NUR 230 Week 6 Notes
NUR 230 Week 6 Notes NUR 230
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This 25 page Class Notes was uploaded by Issy Notetaker on Saturday October 3, 2015. The Class Notes belongs to NUR 230 at Ball State University taught by Marjorie Pyron in Fall 2015. Since its upload, it has received 36 views. For similar materials see Health Appraisal Across the Lifespan in Nursing and Health Sciences at Ball State University.
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Date Created: 10/03/15
Jarvis Book Notes Objectives Clinical Lecture Chapter 13 Head Face and Neck Including Regional Lymphatics Head 0 Skull protects brain and special sense organs 0 Cranial Bones Frontal Parietal Occipital and Temporal o Cranial bones are connected by immobile joints Sutures Not joined rmly at birth bc the head needs change shape during birthing During childhood the plates rmly mold together Coronal is between frontal and parietal Sagittal separates the parietal Lambdoid separates parietal and occipital 0 There are 14 facial bones 0 Supported by C1 atlas and C2 axis through C7 0 Facial expressions are controlled by CN Vll innervated MM Sensations are controlled by CN V o Facial structures are symmetrical and equal bilaterally 0 Base of skull inferior to mandible to just above the Manubrium clavicle rst rib thoracic vertebrae o Passage way for Blood vessels Internal to brain and External to face Carotid Carotid and internal jugular lie under sternomastiod MM 0 External runs across sternomastiod lnnervated by CM Xl MM Strenomastoid creates an anterior and posterior triangle Nerves CN Xl Thyroid gland sits on trachea in the middle neck Endocrine gland Rich blood supply Secretes T3 and T4 Butter y shape w isthmus connecting two halves Cricoid Cartilage is just above Thyroid cartilage Adams apple is above that w hyoid bone just above that Viscera to respiratory and digestive systems Lymphatics 0 Head and neck have 6070 nodes 0 Drain into the neck downward End of the line is into deep cervical chain of lymphatic nodes 0 Major part of immune system 0 Vessels gather lymph which is clear from tissue spaces interstitial space uid Nodes lter out foreign materials 0 Only palpable in head and neck arms axillae an inguinal region 0 Greatest amount resides in the head and neck 0 Development 0 Infants and Children Bones in skull are separated by fontaneIs These allow for growth All are closed by 2 years Head growth reaches 90 full size by age 6 0 Head grows predominately in fetal period Trunk is mainly in infancy Lymphoid tissue is well developed at birth 0 Adult size by age 6 Grows rapidly until age 1011 better than adults 0 Then atrophies after puberty Thyroid tissue enlarges when male voice deepens 0 Pregnant Thyroid gland enlarges 0 Aging Adult Facial bones are more prominent Subjective o Headache Unusually frequent or severe SOLDCART Gradual onset This kind of headache Associated Factors Frequency Location will help to determine type tension Migraine Cluster Medications taken Treatment and coping 0 Head Injury SOLDCART Setting History of illness Associated Symptoms Loss of consciousness in relation to accident before or after falling Patterns and Treatments 0 Dizziness Ask to describe SOLDCART Associated Factors 0 Neck Pain Limited motion SOLDCART Limited ROM EVER Coping mechanisms 0 Lumps or SweIIing Infection or tenderness Durations change in size History Dif culty swallowing Smoking or drinking Thyroid problems 0 History of head or neck surgery For what condition When Results 0 Additional for Infant Aging Objective 0 Head Alcohol or drug use during pregnancy Frequency Delivery method difficuItIy forceps use Growth on schedule Head control at what age Effect on ADLs Facial bones are mre prominent Skin si sagging O Decrease in elasticity subcut fat and moisture Tympanic membrane atrophies and hardens Presbycusis gradual hearing loss due to age 0 Loss in high frequency rst Inspect and Papate Skull Size and Shape O 0 Note general Normocephalic is round and symmetrical skuII shape Appropriate relation to body size Normal varies depending on person Papate the skull