Download Structure and Function

Chapter 15—Nose, Sinuses,
Mouth, and Throat
Copyright © 2015 Wolters Kluwer Health | Lippincott Williams & Wilkins
Structure and Function
• Nose: entry point of air; sense of smell
– Structure
– Nerve and blood supply
– Lymph drainage
• Sinuses: lighten weight of cranium; provide timbre,
resonance to voice; produce mucus
– Major factors r/t normal function
• Sinus ostia patency; expected ciliary function;
expected mucus quality/quantity
– Adenoids
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Structure and Function—(cont.)
• Mouth: sense of taste; chewing; speech articulation
– Roof: contains hard, soft palates
– Hard and soft palates
– Floor of the mouth is highly vascular.
• Facilitates rapid absorption of sublingual
medications
• Tongue: manipulates food during mastication; involved
in sense of taste; speech production
– Taste buds (vallate papillae)
– One of the body’s most vascular muscles
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Structure and Function—(cont.)
• Salivary glands: three drainage ducts within mouth
– Parotid; submandibular; sublingual
– Saliva: protects oral mucosa; transmits taste data;
rinses oral cavity  maintain pH; provides
lubrication
• Teeth, gums: food mastication
– Three layers: crown, neck, and root
– 32 permanent teeth; periodontium
• Throat (Oropharynx): common respiratory/digestive
channel
– Tonsils/adenoids: immunological defense
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Lifespan Considerations: Older Adults
• Age-related conditions
– Gustatory rhinitis: runny nose from smelling/tasting
food
– Decreased: olfactory sensory fibers; saliva production;
number of taste buds
• Cultural and environmental considerations
– Gingivitis: inflammation, bleeding of gums
– Cleft lip, palate; bifid uvula
– Oral and pharyngeal cancers
– Sleep-disordered breathing
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Question
• In the clinic within an adult assisted-living complex, a
68-year-old retired detective reports his mouth is
continually dry. This is problematic for him. What are the
functions of saliva?
A. Provides lubrication
B. Protects oral mucosa
C. Rinses oral cavity
D. All of the above
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Answer
• D. All of the above
• Rationale: Saliva begins the digestive process by
releasing enzymes upon contact with food. Saliva
protects the oral mucosa from heat, chemicals, and
irritants. Saliva also transmits taste information, rinses
the oral cavity to maintain pH, and provides lubrication
for the movement of food.
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Urgent Assessment
• Ludwig angina: edema pushing tongue up and back 
airway obstruction
– Infection of the mouth floor
• Aspiration
• Abrupt loss of smell
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Subjective Data
• Assessment of risk factors
– Personal history
– Medications, supplements
– Family history
– Risk factors
– Dental health
– Psychosocial history
– Environmental exposure
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Risk Assessment and Health Promotion
• Health goals
• Risk factors
– Tobacco use
– Sleep disorders
– Cancer
– Oral health
– Hereditary hemorrhagic telangiectasia: chronic
nosebleeds
• Prevention strategies
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Common Symptoms
• Facial pressure, pain, headache
• Snoring, sleep apnea; obstructive breathing
• Nasal congestion; epistaxis
• Halitosis; anosmia
• Cough; pharyngitis
• Dysphagia; dental pain
• Voice changes; oral lesions
• Lifespan considerations: older adults
• Cultural considerations
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Objective Data Collection
• Common specialty or advanced techniques
– Inspection; equipment
• Comprehensive physical assessment
– External nose: inspection; palpation
– Internal nose: inspection
– Sinuses: inspection; palpation, percussion
– Mouth: external, internal inspection; palpation
– Throat: inspection; palpation
– Swallowing evaluation
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Lifespan Considerations: Older Adults
• Edentulous: toothless
• Teeth
– Discoloration; teeth loosening
• Gums: receding
• Tongue
– Smooth, shiny appearance
– Fissures
• Cultural considerations
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Critical Thinking
• Common laboratory and diagnostic testing
– Lab studies; diagnostic testing; radiographs
– Biopsy; sleep studies
• Diagnostic reasoning
– Nursing diagnoses, outcomes, and interventions
• Outcomes (partial listing)
• Oral mucous membranes are pink, intact.
• Patient swallows with evidence of aspiration.
• Patient reports breathing is more comfortable.
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Critical Thinking—(cont.)
• Diagnostic reasoning—(cont.)
– Nursing diagnoses, outcomes, and
interventions—(cont.)
• Interventions (partial listing)
• Provide oral hygiene every 8 hours.
• Consult with speech pathologist to evaluate
swallowing.
• Encourage fluid increase to 2 L daily to liquefy
secretions.
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