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Clinical Nursing Skills

22.4 Mouth, Throat, Nose, and Sinuses

Clinical Nursing Skills22.4 Mouth, Throat, Nose, and Sinuses

Learning Objectives

By the end of this section, you will be able to:

  • Describe the structures and functions of the mouth, throat, nose, and sinuses
  • Understand how to perform a nursing assessment of the mouth, throat, nose, and sinuses
  • Verbalize different abnormalities of the mouth, throat, nose, and sinuses

The intricate web of structures comprising the mouth, throat, nose, and sinuses is a testament to the remarkable complexity of the human body. These interconnected systems serve as more than mere conduits for air, food, and sound. They orchestrate essential functions that encompass everything from nourishment and communication to protection and sensory perception. Understanding the anatomy of the body’s structures is crucial for performing an effective and accurate physical assessment. When conducting assessments of the mouth, throat, nose, and sinuses, knowledge of their anatomy guides the nurse in using appropriate techniques and interpreting findings.

Structures and Function

To perform an accurate assessment of the mouth, throat, nose, and sinuses, it is important to understand their structure and functions. By aligning assessment techniques with the anatomy of these structures, nurses can gather meaningful information, detect abnormalities, and initiate appropriate interventions. Furthermore, this understanding helps differentiate between normal anatomical variations and potential signs of health issues, ensuring a comprehensive and accurate assessment.

Mouth

The mouth, also known as the oral cavity, is a key anatomical feature located at the opening of the digestive and respiratory tracts. It is composed of lips, teeth, jaws, tongue, palate, uvula, and salivary glands. The lips enclose the entrance to the mouth and are richly supplied with sensory nerves for touch and temperature sensation. The masseter muscle is the main muscle used for chewing because it elevates the mandible (lower jaw) to close the mouth. It is assisted by the temporalis muscle that retracts the mandible. The temporalis muscle can be felt moving by placing fingers on the patient’s temple as they chew (Figure 22.29).

A diagram of the jaw muscles (superficial and deep).
Figure 22.29 Masseter and temporalis muscles found in the jaw are used for chewing. (credit: modification of work from Anatomy and Physiology. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Teeth are hard structures used for biting and chewing food. They play a role in breaking down food into smaller pieces for digestion. The tongue is a muscular organ that aids in tasting, swallowing, and speaking. It is covered with taste buds that help distinguish between different flavors. The palate consists of the hard palate (bony anterior portion) and the soft palate (muscular posterior portion). The soft palate helps close off the nasal passages during swallowing to prevent food from entering the nose. The uvula is a small, fleshy mass that hangs from the back of the soft palate. It plays a role in speech and the closing of the nasal passages during swallowing. Salivary glands produce saliva, which helps break down food, aids in swallowing, and contains enzymes that start the process of digestion.

The mouth is a multifunctional structure involved in various important activities such as eating, tasting, speaking, and initiating digestion. The mouth is the starting point of the digestive process. It receives food and beverages, which are broken down into smaller pieces by chewing. Teeth are used to chew and grind food into smaller pieces that are easier to digest. The tongue contains taste buds that detect different flavors: sweet, sour, salty, bitter, and savory. The mouth’s sensory receptors also help us detect temperature and texture.

The tongue, lips, and other oral structures are essential for forming speech sounds and producing language. Salivary glands in the mouth produce saliva, which moistens food, begins the digestion of starches through enzyme action, and helps lubricate the mouth and throat. The mouth also has immune defenses that help prevent infections, such as antibodies contained in saliva that fight harmful bacteria.

Throat

The pharynx, or throat, is a tube-lined mucous membrane that begins at the nasal cavity and is divided into three major regions: nasopharynx, oropharynx, and laryngopharynx (Figure 22.30). The pharynx’s structure allows it to serve as a conduit for both air and food and participate in breathing, swallowing, speech production, and protection of the airway.

A diagram of the parts of the throat.
Figure 22.30 The throat (or pharynx) makes up a large area of the head and neck. It can be divided into three areas: nasopharynx, oropharynx, and laryngopharynx. (credit: modification of work from Anatomy and Physiology. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

The nasopharynx is the upper portion of the throat, located behind the nasal cavity. It is primarily responsible for conducting air and allowing the passage of air during breathing. At the top of the nasopharynx is the pharyngeal tonsil, commonly referred to as the adenoids. The adenoids are lymphoid tissues that trap and destroy invading pathogens that enter during inhalation.

