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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Question
In the clinic within an adult assisted-living complex, a 68year-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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Answer
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.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Urgent Assessment
• Ludwig angina: edema pushing tongue up and back 
airway obstruction
– Infection of the mouth floor
• Aspiration
• Abrupt loss of smell
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Subjective Data
• Assessment of risk factors
– Personal history
– Medications, supplements
– Family history
– Risk factors
– Dental health
– Psychosocial history
– Environmental exposure
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Risk Assessment and Health Promotion
• Health goals
• Risk factors
– Tobacco use
– Sleep disorders
– Cancer
– Oral health
– Hereditary hemorrhagic telangiectasia: chronic
nosebleeds
• Prevention strategies
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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
Copyright © 2015 Wolters Kluwer • All Rights Reserved
Lifespan Considerations: Older Adults
• Edentulous: toothless
• Teeth
– Discoloration; teeth loosening
• Gums: receding
• Tongue
– Smooth, shiny appearance
– Fissures
• Cultural considerations
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
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.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
Which of the following is part of the upper gastrointestinal
tract?
a. Nasal septum
b. Sinuses
c. Throat
d. Adenoids
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
The nurse is assessing the nares to evaluate the site of
epistaxis. The most common site of bleeding is which of the
following?
a. Ostiomeatal complex
b. Nasal septum
c. Kiesselbach plexus
d. Woodruff plexus
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
The nurse knows that the floor of the mouth is highly
vascular and therefore a good location for which of the
following?
a. Absorption of sublingual medications
b. Identification of malignancy in the pharyngeal fossa
c. Infection with streptococcus
d. Aspiration, even if the gag reflex is present
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
Acute airway obstruction is a situation that should be
a. reassessed during the next visit.
b. evaluated within 8 hours.
c. further assessed thoroughly.
d. quickly assessed and treated.
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
Risk factors for nose, sinus, mouth, and throat problems
include
a. topical decongestant use, smoking, and allergies.
b. smoking, allergies, and high blood cholesterol.
c. allergies, high blood cholesterol, and topical
decongestant use.
d. high blood cholesterol, topical decongestant use, and
smoking
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
The nurse has assessed the nose and documents expected
findings as
a. nose asymmetrical with clear drainage
b. nose symmetrical and midline
c. nose asymmetrical and proportional to facial features
d. nose symmetrical with yellow drainage
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
The nurse is assessing a patient who has been taking
antibiotics for 10 days. Oral assessment is important
because of the increased risk for which of the following?
a. Fordyce granules
b. Pharyngitis
c. Anosmia
d. C. albicans
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
An adolescent male presents with complaints of
nosebleeds. The nurse would further assess for
a. hemangioma.
b. nasal trauma.
c. angiofibroma.
d. cystic fibrosis
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
The nurse assesses the child with purulent, unilateral nasal
discharge. The nurse knows that the most likely causative
factor is
a. allergic rhinitis.
b. choanal atresia.
c. foreign body in nose.
d. cystic fibrosis
Copyright © 2015 Wolters Kluwer • All Rights Reserved
NCLEX-Style Review Questions
During a routine physical examination of a 20-year-old
woman, the nurse notes a septal perforation. This finding
may be significant for which of the following causes?
a. Illicit drug use
b. Nose picking
c. Nasal trauma
d. Bifid uvula
Copyright © 2015 Wolters Kluwer • All Rights Reserved