under the hair Should be symmetric and smooth w normal protrusions and no tenderness Temporal Area and Artery O Papate artery and TMJ upon opening and closing of mouth Inspect the Face FaciaI Structures CN V and VII 0 Neck 0 O O O Expressions Congruent with behavior and mood Symmetry of structures Abnormal changes in pigment of skin or swelling Are their involuntary movements Inspect and Papate Symmetry O 0 ROM 0 Head is midIine and centered Erect and still Neck MM are symmetrical Note limitations O Motions should be smooth and controlled 0 Test Mm strength CN XI 0 O O O O O O O O O O O 0 Are there enlarged glands Salivary Thyroid or Lymph Are pulsations visible Lymph Nodes Gentle circular movement of nger pads to palpate Begin at periauricular and move systemically to all ten areas Do same way each time to not miss any Be gentle Palpate both side at same time to feel symmetry If you palpate a node document Location size shape delimitation mobility consistency tenderness Check upstream of swollen gland for in ammation or other signs Benign Moveable discrete soft nontender Trachea Midline note if deviated Thyroid Gland Mostly done when there is a family history Dif cult to palpate Have pt tilt head back Inspect neck as pt sips water Thyroid should move up and then fall Posterior Approach Move behind person when palpating Tilt head forward and to right slightly 0 Use L hand to push thyroid right 0 Curve R ngers under sternomastoid and as pt to sip water thyroid should move w trachea Do on other side also Thyroid is not normally palpable in a healthy adult Anterior Approach Same as posterior but use thumbs Multiple Nodules indicate in ammation or multinodular goiter lf rapidly enlarging and rm Red ag Single Nodular are mostly benign Suspect painless rapid growth Cancerous are hard and xed Auscultate Thyroid Gland o o 0 Development lf enlarged listen for bruit With bel Infant and Children Abnormal 0 Head 0 Head 0 Head 0 Skull 0 0 Face 0 Neck 0 0 Head size should be measured at each visit until 2 and once a year until 6 Head is 2cm larger than chest for 2 years and then they are Chest is larger during and after childhood Common abnormalities Caput Succedaneum Swelling in part of the head due to birth trauma 0 Will disappear in rst few days after birth Cephalhematoma subperiosteal hemorrhage from birth trauma 0 Will reabsorb Suture lines will feel like ridges Head may appear symmetric after birth but it will quotroundquot out after a few days to a week Place infant on back to prevent SIDS Note posture and head control Turn head side to side by 2 weeks Head control by 4 months Feature are checked for Symmetry appearance swelling Note symmetry when crying or smiling Looks short but will lengthen within the rst 4 years Perform Passive ROM Pregnant Woman Chloasma may appear in face and fades after delivery Thyroid may be enlarged Aging Adult Senile Tremors may occur 0 O O Acromegaly Head nodding tongue protrusion Drooping submandibular glands are palpable Temporal arteries may be prominent Excessive secretion of GH form pituitary after puberty Enlarged skull and thickened cranial bones Elongated head massive face prominent nose lowerjaw Microcephaly Abnormally small head Can result in mental retardation CVA Upper motor neuron lesion Obstruction or rupture of a blood vessel 0 Head 0 Head 0 Head 0 Head 0 Head Upper half of face in unaffected Face droops Bell s Palsy CN Vll is paralyzed Unilateral Herpes virus can cause Can39t wrinkle forehead or raise eyebrows close eyes whistle or show teeth on the right side Hypothyroidism Myxedema Non pitting edema of face Coarse facial features TMJ Palpate both joints Smooth movement w no popping is normal Dentists often detect Headaches are common precursor Migraines Neurogenic Vascular Chemical Meningeal Vasodilation and in ammation Stimulation of cranial and Dural nociceptors Causes more sensory nerve stimulation 0 Trigem ophthalmic branch C2 nerve roots Aura Flashing lights 0 Visual Loss Pins and Needles Motor weakness 0 Language disturbances Brainstem dysfunction 472 hrs Unilateral pulsating moderate to severe aggravated by