The oropharynx is the middle portion of the throat, located behind the mouth. It serves as a passageway for both air and food as well as being involved in speech and taste. The oropharynx contains two sets of tonsils, the palatine and lingual tonsils. The palatine tonsil is located laterally in the oropharynx, and the lingual tonsil is located at the base of the tongue. Similar to the pharyngeal tonsil, the palatine and lingual tonsils are composed of lymphoid tissue and trap and destroy pathogens entering the body through the oral or nasal cavities.

The laryngopharynx is the lower portion of the throat, located behind the larynx. It acts as a pathway for food and air, leading to the esophagus and trachea, respectively. The larynx connects the pharynx to the trachea and helps regulate the volume of air that enters and leaves the lungs. It also contains the vocal cords that vibrate as air passes over them to produce the sound of a person’s voice. The epiglottis is a flexible piece of cartilage that covers the opening of the trachea during swallowing to prevent ingested material from entering the trachea.

Nose

The nose is a prominent facial feature with a complex structure that serves various functions. It consists of both external and internal components. External components of the nose include the nasal bridge and nostrils. The nasal bridge is the upper part of the nose, formed by the nasal bones and the frontal bone. While the bridge is formed by bones, the protruding portion that composes what we see as “the nose” is made of cartilage. Nostrils, also called nares, are the openings through which air enters the nasal passages. Internal components of the nose include the nasal septum, nasal cavities, and turbinates. The nasal septum is the internal wall, composed of bone and cartilage, that divides the nose into left and right nostrils. Nasal cavities are hollow spaces behind the nostrils that are lined with mucous membranes and extend to the back of the throat. Turbinates, also known as nasal conchae, are bony structures covered in mucous membranes that protrude into the nasal cavities and help to humidify and filter the air.

The nose serves multiple important functions, including facilitating breathing, detecting smells, influencing speech, contributing to immune defense, and aiding in temperature regulation. As air passes through the nasal passages, it gets warmed, humidified, and filtered by the mucous membranes and turbinates, which prepares the air for entry into the lungs. The olfactory epithelium in the upper part of the nasal cavities contains specialized receptors that allow us to detect and perceive different scents (smell or olfaction). The information about smells is transmitted to the brain, contributing to the sense of taste (gustation). The shape of the nasal passages and the resonance chambers within the nasal cavities influence voice quality. The mucous membranes lining the nasal passages produce mucus that traps dust, microbes, and other particles. Cilia (tiny hairlike structures) move the mucus toward the throat, where it is swallowed and neutralized by stomach acids. The blood vessels in the nasal cavities help regulate the temperature of the air breathed in. As the air passes through the nasal passages, it exchanges heat with the blood vessels, helping to maintain a stable body temperature.

Sinuses

The paranasal sinuses are a group of air-filled spaces within the bones of the face and skull, located around the nose and above the eyes. The sinuses connect to the nasal cavity and are lined with nasal mucosa. The sinuses help reduce the overall weight of the skull, making it easier for the neck muscles to support the head and allowing us to move our heads more freely. They may play a role in modifying the resonance and quality of the voice. For example, when a person has a cold or sinus congestion, the mucosa swells and obstructs the nasal passage, which may lead to the person sounding “stopped up.” The air inside the sinuses helps insulate the sensitive structures in the skull, such as the eyes and brain, from temperature fluctuations. As air passes through the nasal passages, it is warmed and moistened by the mucous membranes lining the sinuses and nasal cavities, which helps protect lung tissues from cold, dry air. The sinuses also produce mucus, which can trap airborne particles, such as dust and microbes, from entering the cranial cavity.

The paranasal sinuses are named after the bones in which they are located (Figure 22.31). The main types of sinuses are as follows:

  • Frontal sinuses: Located in the forehead bone (frontal bone).
  • Maxillary sinuses: Situated in the cheekbones (maxilla), below the eyes.
  • Ethmoid sinuses: Found between the eyes, within the ethmoid bone. These sinuses are composed of numerous small compartments.
  • Sphenoid sinuses: Located deep within the skull, behind the ethmoid sinuses and between the eyes.
A diagram showing the anterior and lateral view of the sinuses.
Figure 22.31 The paranasal sinuses are named after the bones in which they are located. (credit: modification of work from Anatomy and Physiology. attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)

Nursing Assessment: Inspection and Palpation

Nursing assessment forms the cornerstone of effective patient care, allowing healthcare professionals to gather crucial information about a patient’s health status. When it comes to the examination of the mouth, throat, nose, and sinuses, thorough inspection and palpation play vital roles in unveiling potential abnormalities and guiding appropriate interventions. Through observation and touch, nurses can identify signs of discomfort, infection, inflammation, and other issues that may affect a patient’s overall well-being.

