zinc def iciency, a
drops of sugar and between seventh cranial nerve
salty sweet and (facial) defect, and certain
water on the tip salty. medication
and sides of use.
tongue with
a tongue depressor

2
7
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Part Normal Abnormal
s
Hard Findingsin color
Whitish Findings
Yellow or extreme
palat with a f irm pallor.
e texture and
irregular
Light pink,rugae. Uvula deviates from
Soft palate transverse
smooth and the
midline, asymmetrical rise
upwardly of
the soft palate and/or
movable. uvula
and reddening of the
soft palate and/or
Tonsil Pink, Bright red and
uvula.
s symmetrical enlarged
tonsils or presence of
and normal white
or yellow
28 tonsillar
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sized. exudate.
Part Normal Abnormal
s Finding Findings
Inspect the posterior Throat
s is A bright red throat
pharyngeal wall. normally pink with white or
Keeping the tongue without
yellow exudate
pharyngitis.
17

depressor in place, exudate indicates 20

/
25

shine the penlight on or mucus on throat

Yellowish /
10

lesions. be
mayseen with
the back of the sinus
postnasal
throat. Observe the drainage.
color of the throat,
and note any
exudate or lesions.
Before inspecting
the11/28/2024
nose, discard 29
2
9
gloves and
perform hand
hygiene.
TONSILLITI
STonsillitis is an inf lammation of the tonsils
most commonly caused by viral or bacterial
infection. Symptoms of tonsillitis include
sore throat and fever.

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 Tonsillitis
Gradin
g

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 MOUTH
Mouth cancer refers to cancer that develops in any of the parts
thatCARCINOMA:
make up the mouth. Mouth cancer can occur on the lips,
gums, tongue, inside lining of the cheeks, and the roof and f loor
of the mouth.
Symptoms
Signs and symptoms of mouth cancer may include:
■ A sore that doesn't heal
■ A lump or thickening of the skin or lining of your mouth
■ A white or reddish patch on the inside of your mouth
■ Tongue pain
■ Jaw pain or stiffness

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 CLEFT PALATE AND CLEFT
LIP:
• Cleft lip and cleft palate are birth defects that
affect the upper lip and roof of the mouth. This
can affect the way the child's face looks. It can
also lead to problems with eating, talking and
infections.

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4
3
 HERPES
SIMPLEX
Herpes is an infection that is caused by a herpes
simplex virus (HSV). Oral herpes causes cold
sores around the mouth or face. Some people
have no symptoms. Others get sores near the
area where the virus has entered the body. They
turn into blisters, become itchy and painful, and
then heal.

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 GINGIVITI
S form of periodontal (gum)
Gingivitis is the mildest
disease. Gingivitis is often caused by inadequate
oral hygiene, which leads to plaque buildup.

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 CANDIDIASI
Candidiasis is an fungal infection Signs and
Symptoms: S
• •Creamy white patches in the mouth or on the throat
(oral thrush)
• •Painful cracks at the corners of the mouth (oral
thrush)

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 MOUTH
ULCERS
A mouth ulcer is an open sore inside the
mouth, or rarely a break in the mucous
membrane or the epithelium on the lips or
surrounding the mouth.

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 Thank
you
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 Reference
Bicklay, L. S. (2012). Bates’ guide to physical examination
and history takings (10 ed). Wolters Kluwer/Lippincott
th
Williams & Wilkins Health.
Carol, L.Cox (2010). Physical Assessment for Nurses (2nd.
Ed) Blackwell Publishing Ltd.
Chiocca, E. M. (2011). Advanced pediatric assessment.
Phildelphia, U.S: Wolters Kluwer Health/Lippincott
Williams & Wilkins.
Weber, J., & Kelley, J. H. (2015). Health Assessment in
Nursing
(5th ed). Phildelphia: Lippioncot.

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