Assessment of

Mouth & Oropharynx,

Nose & Sinuses
 STRUCTURES OF THE MOUTH and OROPHARYNX

Oral mucosa

Tongue

TEETH and Gums

LIPS

PROF. JONAHLYN G. CORPUZ,RN,MAN

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 3 pairs of SALIVARY GLANDS

STENSEN’S
duct

The parotid duct, also known as Stensen duct, It

primarily secretes serous saliva that drains into the
oral cavity.

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2 Problems that that Mostly/ Commonly
affects the teeth

1. Dental Caries (Cavities) 2. Periodontal diseases (pyorrhea) or gum

diseases

Both is associated to Plaque and Tartar deposits

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Plaque
Invisible soft film that adheres to the enamel surface of the
teeth; it consists of:
• Bacteria
• Molecules of saliva
• Remnants of epithelial cells
• Leukocytes

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TARTAR
• Is the visible ,hard deposit of plaque and dead bacteria that forms at the
Gums lines
• Its builds up can alter the fibers that is attach to the teeth to the gum and
eventually the bone tissue

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Characteristic of Periodontal disease
Gingivitis

• Red , swollen gingiva

• Bleeding , receding gum lines
• Formation of pockets between the gums and teeth

Advance Periodontal disease

• Teeth are loose
• PUS is evident when gums are pressed

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 Other problems
• GLOSSITIS
• (inflammation of the tongue)

Parotitis
• Inflammation of the Parotid salivary glands
Stomatitis
Inflammation of the oral mucosa
SORDES
The accumulation of foul
matter in the teeth and gums
- Food
- Microorganisms
- Epithelial elements

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 PLANNING:
• PREPARATION:
Equipment:

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ASSESSING the MOUTH and
OROPHARYNX
IMPLEMENTATION:
1. Prior to performance, introduce self and verify the
client’s identity.
To establish rapport
• Explain to the client what you are going to do, why
it’s necessary , and how she or he can cooperate.
Discuss how the results will be used in planning
further care or treatment.

Explain to the patient and family that you will be

looking at his or her mouth and oropharynx and
explain the purpose—to identify potential problems
related to his/her condition which can be used for
further examination and treatment

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IMPLEMENTATION:

• Perform hand hygiene and

observe appropriate infection
control procedures.

• Hand washing is the single, most effective

way for preventing the transmission of
microorganisms and infectious diseases

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IMPLEMENTATION:

3. Provide for client privacy, or

close door./Drape the client if
necessary.

• This ensures client privacy.

• For comfort
• Prevent unnecessary exposure pf body part

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 IMPLEMENTATION:

4.Inquire if the client has any history

of the following :

- Routine pattern of dental care

- Last visits to dentist
- Length of time ulcers or other
lesions present
- Denture discomfort
- Medication the client is receiving

• Position the client comfortably

seated

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Guidelines in collecting information about symptoms:
Character – describe the symptoms
Onset - when did it begin
Location - Where is it?
Duration – How long does it last?
Severity – How bad is it ?Does it bother you?
Pattern – What it makes it better or worse?
Associated factors-/How it affects the patient- what a
other symptoms occur with it? How does it affect
you?

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

LIPS AND BUCCAL Uniform pink color (darker Pallor , cyanosis

MUCOSA Ex: bluish hue , in Blister ; gen. or localized
• Inspect the outer Mediterranean groups and swelling ; fissures , crusts
lips for symmetry dark skinned clients) , or scales may result
of contour, color, Soft , moist , smooth texture from:
and texture. Symmetry of contour • excessive moisture,
Ability to purse lips • nutritional deficiency
• Ask the client to • Fluid deficit
purse lips as if to
whistle • Inability to purse lip
(indicate facial damage)
• Pallor
• leukoplakia (white
patches), red , bleeding

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

7.Inspect and palpate Uniform pink color (freckled Pallor; leukoplakia (white
the inner lips and brown pigmentation in dark- patches), red, bleeding
buccal mucosa for skinned clients)
color , moisture ,
texture , and presence
of lesions Moist smooth, soft glistening, Excessive dryness
• Apply clean gloves and elastic texture (drier oral Mucosal cysts; irritation
• Ask the client to mucosa in older clients due from dentures; abrasions,
relax the mouth to decreased salivation) ulceration ; nodules.
and, for better
visualization, pull
the lip out down
away from the teeth
• Grasp the lip on
each side between
the thumb and
index finger.,