Collecting Subjective Data

Begin the mouth, throat, nose, and sinuses assessment by asking focused interview questions to determine whether the patient is currently experiencing any symptoms or has a previous medical history related to mouth, throat, nose, and sinus issues. Common interview questions to collect subjective assessment data of the mouth, throat, nose, and sinuses can be found in Table 22.4.

Interview Questions Follow-up
Have you ever been diagnosed with a medical condition related to your mouth, such as tooth decay, gingivitis, oral thrush, or cold sores? If yes, please describe with details such as what condition, when, frequency, symptoms, and medical treatment provided.
Have you ever been diagnosed with a medical condition related to your throat, such as strep throat, tonsillitis, pharyngitis, or gastroesophageal reflux disease (GERD)? If yes, please describe with details such as what condition, when, frequency, symptoms, and medical treatment provided.
Have you ever been diagnosed with a medical condition related to your nose or sinuses, such as sinusitis, rhinitis, nasal polyps, deviated septum, or broken nose? If yes, please describe with details such as what condition, when, frequency, symptoms, and medical treatment provided.
Are you currently taking any medications, herbs, or supplements for allergies, sore throat, or mouth sores? If yes, please describe what you take, dose, frequency, route, and if medication is effective.
Have you had any symptoms such as nosebleeds, nasal drainage, sinus pressure, or sore throat? If yes, use the PQRSTU method to gather additional information regarding each symptom.
Specific oral assessment questions:
  • Are you having any pain, bleeding, or other problems with your teeth or gums?
  • Do you have any loose or sensitive teeth?
  • Do you experience bleeding after brushing or flossing your teeth?
  • Are you wearing dentures? Do they fit properly?
  • Are you experiencing bad breath that will not go away?
  • Have your eating patterns changed due to mouth pain or discomfort with chewing?
Table 22.4 Interview Questions for Subjective Assessment of the Mouth, Throat, Nose, and Sinuses

Life-Stage Context

Changes in Smell and Taste

Aging can bring about various changes in the senses, including smell and taste. These changes are often part of the natural aging process and can impact an individual’s overall quality of life. Examples of how smell and taste can be affected by aging include the following:

Smell (olfaction):

  • Reduced sensitivity: As people age, the number of olfactory receptors in the nose can decrease, leading to reduced sensitivity to odors.
  • Loss of discrimination: The ability to distinguish between different smells might decline; therefore, people may find it challenging to identify subtle scents or differentiate between similar odors.
  • Impact on safety and enjoyment: A reduced sense of smell can affect safety, as individuals may have difficulty detecting spoiled food, gas leaks, or smoke. It can also impact the enjoyment of food and the appreciation of fragrances.

Taste (gustation):

  • Decline in taste buds: With age, the number of taste buds on the tongue may decrease, affecting the ability to taste flavors fully.
  • Diminished taste sensitivity: Some older adults may experience reduced taste sensitivity, making it harder to detect subtle flavors like sweetness, bitterness, sourness, and saltiness.
  • Medication effects: Certain medications can alter taste perceptions and lead to a metallic or bitter taste in the mouth, affecting the enjoyment of food.

It is important to note that not all individuals will experience the same extent of changes in smell and taste, and some people might retain their sensory abilities well into old age. Additionally, the interaction between smell and taste means that changes in one sense can influence the other. Maintaining a balanced and nutritious diet, staying hydrated, and practicing good oral hygiene can help mitigate some of the challenges associated with changes in smell and taste.

