Mouth, throat, nose

& sinus Assessment

 • Circumoral Pallor
Mouth ( pallor around lips) seen
in anemia & shock.
• Inspect the lips.
( consistency & color)
• Bluish lips may result
from hypoxia/ cold.
* LIPS are smooth &
moist without lesion or
• Reddish lips in
swelling.
ketoadidosi, Carbon
monoxide poisoning &
COPD w/ polycythemia.
Inspect teeth & gums
• Ask client to open • 32 pearly whitish teeth
mouth w/smooth surfaces &
• Note number, color, edges.
condition, & alignment
of the teeth.
• Put on gloves to retract • No repaired or decayed
client’s lips & cheeks to areas; no missing teeth
check gums for color & or appliances.
consistency.
• Yellowish/ brownish teeth – smoker, drink large quantitites of
coffee or tea or excessive intake of flouride.

• Tooth Caries/ Decay- brown dots covering the chewing

surfaces.

• White spots- antibiotic therapy

• Gingivitis ( red swollen • Lead poisoning – Bluish
gums that bleed) black/ grey-white line in
the gum line
• Perodontitis ( Red gums
with loss of teeth)

• Hyperplasia ( enlarged
reddened gums)
Inspect the buccal mucosa.
• Use penlight & tongue • Leukoplakia- precancerous
depressor to retract the lesion
lips & cheeks.
• Thrush- whitish, curdlike
patches over the mucosa
• Buccal mucosa should
be pink & smooth • Koplik’s spot- tiny whitish
without lesions. spots that lie on the mucosa.
• Canker sores- brown patches
in the cheeks w/
adrenocortical insufficiency.
Inspect & palpate tongue.
• Stick out tongue.
• Inspect for color,
moisture, size & texture.
• Palpate for lesions.
• It should be pink, moist,
with papillae.
• Fissures- dehydration
• Black tongue – Bismuth
toxicity
• Enlarged tongue-
hypothyroidism,
acromegaly, Down’s
syndrome.
• Small tongue- malnutrition
• Atrophied tongue- CN12
damage
Assess ventral surface of tongue.
• Touch the tongue to the • Leukoplakia, lesions,
roof of mouth & use ulcers/ nodules- indicate
penlight. cancer.

• It should be smooth,
shiny, pink or slightly
pale with visible veins &
no lesions.
Inspect for the Wharton’s ducts.

• The Frenulum is
midline. Wharton’s ducts
are visible with salivary • Lesions, ulcers, nodules,
flow in the area. No hypertrophied duct
swelling, redness, or openings.
pain.
Observe sides of the tongue.
• Use gauze pad to hold • Canker sores-
the tongue. Palpate for chemotherapy
lesions, ulcers, nodules.
• Leukoplakia

• No lesions, or nodules
are apparent.
Check for the strength of the tongue.
• Place fingers on external
surface of the cheeks.
• Ask to press the tongue’s • Decreased tongue
tip against the cheek to strength – defect on
resist pressure. Repeat CN12
on the opposite cheek.

• The tongue offers strong

resistance.
Check for the anterior tongue’s ability to
taste.
• Place drops of sugar &
salty water on the tip &
sides of tongue w/ • Loss of taste
tongue depressor. discrimination – zinc
deficiency, 7 CN defect,
• Can distinguish between medication use.
sweet & salty.
Inspect hard & soft palates & uvula.
• Open mouth wide while • White plaques- candida
use a penlight to look at infections
the roof.
• Observe color & integrity. • Deep purple, raised
lesion- Kaposi’s sarcoma
• Note for odor.
• Yellow tint- jaundice
• Hard palate is pale or
whitish w/ firm transverse
rugae.
• Fruity/ acetone breath- • Fecal odor- bowel
ketoacidosis obstruction

• Ammonia odor- kidney • Sulfur odor( fetor

disease hepaticus)- End stage
liver disease.
• Foul odor- oral
respiratory infection,
tooth decay,
Assess uvula
• Apply tongue depressor • Bifid uvula split into two
& shine penlight into or partially severed =
wide-open mouth. submucous cleft palate.
• Note characteristics &
position.

• It should be fleshy, solid

structure that hangs
freely in the midline. No
redness/ exudate.
Inspect tonsils.
• Keep mouth open using
tongue depressor.
• Inspect for color, size, &
presence of exudate/
lesions.
• Pink & symmetrical.
Enlarged to 1+.
• Tonsilitis Grading
• 1+ = tonsils visible
• 2+ = midway between
tonsillar pillars & uvula
• 3+ = touch the uvula
• 4+ = touch each other
Inspect posterior pharyngeal wall.
• Keep tongue depressor • Pharyngitis- bright red
in place, shine penlight throat w/ white or
at the back of throat. yellow exudate.

• Post nasal sinus

• Throat is pink without drainage- yellowish
exudate or lesions. mucus on throat.
 NOSE
• Inspect & palpate external
nose
• Local infection= nasal
• Note color, shape, tenderness on palpation
consistency, & tenderness

• Color is same as the rest

of the face; nasal structure
is smooth & symmetric,
no tenderness.
Check for patency of air flow through
nostril.
• Occlude one nostril at a
time & ask client to
sniff.
• Cannot sniff – sign of
swelling, rhinitis,
• Able to sniff through foreign body
each nostril while other obstruction.
is occluded.
Inspect internal nose.
• Use otoscope with short • Allergic- swollen & pale pink
wide- tip attachment. or bluish gray

• URI- red & swollen

• Nasal mucosa is dark
pink, moist & free of • Bacterial Rhinosinusitis-
exudate. Nasal septum is purulent nasal discharge
intact & free of ulcers.
Turbinates are dark pink, • Perforated septum- cocaine
moist & free of lesions. use, trauma & chronic
infection,chronic nose picking.
Sinuses
• Palpate the sinuses

• When infection is suspected,

examine thru palpation,
percussion, & transillumination.

• Palpate frontal sinuses using • Frontal & maxillary

thumb on the brow on each sinuses are non
side of nose.
• Palpate maxillary sinuses by
tender & no crepitus
pressing thumbs on maxillay
sinuses.
• Acute bacterial
rhinosinusitis/ allergies-
tender frontal or
maxillary sinuses.

• If w/ large exudate,
crepitus is evident upon
palpation.
Percuss sinuses.

• Lightly tap over the

frontal sinuses & over • Sinus infection/
the maxillary sinuses for allergies- tender frontal
tenderness. & maxillary sinuses.

• Sinuses are not tender on

percussion.