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 ASSESSMENT :
TEETH and GUMS
Inspect the teeth and gums while
examining the inner lips and
buccal mucosa
• Ask the client to open mouth .
using a tongue depressor ,
retract the cheek
• View the surface of the buccal
mucosa from top to bottom
and back to front. A flashlight
or penlight will help illuminate
the surface
• Repeat the procedure for the
other side.
• Examine the back teeth . For
proper vision of the molars,
use the index fingers of both
hands to retract the cheek.
• Ask the client o relax the lip
and first close , then open the
open, the jaw
KOZIER AND ERBS FUNDAMENTAL OF
NORMAL FINDINGS DEVIATIONS FROM NORMAL
32 adult teeth • missing teeth;
Smooth , white , shiny • ill –fitting dentures
tooth enamel • Brown or black
discoloration of the
enamel (may indicate
staining or presence of
Pink gums (bluish or carries)
brown patches in • Excessive red gums
dark-skinned client)
Moist , firm texture to • Spongy , texture ;
gum bleeding; tenderness
(may indicate
No retraction of gums periodontal disease)
(pulling away from the • Receding , atrophied
teeth) gums; swelling that
partially covers the
teeth.
 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

RATIONALE:
Closing the jaw assists in
observation of tooth alignment
and loss of teeth;
Opening of the jaw assists in the
observation of dental fillings and
carries.
Observe the number of teeth,
tooth color, the state of fillings,
dental carries and tartar along the
base of the teeth.
Note the presence and fit of partial
or complete dentures.
• Inspect the gums around the
molars . Observe for bleeding ,
color ,retraction (pulling away
from the teeth)edema, and
lesions.

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

9. Inspect the dentures. Smooth , intact dentures Ill- fitting dentures; irritated
Ask the client to remove and excoriated area under
complete or partial denture
dentures inspect their
condition , noting in
particular broken or
worn areas.

TONGUE/FLOOR of the
MOUTH
10. Inspect the surface Central position
of the tongue for Pink color (some brown
position , color , and pigmentation on the
tongue borders in the
texture
dark-skinned
Ask the client to clients)moist , slightly
protrude tongue rough, thin, whitish
coating .
Smooth, lateral margins;
no lesions
Raised papillae (taste
buds)
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Deviated from center (may
indicate damage to CN 12th)
excessive trembling
Smooth red tongue (may
indicate iron vitB 12 ,or vit. B3
deficiency)
Dry, funny tongue (associated
with fluid deposit) white
coating (maybe oral yeast
infection)
Nodes,ulceration,discoloratio
ns (white,red areas) areas of
 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

11. Inspect tongue Moves freely; no restricted mobility

movement. Ask the
client to roll the tenderness
tongue upward and
move it from side to
side

Swelling ,ulceration
12. Inspect the base of Smooth tongue
the tongue, the mouth, base with
the floor, and the
frenulum. Ask the prominent veins
client to place the tip
of the tongue against
the floor of the mouth.

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

PALATE AND UVULA Light, pink,smooth,soft discoloration (jaundice

13. Inspect the hard and soft palate palate ,pallor)
for color, shape and texture and the
presence of bony prominences.
Lighter pink hard Palates the same color
palate,more irregular Irritations
Ask the client to open the mouth texture Exostoses (bony growths)
wide and tilt the head backward. growing from the hard
Then, depress the tongue with the palate
tongue depressor as necessary ,and
use a penlight for appropriate
visualization

14. Inspect the uvula for position and

mobility while examining the palates .
To observe the uvula , ask the client
to say “ah” so that the plate soft
palate rises.
Deviation to one side from
tumor or trauma;
Positioned in the immobility (may indicate
midline of soft palate damage to 5th CN) and
,rises during 10th CN
vocalization
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 ASSESSMENT :
OROPHARYNX AND
TONSILS
15. Inspect the oropharynx
for color and texture .
Inspect one side at a time to
avoid eliciting the gag
reflex.
To expose one side of the
oropharynx ,press a tongue
depressor against the
tongue on the same side
about halfway back while
the clients tilts the head
back and opens the mouth
wide.
Use a penlight for
illumination (if needed)
16. Inspect the tonsils
(behind the fauces ) for
color,discharge,and size.
NORMAL FINDINGS
Pink and smooth posterior
wall
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DEVIATIONS FROM NORMAL
Reddened or
edematous;presence or
lesions,plaques,or
drainage.
nflamed
Presence of discharge
Swollen
• Grade2 :tonsils are between
the pillarsa and the uvula
• Grade 3- tonsils touch the
uvula
• Grade 4 one or both
tonsils extend to the
midline of the oropharynx
 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Assignment :

Write and review the lifespan considerations of:

1. Assessing mouth and oropharynx
2. Assessing Ear and hearing
3. Assessing Nose and sinuses

KOZIER AND ERBS FUNDAMENTAL OF

PROF. JONAHLYN G. CORPUZ,RN,MAN
KOZIER AND ERBS FUNDAMENTAL OF
 ASSESSING the NOSE and SINUSES
Inspection and palpation
EXTERNAL PART
ASSESSMENT INCLUDES
- Patency of nasal cavities
- Inspection of the nasal
cavities.