physical ctivity or lack of Associated factors NN photo and photophobia mental status changes irritability neck stiffness cravings anorexia yawning Cluster Headaches Extracranial Vasodilation Substance P and others increase vasodilation and in amed vessels stimulate afferent pain bers 13 days over 48 weeks Nonthrobbing but everyday pain Severe to very severe pain Unilateral in eye or temporal area 15180 minutes Associated Nasal congestion eyelid edema foreheadfacial sweating ushing or pallor miosisptosis sense of restlessness 0 Head Tension Headaches 30 minutes to days Neck pain Nonplusing pressure Mild to moderate Bilateral No NV Anorexia Photo or phonophobia 0 Neck Hyperthyroidism Goiter Bulging eyes Tachycardia SOB Excessive Sweating Grave s Disease Nervousness Fatigue Weight Loss MM cramping Heat intolerance Chapter 14 Eyes 0 External Anatomy 0 1 inch in diameter 0 Protected by Orbital cavity Cushion of surrounding fat Eyelids and eyelashes Filterprevent entrance of dustparticles or strong light 0 Meibomian Glands are modi ed sebaceous glands secreting oil that lubricates the eye Conjunctiva is the mucus membrane that covers the eyes Cornea protects the iris and pupil Lacrimal Apparatus is a continuous lubrication set up Extraocular MM 6 MM give straight and rotary movement Each mm is coordinated with the same mm in the other eye to ensure parallel movement Humans have binocular single image vision system CN Vl lateral Rectus lV Superior Oblique and Ill All others 0 Internal Anatomy 0 Asymmetric Sphere 0 Three layers Sclera Outer layer tough white protective Continuous w the cornea o Cornea bends incoming light rays very sensitive CN V and CN Vll cause the corneal blink re ex Choroid Vascular Middle layer dark pigment to prevent internal re ecting of light 0 Continuous w ciliary bodies and iris OOOO Pupil is round and regular 0 Simulation is made by CN Ill 0 Lens is biconvex disc just behind pupil o Focusing apparatus 0 Thickness is determined by ciliary bodies 0 Chamber 0 Anterior chamber is in front up to cornea o Posterior chamber is behind iris to lens 0 Contain uid produced by ciliary bodies the delivers nutrients ReUna lnner layer 0 Light rays are turned into nerve impulses and an upside down image is formed 0 Inside is a vitreous body 0 Structures 0 Optic Disc Fiber merge to form optic nerve o Retinal Vessels Paired artery and vein in each quad Smaller toward periphery Background 0 Macula Temporal Side Darker pigment Surrounds fovea capitis sharp vision Receives and transduces light 0 0 Visual Fields and Pathways 0 Light strikes retina rays are turned into nerve impulses travel to occipital lobe 0 Image is formed upside down 0 Optic Chiasm Right and Left elds switch in the brain 0 Visual Re exes o Pupillary Light Normal constriction upon bright light shining into retina CN II and CN lll Link bw CN II and CN Ill 0 When one eye is exposed to a bright light both will constrict o Fixation Eye goes to object attracting our attention lmpaired by drugs alcohol fatigue inattention 0 Accommodation Eye adapts to near vision Tested through convergence of axes Development 0 Infants and Children Birth yield limited eye function Peripheral vision is intact at birth Macula is absent at birth but develops fully by 8 months O 34 months a baby can focus on one object Most babies are far sighted Eyeball reaches adult size at age 8 Aging Adult Wrinkling drooping decreased tear production Pupil size decreases Lens losses elasticity inability to see near objects Presbyopia Floater appear Acuity decreases mainly near vision Vision changes Common Cataract Cloudiness of lens from protein build up 0 Fixed w surgery Glaucoma Loss of peripheral vision optic nerve neuropathy 0 Increased intraocular pressure AgeRelated Macular Degeneration Loss of central vision no affect on peripheral 0 Risk rises w age 0 Diabetic Retinopathy Causes Blindness Culture and Genetics 0 Ethnic differences appear in palpebral ssures Narrowed space between eyelids Lighter retinas have better vision but are more easily harmed by too much light Racial variation in disease Cataract Higher among whites Glaucoma