Physical assessment Ear Nose Mouth and Throat Health

Physical assessment Ear, Nose, Mouth, and Throat Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Anatomy and Physiology Review • • Internal and external ear Nose and sinuses Oral cavity Pharynx or throat Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Ear • Sensory organ that functions in hearing and equilibrium • External ear • Auricle or pinna • Helix • Tragus • Lobule • External auditory canal • Lined with yellow-brown cerumen (wax) Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Ear • Middle ear • Tympanic membrane • Separates external and middle ear • Ossicles • Malleus • Incus • Stapes • Eustachian tube • Connects middle ear and nasopharynx Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Ear • Inner ear • Controls equilibrium • Hearing sensors Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 16. 1 External ear. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Figure 16. 2 The three parts of the ear. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Nose and Sinuses • External and internal structures of nose • Bridge and tip of nose • Septum and turbinates • Function to clean, warm, moisten air • Nasal mucosa • Paranasal sinuses • Mucus-lined, air-filled cavities that surround the nasal cavity Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Nose and Sinuses • Paranasal sinuses • Function to clean, warm, moisten air • Olfactory cells connect to the olfactory nerve (cranial nerve I) and are responsible for the sense of smell • Another function to provide resonance for voice Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

The nose Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Nasal sinuses Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Mouth • • • Maxilla Mouth Teeth Tongue Gums Uvula Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Mouth • Lips • Inside of the cheeks • Palate • Hard palate • Soft palate • Mandible Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Oral cavity Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Innervation of the tongue Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Throat • Known as pharynx • Leads to esophagus and trachea • Sections • Nasopharynx • Oropharynx • Laryngopharynx • Epiglottis • Tonsils Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Special Considerations • • Age Developmental level Race Ethnicity Work history Living conditions Socioeconomics Emotional well-being Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Lifespan Considerations • Infants and children • Shorter auditory canal • Increased incidence of otitis media • Beginning of salivation in infants • Development of deciduous and permanent teeth in children • Slightly enlarged, noninfected tonsils common in children ages 4 to 8 Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Lifespan Considerations • The pregnant female • • • Fullness or earaches Rhinitis Epistaxis Heightened sense of smell Edema of vocal cords Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Lifespan Considerations • The older adult • • • Loss of high-frequency hearing Gradual hearing loss (presbycusis) Decreased sense of taste and smell Decreased production of saliva Receding gums Tooth loss Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Psychosocial Considerations • • Mouth ulcers Lip biting Involuntary muscle spasms (tics) Relaxation techniques may help relieve stressrelated behaviors. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Cultural and Environmental Considerations • Variances among ethnic ancestry • Cleft uvula, lip, and palate • Occupational risk for hearing loss • Financial constraints • Lower socioeconomic status places children at risk for otitis media. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Focused Interview • Observe patient and be active listener • Consider in relation to normative parameters and expectations of function as well as other factors • Follow-up questions may be necessary. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Secondary Sources for Patient Data Related to the Ears, Nose, Mouth, and Throat Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Focused Interview • Focused interview questions • • General Illness or infection Symptoms, pain, and behaviors Environment • Internal • External continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment Techniques • • Inspection Palpation Percussion Transillumination Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Table 16. 6 (continued) Overview of Disorders of the Mouth and Throat continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment Techniques Inspection of the external ear Palpation of the auricle and tragus Palpation of the mastoid process Inspection of the auditory canal using the otoscope • Examination of the tympanic membrane using the otoscope • • Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment Techniques • Administration of the whisper test • Administration of the Rinne and Weber tests using the tuning fork • Administration of the Romberg test Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Palpating the tragus. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Palpating the mastoid process. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Pulling the pinna to straighten the canal. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment Techniques • Otoscope • Auditory canal • Inserting the otoscope • Handle up or down • Straightening the ear canal • Tympanic membrane Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Two techniques for holding and inserting an otoscope. Otoscopic examination with otoscope handle in downward position. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Two techniques for holding and inserting an otoscope. Otoscopic examination with otoscope handle in upward position. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Performing the whisper test. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Activating the tuning fork. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Rinne test. Bone conduction. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Rinne test. Air conduction. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Weber test. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Romberg test. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment Techniques • Nose and sinuses • Inspection of the nose and patency testing • Palpation of the external nose • Inspection of the nasal cavity using a nasal speculum • Palpation of the sinuses • Percussion of the sinuses • Transillumination of the sinuses Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Inspection of the nose. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Using the otoscope for nasal inspection. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Palpating the frontal sinuses. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Palpating the maxillary sinuses. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Percussion of frontal sinuses. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Percussion of maxillary sinuses. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Transillumination of the frontal sinuses. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Observing transillumination of the frontal sinuses. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Transillumination of the maxillary sinuses. continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Transillumination of the maxillary sinuses using alternate technique. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Assessment Techniques • Mouth and throat • Inspection and palpation of the lips • Inspection of the teeth • Inspection and palpation of the buccal mucosa, gums, and tongue • Inspection of the salivary glands • Inspection of the throat Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Inspecting the teeth. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Palpating the tongue. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Inspecting the throat. Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Abnormal Findings • • Lesions Deformities Infectious processes Dental problems Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Table 16. 6 (continued) Overview of Disorders of the Mouth and Throat continued on next slide Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved

Table 16. 6 (continued) Overview of Disorders of the Mouth and Throat Health & Physical Assessment in Nursing, Third Edition Donita D'Amico | Colleen Barbarito Copyright © 2016, © 2012, © 2007 by Pearson Education, Inc. All Rights Reserved