Upper 3rd is BONES

cartilage

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Inspection to the nasal passages by:

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Perform the Olfactory Sense

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Inspect and Palpates the face sinuses

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ASSESSING the Ears and
IMPLEMENTATION:Hearing
1. Prior to performance, introduce self and verify the
client’s identity.
To establish rapport
• Explain to the client what you are going to do, why
it’s necessary , and how she or he can cooperate.
Discuss how the results will be used in planning
further care or treatment.

Explain to the patient and family that you will be

looking at his or her entire nose and sinuses
and explain the purpose—to identify potential
problems related to his/her condition which can be
used for further examination and treatment

KOZIER AND ERBS FUNDAMENTAL OF

ASSESSING THE Skull and Face

IMPLEMENTATION:

• Perform hand hygiene and

observe appropriate infection
control procedures.

• Hand washing is the single, most effective

way for preventing the transmission of
microorganisms and infectious diseases

KOZIER AND ERBS FUNDAMENTAL OF

IMPLEMENTATION:

3. Provide for client privacy, or

close door./Drape the client if
necessary.

• This ensures client privacy.

• For comfort
• Prevent unnecessary exposure pf body part

KOZIER AND ERBS FUNDAMENTAL OF

 IMPLEMENTATION:
4. Inquire if the client has any history of the
following :
 Allergies
 DOB through the nose
 Sinus infections
 Injuries to nose or face
 Nosebleeds
 Medication taken
 Changes in the sense of smell.

• Position the client comfortably seated.

KOZIER AND ERBS FUNDAMENTAL OF

Guidelines in collecting information about symptoms:
Character – describe the symptoms
Onset - when did it begin
Location - Where is it?
Duration – How long does it last?
Severity – How bad is it ?Does it bother you?
Pattern – What it makes it better or worse?
Associated factors-/How it affects the patient- what a
other symptoms occur with it? How does it affect
you?

KOZIER AND ERBS FUNDAMENTAL OF

 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Inspect the external • Symmetric and straight • Asymmetric

nose for any deviations • No discharge or flaring • Discharge from nares
in shape , size or color , • Uniform color • Localized areas or
and flaring or discharge redness or presence of
from the nares. skin lesions

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Lightly palpate the • Not tender Tenderness on palpation ,

external nose to • No lesions presence of lesion
determine any areas
of tenderness ,
masses, and
displacement of
bones and cartilages

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Determine the patency • Air move freely as the • Air movement is

of both nasal cavities. client breaths through the restricted in one or both
Ask the client to close nares nares
the mouth , and exert
pressures on one naris
and breathe through the
opposite naris.

Repeat the procedure to

assess the patency of
the opposite naris.

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Inspect the nasal cavities using a

flashlight or nasal speculum:
• Hold the speculum your right
hand to inspect the clients left
nostril and tour left hand to to
inspect the right clients Right
• Tip the client’s head back
• Facing the client, insert the tip
of close speculum (blades
together)about 1 cm (0.4 in) or
up to the point at which the
blade widens
• Care must be taken to avoid
pressure on the sensitive
nasal septum.
• Stabilize the speculum with
your index finger against the
side of the nose. Use the other
hand to position the head and
then hold the light
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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

• Open the speculum as

much as possible and
inspect the floor pf the nose
(vestibule)
- the anterior portion of
septum , the middle
meatus , and the middle
turbinates' . The posterior
turbinate is rarely visualize
because of its position

• Inspect the lining of the

nares and integrity and
position of the nasal
septum

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Observe for the • Mucosa pink • Mucosa red,

presence of redness, • Clear watery discharge edematous
swelling, growths and • No lesions • Abnormal discharge
discharge of the nares (pus)
• Presence of lesion
(polyps)

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

Inspect the nasal septum • Nasal septum intact Septum deviated to the
between the nasal chambers and in midline. right or to the left

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

FACIAL SINUSES • Not tender • Tenderness in one or

• Palpate the maxillary more sinuses
and the frontal
sinuses for
tenderness

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 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

20. Document findings in the

client record using forms or
checklists supplemented by
narrative notes when
appropriate.

EVALUATION:
• Perform a detailed follow up
follow up examination of • Report deviations from expected or normal
other system based on the findings to the primary care provider.
findings that deviated from
expected or normal for the
client.
• Relate findings to the
previous assessment if
available.

KOZIER AND ERBS FUNDAMENTAL OF

 ASSESSMENT : NORMAL FINDINGS DEVIATIONS FROM NORMAL

20. Document findings in the

client record using forms or
checklists supplemented by
narrative notes when
appropriate.

EVALUATION:
• Perform a detailed follow up
follow up examination of • Report deviations from expected or normal
other system based on the findings to the primary care provider.
findings that deviated from
expected or normal for the
client.
• Relate findings to the
previous assessment if
available.

KOZIER AND ERBS FUNDAMENTAL OF