is higher in Blacks AMD is higher among whites Diabetic retinopathy is higher among Blacks and Hispanics Visual impairment is higher among those in poverty Higher among Native Americans Puerto Ricans Dominicans and those of mixed races Subjective 0 Vision dif culty Dif culty seeing or blurry vision Blind spots One or both eyes Floaters Photophobia Pain Describe Foreign body sensation Strabismus or Diplopia History of cross eyed Seeing double Redness or Swelling Infection 0 Watering or Discharge Hard to open eyes Color 0 History of Ocular Problems Eye Surgery Allergies o Glaucoma Testing Family History 0 Use of glasses or contact lenses Near or farsightedness Do they work Care for contacts Last check up Eye drop use Clean eye 0 PtCentered Care Last vision test Color vision test Smoking Vision loss experiences 0 Additional for Infant and Children Vaginal infections in mother at birth Developmental vision milestones Routine vision testing Safety measures Aging Adult Objective Vision dif culty causing decreased activities Night vision dif culty Last glaucoma test History of cataracts Dry or burning eyes 0 Test Central Visual Acuity Snellen Eye Chart Place chart 20 feet away from person top 20 0 Bottom number is the distance from which a normal eye can read Shield one eye Leave on glasses or contacts Have person read to smallest line possible 0 Note squinting Hesitation leaning forward misreading Record numbers on last successful line read 0 Note wrong letter read and use of corrective lenses Near Vision Test w handheld vision screener w different sized letters Normal is 1414 0 Test Visual Fields Confrontation Test 0 Stand 2 feet in front of person facing each other 0 Hold nger in front and move it into the periphery in different directions 0 Ask person to say a word when they rst see the nger 0 Inspect Extraocular MM Function Corneal Light Re ex Hirschberg Test 0 Parallel alignment of eyes Shine light toward persons eyes Diagnostic Positions Test 0 Do the CN II test 0 Note nystagmus 0 Inspect External Ocular Structures General 0 Persons ability to move about room Facial expressions Eyebrows Symmetry movements no scaling or lesions Eyelids and Lashes Overlap superior part of iris Approximate w lower lid when closed 0 No redness swelling discharge lesions 0 Horizontal or upward slant EyebaHs Aligned normally 0 No protrusion or sunken appearance Conjunctiva and Sclera Pull down lower lid 0 Eyes should look moist and glossy Blood vessels should be transparent AA pt may have small brown macules Eversion of Upper Lid 0 Open eyes and look down 0 Lift up eyelashes and pull outward Place q tip under and ip eye lid up Lacrimal Apparatus Inspect outer part of upper lid for redness or swelling 0 Inspect Anterior Eyeball Structures Cornea and Lens Shine light to check for smoothness and clarity Arcus senile is a normal nding in aging persons 0 Note if any discoloration Iris and Pupil Iris 0 Normally at round and regular shape even color Pupils 0 Note size shape and equality 0 Test light re ex Shine light in from side and watch both pupils constrict 0 Test accommodation by having person look at a faraway object and then a near one Watch pupil response 0 Inspect Ocular Fundus Use ophthalmoscope to inspect media and ocular fundus Examine in a dark room to dilate pupils Have pt stare at distance xed mark and shine white light into eye Begin farther away from person and then move closer Red re ex will occur focus on that and move closer If you and pt have normal vision then the adjustment should stay at 0 Myopia nearsightedness number Hyperopia farsightedness number Inspect ocuIar disc retinaI vessel general background and macuIa Optic Disc 0 Color yeIIowpink 0 Shape Roundoval o Margins Sharp 0 Cupdisc Ratio varies smaII width and bright yellow 0 Variations ScIeraI Crescent Graywhite Pigment Crescent Black Retinal vessels 0 Number Pairing Color Arteries are brighter than veins AV Ratio Width is a 23 Caliber Decrease into periphery A V Crossing May cross paths Tortuosity Vessel twisting o Pulsation Present in veins near disc 0 General Background 0 Color varies from light to dark red