Collecting Objective Data

During a thorough assessment of the mouth, throat, sinuses, and nose, inspection is a critical step to visually examine these structures for any abnormalities, inflammation, lesions, or signs of infection. Examination of the mouth includes assessing the lips for dryness, cracks, ulcers, or lesions. Ask the patient to open their mouth and say “Ah.” This step is important because it raises the posterior palate and uvula and depresses the back of the tongue, allowing a clear view of the throat. Using a good light and tongue blade, inspect the oral mucosa, gums, cheeks, tongue, and floor of the mouth for redness, swelling, white patches, or other abnormalities. Use a gloved hand to retract the lips and cheeks to fully examine the gums and teeth. Assess the teeth for cavities, staining, decay, or missing teeth. If the patient wears dentures, remove them so you can assess the underlying mucosa. Note the color of the gums, which are normally pink. Inspect the gum margins for swelling, bleeding, or ulceration. Assess for loose teeth with a gloved thumb and index finger, and note if halitosis (bad breath) is present. Observe the tongue’s color, texture, and any coating. Check for any lesions, bumps, or abnormal movements. Inspect the hard and soft palate for any growths, ulcers, or color changes. Examine the tonsils for size, redness, exudates, or tonsillar enlargement. Observe the uvula’s position and any swelling or deviation. It should be midline and should rise symmetrically when the patient says “Ah.” Check for any swelling or tenderness of the salivary glands, such as the parotid and submandibular glands. Assess if the patient is able to swallow their own secretions. If the patient has had a recent stroke or you have any concerns about their ability to swallow, perform a brief bedside swallow study according to agency policy before administering any food, fluids, or medication by mouth.

Examination of the throat includes using a tongue depressor and light to visualize the pharynx. Assess for redness, swelling, exudates, or any abnormalities. Gently press down on the tongue with the tongue depressor and ask the patient to say “Ah” while observing the movement of the structures.

Examination of the sinuses includes inspecting the face for any visible swelling or puffiness, especially around the eyes, which can indicate sinus congestion. Check for any tenderness, deformities, or fractures on the nasal bridge. Gently press on the sinus areas (forehead, cheeks) to assess for tenderness or pain.

Examination of the nose includes observing the external nose for any deformities, asymmetry, swelling, or skin changes. Use a nasal speculum and light to inspect the nasal passages. Look for any redness, swelling, or discharge. Inspect the nose for patency, and note any nasal drainage. Assess the nasal septum for any deviation, perforation, or bleeding. Examine the nasal turbinates for any congestion, color changes, or polyps. If there is suspicion of a nasal fracture, gentle palpation can help assess for tenderness, crepitus (crackling sensation), or deformities along the nasal bridge. In cases of suspected sinusitis or sinus discomfort, gentle palpation can be applied to the sinus areas (forehead, cheeks) to check for tenderness, which can indicate inflammation.

Validating and Documenting Findings

Validating and documenting assessment findings of the mouth, throat, nose, and sinuses are essential steps in the nursing process, ensuring accurate communication and informed decision-making. Validation involves cross-referencing subjective and objective findings to ensure the data collected are reliable and accurate. Data may be validated by repeating the assessment, asking additional questions to clarify data, and comparing the objective findings with the subjective findings to determine if any discrepancies are present. For example, additional assessment and questioning may be warranted if the patient reports brushing their teeth twice daily, however, poor dentition, plaque, and bad breath are noted.

Documentation provides a clear record of the patient’s condition for future reference and collaboration among healthcare providers. Documentation should include both subjective and objective data. Table 22.5 provides examples for documenting subjective and objective findings.

Subjective Data Objective Data
Collected by asking the patient about their health history Collected through the physical assessment
Include direct quotes when possible Include the facts
Examples of documentation:
“Patient reports sinus pressure and nasal congestion lasting four days.”
“Patient reports history of cold sores.” “Patient reports brushing teeth twice daily.” “Patient complains of sore throat ‘that feels like swallowing razor blades’ for the past two days.”
Examples of documentation:
“Oral mucosa is pink and moist.”
“Tonsils are symmetrical, no swelling or exudates observed.”
“Uvula is midline position, no swelling or deviation noted.”
“No tenderness noted upon gentle palpation of sinus areas.”
Table 22.5 Documenting Subjective and Objective Data

Abnormalities of the Mouth, Throat, Nose, and Sinuses

When conducting a health assessment, it is important to be able to recognize abnormalities of the mouth, throat, nose, and sinuses. These regions are not only central to our ability to breathe, speak, and consume food, but they also provide insights into our overall well-being. Abnormalities of the mouth, throat, nose, and sinuses encompass a diverse range of conditions, from common issues to more complex medical concerns. Identifying abnormalities allows healthcare professionals to detect potential issues early, enabling timely intervention and treatment.

