Assessment of Nose and sinuses

Assessment of Nose and sinuses

Equipment's required:

·         flashlight

·         nasal speculum

·         penlight

·         gloves

Assessment of the nose includes inspection and palpation of the external nose.

·         Patency  of the nasal cavities.

·         Inspect the external nose for any deviations in shape, size, or colour and flaring or discharge from the nares.

·         Lightly palpate the external nose to determine any areas of tenderness, masses, and displacements of bone and cartilage.

·         Determine patency of both nasal cavities.--Ask the client to close the mouth, exert pressure on one naris, and breathe through the opposite naris.  Inspect the nasal cavities using a flashlight or a nasal speculum.

·         Hold the speculum in your right hand to inspect the client's left nostril and your left hand to inspect the client's right nostril. Tip the client's head back. Facing the client, insert the tip of the closed speculum (blades together) about 1 cm or up to the point at which the blade widens. Stabilize the speculum with index finger against the side of the nose. Use the other hand to position the head and then to hold the light. Open the speculum as much as possible and inspect the floor of the nose (vestibule), the anterior portion of the septum, the middle meatus, and the middle turbinates.

·         Inspect the lining of the nares and the integrity and the position of the nasal septum. Observe for the presence of redness, swelling, growths, and discharge. Inspect the nasal septum between the nasal chambers

Abnormal:

In rhinitis nasal mucosa is swollen

Bright red with an 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 gray.

A deviated septum looks like a hump or shelf in one nasal cavity.

Perforation is seen as a spot of light from penlight shining in other naris and occurs with cocaine use.

Facial Sinuses

Palpate the maxillary and frontal sinuses for tenderness.

Palpate frontal sinus by exerting pressure with thumb up and under patient’s eyebrow. Document findings in the client

ASSESSMENT OF MOUTH AND OROPHARYNX

It composed of lips, inner and buccal mucosa, the tongue and the floor of the mouth, teeth and gums, hard and soft palate, uvula, salivary glands, tonsillar pillars and tonsils.

Dental carries and periodontal disease (pyorrhoea)- the two problems that most frequently affect  the teeth.

Plaque is an invisible soft film that adheres to the enamel surface of teeth; it consists of bacteria, molecules of saliva, and remnants of epithelial cells and leukocytes.

Tartar is a visible, hard deposit of plaque and dead bacteria that forms at the gum lines.

Peridontal disease is characterzied by Gingivitis.It is a red swollen gingiva,(i.e. gum), bleeding, receding gum lines, and the formation of pockets between the teeth and gums.

Glossitis -inflammation of the tongue.

Stomatitis: inflammationof the oral mucosa.

Parotitis: inflammation of the parotid salivary gland.

Sordes:accumulation of foul matter (food, microorganisms, and epithelial elements) on the teeth and gums.

Assessment of lips and buccal mucosa. Inspect the outer lips for symmetry of contour,colour and texture. Ask the client to purse the lips as if to whistle.	Uniform pink color.(darker,e.g., bluish hue) Cherry coloured lips- in carbon monoxide poisoning Soft, moist, smooth texture.
Inspect and palpate the inner lips and buccal mucosa for color, moisture, and the presence of lesions	Uniform pink color. Moist, smooth, soft, glistening, and elastic texture.

Buccal mucosa

Ask patient to open mouth, gently retract cheeks with tongue depressor. View from right to left, top to bottom. Jaundice can be assessed

Leukoplakia (white patches) – seen in smokers, alcoholics

Palpate any buccal lesion by placing index finger within buccal cavity and thumb on outer surface of cheek

Assessment of teeth and gums:

Inspect the teeth and gums while examining the inner lips and buccal mucosa. Inspect the dentures. Ask the client to remove partial dentures.	32 adult teeth. Smooth, white, shiny tooth enamel. Smooth intact dentures.
Assessment of tongue/floor of the mouth: Inspect the surface of tongue for position color, and texture. Ask the client to protrude the tongue.	Central position Pink color; moist; slightly rough.
Inspect the tongue movement. Ask the client to roll  the tongue Upward and move it from side to side.	Moves freely; no tenderness
Inspect the base of the tongue, the mouth floor and the frenulum. Ask the client to place the tip of the tongue against the roof of the mouth.	Smooth tongue base with prominent veins.
Palpate the tongue and floor of the mouth for any nodules, lumps or excoriated areas. To palpate the tongue, use a piece of gauze to grasp its tip and with the index finger of your other hand, palpate the back of the tongue.	Smooth tongue base with prominent veins.

Salivary Glands
Inspect salivary duct openings for any swelling or redness.

Palates and Uvula

·         Inspect the hard and soft palate for color, shape, texture, and the presence of bony prominences.

·         Ask the client to open the mouth wide and tilt the head backward. Then, depress tongue with a tongue depressor, use a penlight for appropriate visualization.

·         Inspect the uvula for position and mobility-Positioned in midline of soft palate. To observe the uvula, ask the client to say ah" so that the soft palate rises.

Oropharynx and Tonsils

·         Inspect the oropharynx for color and texture.

·         Press a tongue depressor against the tongue on the same side about halfway back while the client tilts the head back and opens the mouth wide.

·         Inspect the tonsils for color, discharge, and size.

·         Elicit the gag reflex by pressing the posterior tongue with a tongue depressor.

Abnormal

In acute infection, tonsils are bright red, swollen and may have exudates or large white spots. A white membrane covering the tonsils may accompany infectious mononucleosis, leukaemia and diphtheria.

 Diabetic ketoacidosis has a sweet fruity breath odour.

An ammonia breath odour with uraemia

A musty odour with liver disease

A foul, fetid odour with dental or respiratory infections

Mouse like smell of breath with diphtheria.

Grading of tonsilitis

 1+  Visible.

2+  Halfway between   tonsilar  pillars and uvula.

3+  touching the uvula.

4+touching each other.