MacuIa o Darker than rest of the area 00000 0 Development Infants and Children Examined win a few days after birth in HCP visit Preterms are test in HC facility 0 Visual Acuity Dependent upon age 0 Light perception Blink re ex Birth2 weeks won t open eyes to bright light alertness is increasing xation 24 weeks Fixation 1 month Fixate and follow lighttoy 6 weeks Visual response to face 34 months Fixate Follow Reach for toy 610 months Fixate and Follow toy in all directions Allen test of Snellen test is used 2020 by age 67 0 Visual Fields Begin at age 3 0 Peripheral vision test 0 Color Vision 0 Test using color letter cards 0 Boys are tested from age 48 girls not until later Extraocular MM Function 0 Strabismus squintcross eyes 0 Important to screen for o Corneal Light Re ex Same spot shining in each eye 0 Cover Test Have child focus on an object and over one eye check that other eye stays focused lf relaxes uncover eye and watch it move back to focused External Eye Structures 0 Don t pry open a neonates eyes 0 Eyes will look in same direction the baby is turned Eyelids and Lashes o Etra skin fold over eyelid is common but will disappear Conjunctiva and Sclera 0 Blue tint may occur at birth 0 Lacrimal glands are not functional lris and Pupils 0 Blue slate gray or brown 0 Permanent color is shown by 69 months Ocular Fundus 0 Data collection will depend on length of time child keeps eyes open Aging Adult 0 Visual Acuity 0 Same exam Central acuity may decrease peripheral may be diminished 0 Central decreases Ocular Structures 0 Skin around eyes may droop and crow39s feet may occur 0 000000 Pseudoptosis may occur Eyes may look sunken in Cornea may look cloudy Symmetical constriction of pupils but slow response to re ex o Pinguecule may occur Yellowing elevated nodules o Xanthelama soft yellow plaques on lids Ocular Fundus o Retinal structures with less shine OOOO Abnormalities Chapter 15 Ears Hearing and equilibrium 0 Three parts 0 External AuriclePinna made of cartilage Allows for funneling of sound waves into external auditory canal ending at the eardrum Canal is lined with glands that secrete earwax Outer third is cartilage inner two thirds is sensitive skin covering bone moves down and towards the nose EardrumTympanic membrane is end of external ear and beginning of middle 0 Translucent and pearlygray color 0 Oval and concave 0 Middle Tiny air lled cavity Malleus incus stapes are bones Oval and round window Eustachian tube connects middle ear to nasopharynx to normalize pressures Functions Conducts vibrations to inner ear Reduces amplitude of sound Equalization of pressure so TM doesn39t rupture 0 Inner Boney labyrinth to hold sensory organs Vestibule Semicircular canals Cochlea Equilibrium Vertigo vs dizziness Hea ng 0 Three levels Peripheral Transmits sounds and converts vibrations into impulses Amplitude and Frequency 0 Organ of Corti are the bers along the basilar membrane win the cochlea that are the sensory organ Impulses travel along CN VIII to brainstem Brainstem Binaural Interaction Location and Direction of sound Cerebral Cortex Interpretation of sound 0 Response is made in reticular activating system 0 Pathways Normal is air conduction Bone Conduction ConducUon Transmitted by CN VIII Conductive mechanical dysfunction of external or middle 0 Partial Ioss Sensorineural pathology of inner ear CN VIII or cerebral cortex auditory areas Mixed is a combination in same ear 0 Equilibrium Semicircular Canals feed information about the body in relation to space 0 If in amedVertigo staggering Development 0 0 Adult 0 Aging Infants and Children Develops in 5th week of gestation Posteriorly set and low Rubella during gestation can impair hearing by damaging organ of Corti Eustachian tube is short an wide allowing for increased risk of infection 0 Increased risk from secondhand smoke PuII back and down Skin Tags Rt development of ear Bilat increases risk of renal abnormalities 0 Ear and kidneys are developed at the same time Otosclerosis Cause of conduction hearing loss 0 2040 years of age Gradual bone formation 0 Stapes if xed to oval window 0 Progressive deafness Adult