HEALTH ASSESSMENT SKILLS LECTURE-MIDTERMS
MOUTH AND THROAT
Content
- Breathe, lips, tongue, gums, teeth, palates, throat
- dentures shkuld be removed before examination begins
- use clean gloves
ASSESSMENT OF THE MOUTH
- stand facing the client about 12 inches away & smell
the breath
    Normal: breath should smell fresh
    Abnormal :the breath smells foul (halitosis)
    : the breath smells  like acetone (fruity breath)
    : the breath smells like amonia ( end stage renal
failure)
Lips- inspection
- observe lips for color, moisture, swelling, lesions.
Instruct to open mouth, use tongue blade
    Normal: lips should ve pink and moist with no lesions
or inflammation
    Abnormal: lips are pale, cyanotic, dry, cracked,
swollen, inflammation of mouth corners, herpes simplex
lesions, chancre, wart, nodule. Etc.  - observe for color, inflammation, hydration & lesions
Lip palpation
- don gloves, gently pull down lower and upper lips with
thumb and index fingers, note tone of lips, palpate lesion
for consistency & tenderness
    Normal: lips should not be flaccid and lesions should
not be present
Tongue
- ask to stick out tongue (CN XII hypoglossal assessess
tongue movement)  3. Pale mucosa - may result from anemia or possibly
- observe dorsal surface for color, hydration, texture,
symmetry, atrophy, fasciculation, position in mouth,
presence of lesions  back of soft palate
-ask to move tongue from side to side and up and down  5. Xerostomia- excessive dryness of mucosa or
- with tongue back in mouth, ask to press against cheeks.
Provide resistance with you finger pads held on outside
of cheek. Note strength of tongue and compare
bilaterally  -ask to open mouth
- ask to touch tip of the tongue to the roof of the mouth.
You may also grasp the tip of the tongue with a gauze
square held between the thumb and the index finger of
the gloved hand
- with a gauze square, pull tongue to the left & inspect
and palpate tongue using finger pads
    Normal: tongue is in midline of the mouth, dorsum of
tongue is pink, moist, rough (from taste buds), without
lesions
    : tongue is symmetrical and moves freely, strength is
symmetrical and strong 
    : lateral aspect of tongue is pink, smooth and lesion
free
    Abnormal: tongue is enlarged, red, smooth with
absent papillae, thick,  white coating (thrush) 
> Conditions 
1. Enlarged tongue- maybe associated with myxedema,
acromegaly, down syndrome
2. Glossitis - tongue is red and smooth with absence of
papillae
3. Candidiasis- thick, white, curdlike coating on tongue.
Also called oral thrush. (fungal infection or due to
medication) 
4. Leukoplakia- thin, pearly white lesions that coalesce
and become thick and palpable
5. Apthous ulcer - painful, round, white ulcerated lesion
with erythematous boarders
6. Deviated tongue- deviation of tongue to one side due
to unilateral paralysis of tongue muscles 
Buccal mucosa
- ask to open mouth as wide as possible
- use a tongue depressor & penlight to assess the inner
cheeks & the openings of stensen's ducts
    Normal: color may vary according to race, African
Americans has bluish hue, Caucasian has pink 
    : should be moist, smooth & free of lesions
    : freckle-like macules may appear on inside of buccal
mucosa. 
> conditions
1. Leukoplakia - leathery, painless white painted-looking
patches 
2. Apthous ulcer- small, round white ulcers
hypoxemia
4. Stomatitis- mucosa is reddish. Usually occurs at the
decreased activity of salivary gland 
Gums
- observe for dentures or orthodontics for fit
- Remove any dentures or removable orthodontia
- Shine penlight in the mouth 
- use tongue depressor to move tongue to visualize gums
-observe for redness, bleeding, swelling, etc. 
    Normal: light skinned- gums are pale red stippled
surface. Dark skinned- patchy brown pigmentation 
    - gum margins should be well defined with no pockets
existing between the gums and the teeth and no swelling
or bleeding
> conditions      Normal: uvula is midline, throat is pink, without
1. Gingivitis- gingiva are red tender swollen and bleed swelling exudates or lesions
easily     : normal tonsils is evaluated as 1+ or 2+. This
2. Peridontitis- ginigival borders are red and infection of indicates that the both tonsils are behind the pillars
pockets formed between receding gums and teeth.     : patients gag reflex should be present but is
Purulent drainage may be present.  congenitally absent to some clients
3. Addison's disease- gums are brownish > conditions:
1. 0
Teeth 2. Chronic 3+ or 4+ tonsils- may lead to loud snoring
- ask to open mouth and obstructive sleep apnea
- count the upper and lower teeth
- observe the teeth for discoloration, loose or missing
teeth, carries, malocclusion, and malformation
    Normal: adult normallh has 32 teeth, white with
smooth edges in proper alignment & without carries 
> conditions
1. Absent- teeth are absent due to loss or failure of
development
2. Dental carries- white or black patches on the surface
of the tooth, may become eroded as damage progresses
3. Dead tooth- tooth is dark in color and the client
reports insensitivity to cold
4. Hutchinson's inscisors- teeth that have serrated edges

Palate
-ask to tilt head back & open mouth as wide as possible 
- shine the pen light in the patient's mouth
- observe both the hard & soft palate
- note shape and color & presence of lesions or
malformation
    Normal: hard and soft palates are concave and pink.
Hard palate has many ridges and soft palate is smooth
> conditions:
1. Infection- red swollen, tender or with lesions 
2. Torus platinus- there is bony ridge in the midline of
hard palate, benign conditon, develops in adulthood 
3.  Turner's syndrome or marfan syndrome-  the palate is
highly arched
4. Palatine perforation- there is a hole in the hard palate

ASSESSMENT OF THE THROAT

- ask to tilt head back and open mouth as wide as
possible
- with right hand, place tongue blade on the middle third
of tongue
- with the left hand, shine a light at the back of the
patients throat, ask to say "AH" 
- observe the position, size, color & general appearance
of tonsils & uvula
Throat
- touch the posterior third of the tongue with tongue
blade
-note movement of the palate and the presence of  gag
reflex 
- assess the color of the nasophraynx , note for the
presence of swelling, exudates or lesions