Superior labial ‘Superior lip frenulum Gingiva (gums) Hard palate Anterior pillar Soft palate Inferior pillar Cheek Palatine tonsil Uvula Posterior pharyngeal wall Tongue Lingual frenulum Inferior labial frenulum Opening of duct of submaridibular gland Inferior lip (pulled down) Gingiva (gums) FIGURE 18-1 Structures of the mouth NOSE ‘The nose consists of an external portion covered with skin and an internal nasal cavity. It is composed of bone and cartilage, and is lined with mucous membrane. The external nose consists of a bridge (upper portion), tip, and two oval openings called nares. The nasal cavity is located between the roof of the mouth and the cranium. It extends from the anterior nares (nostrils) to the posterior nares, which open into the nasopharynx. The nasal septum separates the cavity into two halves. The front of the nasal septum contains a rich supply of blood vessels and is known as Kiesselbach’s area. This is a common site for nasal bleeding Central incisor (7-8 yr.) Lateral incisor (8-9 yr.) Cuspid or canine (11-12 yr.)The sternum, or Dreastbone, les in the center of the chestante- of ribs articulates wil riorly and is divided into three parts: the manubrium, the nous process of the body, and the xiphoid process. The manubrium connects lat- the vertebra prominens, erally with the clavicles (collarbones) and the first two pairs flexed. The process im of ribs, The clavicles extend from the manubrium to the acro-_nens is the first thorac mion of the scapula, terior aspect of the fir 70 UNIT 3.» +» NURSING ASSESSMENT OF PHYSICAL SYSTEMS. Suprasternal Clavicle notch Manubrium of sternum Costal cartilage Manubriosternal Intercostal angle spaces (angie of Louis) Dome of the Body of sternum diaphragm Xiphoia process Costal angle Y Costochondral Costal margin junetion CLINICAL TIP the circumference of the When counting the spinous processes, it is helpful nary lines running vertical » know that they align with their corresponding ribs only chest, these lines are knov » the fourth thoracic vertebra (T4). After this, the spinous ‘and left mid-clavicular lines rocesses angle downward from their own vertebral body The posterior thorax i rd can be palpated over the vertebral body and rib and the right and left sap elow. inferior angle of the seapt side (Fig. 19-4), The lateral aspect of thy lines, The mid-axilary line the level of the 12th rib. 1 the anterior axillary fold ‘ertical Reference Lines thorax, whereas the poster counting the ribs, an examiner can describe the location rior axillary fold down th a finding vertically. However, to describe a location around wall (Fig. 19-5). The lower tip of each scapula is at the level of the seventh eighth rib when the arms are at the client’s side (Fig. 9-2) Vertebralside (Fig, 19-4), The lateral aspect of the lines, The mid-axillary line 22); the level of the 12th rib. T the anterior axillary fold : thorax, whereas the poster ¥ counting the ribs, an examiner can describe the location rior axillary fold down th a finding vertically. However, to describe a location around wall (Fig. 19-5). The lower tip of each scapula is at the level of the seventh r eighth rib when the arms are at the client's side (Fig ertical Reference Lines Vertebral pprominens Clavicle Acromion process P i Spinous process ofT3 Scapula Lower tip of scapula | Floating ros # seek Anterior axiiary line Midsternal line Midaxilary line Right midclavicular line Let midclavieular line FIGURE 19-3 Anterior vertical lines (imaginary landmarks) FIGURE 19.5 Laterexternal jugular vein lies diagonally over the surface of these muscles, The purpose and assessment of these major blood vessels are discussed in Chapter 21. It is important to avoid bilaterally compressing the carotid arteries when assessing the neck, as bilateral compression can reduce the blood supply to the brain. Thyroid cartilage Hyoid bone Cricoid cartilage Stemomastoid Throid: muscle Isthmus Lobe FIGURE 15-2 Structures of the neck.Thyroid Gland er The thyroid gland is the larg he It produces thyroid hormones that increase the metabolic rate 2se of most body cells. The thyroid gland is surrounded by several od structures that are important to palpate for accurate location sid of the thyroid gland. The trachea, through which air enters the he lungs, is composed of C-shaped hyaline cartilage rings. The to first upper tracheal ring, called the cricoid cartilage, has a small notch in it. The thyroid cartilage (“Adam's apple’) is larger and endocrine gland in the body Sternomastoid: sternal head clavicular head. FIGURE 15-3 Neck muscles and landmarks. 15 ASSESSING HEAD AND NECK 275 located just above the cricoid cartilage. ‘The hyoid bone, which is attached to the tongue. lies above the thyroid cartilage andFIGURE 15-4 Cervical vertebrae. Preauricular. Posterior auricular Occipital Tonsillar Superficial cervical Deep cervical chain ‘Submandibular Posterior. cervical ‘Submental FIGURE 15-5 Lymph nodes in the neck (left). Direction of lymph flov may be palpated in the scalp under the hair. 276 —_-UNIT3 +» * NURSING ASSESSMENT OF PHYSICAL SYSTEMS. metastasizes to the lymph nodes, they may enlarge but not be thy