Cilia lining canal stiffen Reduces hearing Impacted cerumen is common Presbycusis Hearing loss in 60 of 65 High frequency tone loss is rst 0 Culture and Genetics 0 Otitis Media middle ear infection is common in childhood Higher risk in indigenous children from North America Australia New Zealand and Northern Europe Increased risk factors 0 Not breastfeeding Secondhand smoke exposure daycare attendance male sex using a paci er and seasonal changes 0 Genetic Cerumen Dry Gray and aky Wet Honey Brown Chromosome 16 determine wet vs dry Subjective o Earache SOLDCART Ever been hit in the ear or side of head Sinus problems colds sore throat Foreign body trauma 0 Infections History and frequency 0 Discharge What does it look like odor 0 Hearing Loss SOLDCART Situations Recent airplane travel 0 Environmental Noise Noise level at work home Noise protection 0 Tinnitus Ringing cracking buzzing Medications Effect on life 0 Vertigo Objective Room spins Subjective Person spins o PtCentered Care Cleaning care of ears Last exam 0 Any sudden loss in one or both ears are NOT related to Respiratory infect need to be reported ASAP 0 Additional for Infants and Children Ear Infections First episode ages frequency tubes or surgery 0 Smoking in home Is the child hearing well Put objects in ears contact sports 0 Objective 0 Prep Sitting strait up at eye level Clean cerumen by irrigation 0 Inspect and Papate External Ear Size and Shape Equal size bilat No selling or thickening Skin Condition 0 Color consistent w face Intact w no lumps or lesions Darwin39s tubercle nodule on helix 0 Dry Tenderness Pinna and Targus should feel painless and rm Piercings location amount type External Auditory Meatus Size of opening 0 No swelling or redness should be present 0 Some cerumen is present to lubricate and protect 0 Inspect w Otoscope Choose largest tting end Tilt head away from you Pull pinna up and back for adults and older children 0 Down and forward for children Hold otoscope upside down Insert carefully Avoid touching inner wall of ear Perform before testing hearing External Ear Canal 0 Note if redness swelling or lesions are present 0 Color and odor of discharge 0 Note irritation from hearing aid if present Tympanic Membrane Color and Characteristics 0 Explore the landmarks 0 Should be shiny and translucent o Coneshaped Position 0 Flat and slightly pulled at center Integrity of Membrane 0 Check entire surface for perforations o Scarring will be present w frequent ear infections 0 Test Hearing Acuity If they are having dif culty hearing perform audiometric testing 0 Pure tones to give quantitative measure of hearing Raise hand when hearing a pitch If no hearing problems use whisper test Whispered Voice Test 0 Stand armslength behind the person 0 Have pt cover ear on side opposite of you Whisper 3 letters numbers or combination 0 Have pt repeat them back 0 Repeat Tuning Fork Tests 0 Measure hearing via Air Conduction or Bone Conduction o Vestibular Apparatus Romberg Test assesses maintenance of standing balance 0 Development Infants and Young Children 0 Top of pinna should match corner of eye 0 10 degree vertical positioning Otoscope Exam 0 O O 0 Use toward end of examination Let child manipulate tool Pull down on pinna and slowly and gently insert tool Test vibratility by pumping a small amount of air in and observe movement in positive and negative pressure changes 0 Test Hearing Acuity O O O Aging Adult Use developmental milestones Listen to parent concern Room should be silent and make a loud noise Newborn Startle and blink re ex 34 months Blinks quite crying 68 Respond to sound and name Preschool school age Audiometry screening Eardrum may be whiter and look thickened High tone impaired hearing may be present Thinks people might be mumbling and feel isolated Abnormal o Conductive hearing loss sound waves are blocked from contact External or middle ear disorders 0 In ammation or obstruction change in TM otosclerosis OOOOOOOO Trisomy 13 Trisomy 18 Trisomy 21 Down syndrome Potter Syndrome Lack of amniotic Fluid and Kidney failure Ear Tag Preacuricular Tags Congenital Ear Deformity Otitis Externa