Health Assessment Exam 2 Study Notes – Units 3–5: Integumentary, Neurologic, and HEENT Systems

Ch. 17: Nose, Mouth, and Throat
pp. 354-366, 369-372 (Recommended 351- 354)


Normal Findings
Infants & Children

• Nose: Nares patent; mucosa pink; septum midline; turbinates smooth, light red.
• Lips: Pink, moist, smooth, symmetric.
• Teeth & Gums: Teeth emerge straight; enamel white, smooth; gums pink, firm,
tight.
• Tongue: Pink, moist, dorsal roughened by papillae; protrudes midline; no tremor.
• Buccal mucosa: Pink, moist; Stensen ducts visible; no lesions.
• Palate: Hard palate white with rugae; soft palate pink, smooth, movable; torus
palatinus may be present.
• Uvula & Throat: Uvula midline, rises on phonation; tonsils small/not visible at birth;
gag reflex present.
• Reflexes: Sucking reflex strong, present up to 12 months.
• Teeth eruption: Age-appropriate, sequence correct; no caries.
• Bednar aphthae: Small traumatic ulcers on posterior hard palate (normal in infants
who suck).

Pregnancy

• Gums: Smooth hypertrophy may occur (pregnancy gingivitis); stippling disappears;
may be mild and normal.

Aging Adult

• Nose: Appears more prominent due to loss of subcutaneous fat.
• Mouth & Lips: Edentulous patients—lips fold inward, “purse-string” appearance.
• Teeth: Yellowing uniform; worn enamel; receding gums; vertical cracks may be
present.
• Tongue: Smoother due to papillary atrophy.
• Buccal mucosa: Thinner, shinier, “varnished” appearance.

,Abnormal Findings

Finding Possible Cause/Condition Notes
Nursing bottle caries Early childhood caries Brown discoloration on upper front
teeth
Gingivitis Poor oral hygiene, infection Red, swollen gums; bleeding
Dental caries Tooth decay Brown/black spots, sensitivity
Oral lesions Trauma, infection, White patches, ulcers, candidiasis
precancerous
Tonsil enlargement 3–4+ Infection Pharyngitis, mononucleosis
Deviated septum, Trauma, congenital May cause breathing difficulty
obstruction
Epistaxis Trauma, clotting disorders Nosebleed
Bednar aphthae Trauma Usually heals quickly; monitor if
(large/painful) severe
Cyanosis of lips Hypoxia Medical emergency
Pallor of gums/lips Anemia Assess further
Loose teeth in older Bone resorption Age-related or poor oral care
adults



Special Procedures / Assessment Techniques

Nose

• Inspect external nose and nares for symmetry and lesions.
• Palpate for tenderness or deformity.
• Check nostril patency by occluding one side and asking patient to sniff.
• Use nasal speculum to inspect mucosa and turbinates.
• Palpate sinuses for tenderness (frontal, maxillary).

Lips

• Inspect at rest and during smile.
• Check moisture, color, symmetry, lesions.

Teeth & Gums

• Inspect teeth for color, alignment, decay.
• Palpate gums for swelling, tenderness, recession.
• Check eruption pattern in children; note enamel quality.

, Tongue

• Hold tongue with gauze for traction.
• Inspect dorsal, ventral, lateral surfaces.
• Palpate for nodules, ulcerations, white patches.

Buccal Mucosa

• Retract cheeks with tongue blade.
• Inspect for lesions, Fordyce granules, Leukoedema.
• Palpate suspicious areas.

Palate

• Inspect hard and soft palate with tongue blade.
• Ask patient to say “ah” to check uvula rise.
• Palpate hard palate if lesions suspected.

Uvula & Throat

• Inspect tonsils, uvula, posterior pharynx.
• Test gag reflex (cranial nerves IX/X).
• Assess tongue protrusion (cranial nerve XII).

Infants

• Palpate hard and soft palate while infant sucks.
• Inspect teeth eruption, alignment, enamel, and tonsils.

Aging Adults

• Inspect tooth wear, gum recession, oral lesions.
• Palpate loose teeth or oral masses.
• Observe denture fit.

Documentation Guidelines

• Subjective: Pain, sensitivity, difficulty chewing/swallowing, oral lesions, history of
dental care, smoking status.