Swimmers Ear O Swelling of canal from irritation ot infection Red swollen and tender Decreases hearing Prevented by rubbing alcohol or 2 acetic acid after swimming Otitis Media In ammation in Mucous Selling and irritation of ossicesDPuruent in ammatory exudates Perforated TM Otosclerosis Spongey bone formation causing a decrease in vibration transmission to the inner ear and xes footplate of stapes in oval window Sensorineural Hearing Loss Damage to the inner ear from prolonged exposure to loud noises and aging Cholesteatoma Epidermal tissue overgrowth in middle eartemporal bone TM perforation may be cause Growth erodes bones and causes hearing loss Chapter 16 Nose Mouth Throat 0 NOSE O O 0 First part of Respiratory System Warms moistens lters air Smell organ CN I transmits signal to temporal lobe Large nasal cavity Extends over back of mouth Divided by the septum Anterior rich vascular network Kiesselbach plexus 0 Common site of nose bleeds Olfactory receptors are on the roof of the nasal cavity in upper third of septum Anterior has course nasal hairs Rest has mucus lining that is ciliated Filters Mucosa is more red than ora Aids in nutrition Paranasal sinuses air lled pockets in cranium Resonators for sound Lighten skull weight Provide mucus Additional Sinuses Frontal Sinuses Develop from 78 years Maxillary Sinuses Present at Birth 0 Reach full size after permanent teeth come in Ethmoid Present at Birth Grow quickly from age 68 Sphenoid Develop after puberty Mouth 0 First segment of digestive system 0 Oral cavity Lips Anterior border transition from outer skin to inner mucosa Palate Arching roof in two parts 0 Hard anterior part made of bone 0 Soft Posterior MM movable Cheeks Side walls of oral cavity Tongue Uvula Free projection hanging down from midline Short Teeth Gums Tongue Salivary Glands Uvula hangs down from middle of soft palate o Tongue is taste sense 0 Salivary Glands Parotid is win cheeks Submndibular is beneath mandible Sublingual is under the tongue and almond shaped Wharton39s Duct up the oor of the mouth Secrete saliva to moisten food and starts digestion o 32 permanent teeth are present Throat o Pharynx is behind the mouth 0 Oropharynx is separate from the mouth Tonsils and masses of lymphoid tissue Anterior Tonsillar Pillar o Nasopharynx continues from oropharynx behind nasal cavity Pharyngeal tonsils are here Eustachian tube opens here 0 Tonsils Mass of granular looking lymphoid tissue w deep crypts Development 0 Infants and Children Salivation starts at 3 months Drools before learning to swallow saliva 20 deciduous teeth are developed in utero and begin to emerge at 624 months 0 All should appear by 25 0 Loss begins at age 6 and ends around 12 0 Central incisors begin 0 Appear in girls rst Nose develops during adolescence 0 Pregnant Nasal stiffness may occur O Increase vascularity Gums are more sensitive and may bleed Peridontal Disease can cause premature labor Aging Adult Nose appears more prominent Nasal hairs are more coarse and tiff Sense of smell diminishes Taste buds reduce Decrease in saliva production 0 Dry mouth occurs sometimes bc of medications Increase in oral infections can occur Teeth erode at the gum line as gums recede W loss of teeth others will move malocclusion 0 Further tooth loss 0 MM imbalance of mandible 0 Stress on TMJ Reduced interest in food and side effects of aging increase risk of malnutrition Culture and Genetics 0 00000 Bi d Uvula is a split uvula 2 of general population 10 of American Indians Cleft Lip and Palate occurs in one in every 600 births Torus Palatinus boney ridge on hard palate Leukoedema Bluish white appearance of buccal mucosa Natal Teeth teeth at birth are rare AA mouth can appear bluish around lips and darkened along gingival margin Whites have more tooth decay AA have harder more dense enamel AA Hispanics NA and AN have poorest dental health AA have highest rate of oral cancers 0 Lower 5 year survival rate 0 Poverty makes this worse Smokeless tobacco Include sugar for promotion of tooth decay Greater risk of oral cancer Pain isn39t early sign of cancer Risks Cancer Fetal myocardial infarcts Stroke Hypertension Decreased sperm count Subjective O Nose Discharge or runny nose 0 Color and Consistency Frequent Colds Unusual amount URI Sinus Pain 0 Chronic Postnasal Drip Trauma To nose Surgery Breathe through nose obstruction in one or both sides Epistaxisnosebleeds Frequency amount of bleeding color nostril Allergies Allergen determination environment use of medications and length of use Altered Smell o Mouth andThroat SoreLesions Duration amount association treatment Sore Throat Strep documentation Tonsil removal SOLDCART Bleeding Gums How long have you had them Toothache Sensitivity to 0 Loss of teeth Hoarseness Voice change How long Reason Dysphagia Pain food stopping at certain point Altered Taste Smoking Alcohol PtCentered Care Dental Care Plan Dentures or appliances 0 How often do you brush and oss Dentures Sores or irritation on gums Problems with talking 0 Additional for Infants and Children Mouth infections or sores Sore throat frequency 0 Teeth eruption on time 0 Dental habits Aging Adult 0 Dry Mouth 0 Loss of teeth ability to chew all types of food Objective Selfca re Denture use 0 Prep Sitting up straight facing you 0 Inspect and Palpate Nose External Nose Symmetric and midline In Proportion to other features Gently papate if there is a deformity Palpate movable nares Piercings NasalCav y Use wide tipped speculum Nasal mucosa should be red smooth and moist Look for septum deviation Inspect the turbinates 0 See middle and inferior o Palpate Sinus Areas Use thumbs and press into eyebrows and over maxillary sinus No pain should be felt Transillumination Not a valid test 0 Inspect the Mouth Begin anteriorly and move posteriorly Lips 0 Look for color moisture cracking lesions Look at inner surface 0 More pink than facial color Teeth and Gums Teeth re ect general health Note decayed absent loose or abnormally positioned teeth Note number of teeth 0 Appropriate for age Note biting pattern Gum line should be pink not bleeding and well de ned Tongue Raisedrough Papillea Venous Pattern Thin white coating Color Surface Moisture Pink and even Touch tongue to roof of mouth to inspect underside Have pt stick tongue out and view both sides Buccal Mucosa Hold cheek open with tongue depressor Palate Color nodules and lesions should be noted Shine light up to roof of mouth Observe the uvula 0 Ask person to say ah and watch uvula rise w phona on o CNX 0 Inspect the Throat Observe tonsils Should be pink Graded in size 0 1 Visible 0 2 Halfway bw Tonsillar Pillar and uvula 0 3 Touching uvula 0 4 Touching one another 1 and 2 are normal Careful not to initiate the gag re ex CN IX and CN X w tongue depressor CN Xll is tested when pt is asked to stick out tongue Note breath odor halitosis Cause by poor oral hygiene Note any other odor smoke alcohol 0 Development Infants and Children Perform at the end Let parent position child Most of the time the child will happily open the whole mouth but when not slide tongue depressor along the cheek and rotate at back teeth to open the mouth and initiate the gag re ex allowing for a brief look Nose Perform at end Milia is common Determine patency of nares in newborn Shape and nasal aring is noted Until 3 months baby s breathe through nose 0 Once 8 palpate sinuses Mouth and Throat o Sucking Tubercle is a normal nding Pad in upper lip created by friction of feeding o Childs age in months 6 should amount of teeth present if under the age of 2 o Bednar aphthae are traumatic ulcers from abrasive sucking OOOOO Pregnant Women Gum hypertrophy may occur Aging Adult Abnormal Teeth may fall out or turn yellow Gum line may recede Nose is more prominent Nasal hairs are coarser Decreased sense of smell bc decrease is olfactory nerve bers 0 Sinus Infection Facial pain usually described as quotthrobbing in cheeks and teeth Redswollen nasal mucosa Swollen turninates Purulent discharge Feverchillsmalaise Pain with palpation o Allergies Itching of nose amp eyes Nasalcongeonn Sneezing Serous edema amp swelling of turbinates Seasonal or perennial Family history Usually solved by OTC medications
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