Abnormalities of the Mouth and Throat

Abnormalities of the mouth and throat can encompass a wide range of conditions, each with its own causes, symptoms, and implications. These abnormalities can result in various symptoms, including pain, difficulty swallowing, hoarseness, and in some cases, life-threatening conditions. Accurate assessment and appropriate intervention by nurses is essential for managing and mitigating these conditions.

Mouth Abnormalities

Some common abnormalities that can be observed during a physical examination of the mouth include the following:

  • Oral ulcer: A painful sore on the lips, tongue, gums, or inside the cheeks, called an oral ulcer can be caused by conditions like oral herpes, aphthous stomatitis, or infections.
  • Leukoplakia: Thickened, white patches on the oral mucosa, called leukoplakia, may be a sign of irritation, fungal infections, or precancerous lesions.
  • Erythroplakia: Red patches on the oral mucosa that do not heal, called erythroplakia, may indicate potential precancerous changes or oral cancer.
  • Candidiasis (thrush): A fungal infection that appears as white patches that can be scraped off is called candidiasis (also, thrush); it is often seen in immunocompromised individuals (Figure 22.32).
    A photo of a man’s tongue with white patches due to candidiasis.
    Figure 22.32 Candidiasis (oral thrush) is a fungal infection that results in white patches on the tongue and in the mouth. Treatment includes antifungal medications (such as clotrimazole, miconazole, or nystatin), proper oral hygiene, and managing underlying conditions. (credit: "Clinical photograph showing typical presentation of oral thrush (white curdy patches in dorsum of tongue)" by National Library of Medicine, CC BY 2.0)
  • Oral cancer: Lesions that do not heal, bleeding, changes in color, or lumps can be signs of oral cancer. Oral cancer often forms on the floor of the mouth, under the tongue.
  • Cleft lip: A cleft lip is a birth defect that involves a partial or complete failure of the right and left portions of the upper lip to fuse together, leaving a cleft (gap) (Figure 22.33a).
  • Cleft palate: A cleft palate is a birth defect resulting from a failure of the two halves of the hard palate to completely come together and fuse at the midline, thus leaving a gap between the nasal and oral cavities (Figure 22.33b). Because of the communication between the oral and nasal cavities, a cleft palate makes it very difficult for an infant to generate the suckling needed for nursing, thus creating risk for malnutrition. Surgical repair is required to correct a cleft palate.
    On the left, a photo of a child with a cleft lift. On the right, an image of a cleft palate.
    Figure 22.33 (a) A cleft lip is caused by failure of the lips to fuse together; (b) a cleft palate is caused by failure of the hard palate to fuse together. (credit a: modification of work “Cleft lip child” by “Raj d0509”/Wikimedia Commons, Public Domain; credit b: modification of work “Cleft palate” by Centers for Disease Control and Prevention/Wikimedia Commons, CC BY 1.0)

Other abnormalities of the mouth relate to poor oral health. Poor oral health can manifest in various signs and symptoms, indicating potential issues with dental hygiene, gum health, and overall oral well-being. Common signs of poor oral health include the following:

  • Halitosis: Persistent bad breath, even after brushing and using mouthwash, is known as halitosis; it can be a sign of oral health problems like gum disease or cavities.
  • Tooth decay: Visible cavities or holes in the teeth, along with sensitivity to hot, cold, or sweet foods, can indicate tooth decay.
  • Gum disease: Gums that bleed when brushing or flossing are often an early sign of gum disease. Inflammation of the gums can indicate gingivitis or more advanced periodontal disease. Gums that pull away from the teeth, exposing the tooth roots, are a sign of gum recession and potential periodontal problems.
  • Tooth sensitivity: Sharp pain or discomfort, tooth sensitivity, when consuming hot, cold, sweet, or acidic foods and beverages can indicate enamel erosion or gum recession.
  • Tooth mobility: If teeth feel loose or shift position, showing tooth mobility, it could be due to advanced gum disease affecting the tooth-supporting structures.
  • Persistent toothache: Unexplained and persistent toothache can be a sign of infection or decay.
  • Discolored teeth: Stained or discolored teeth, especially in the absence of lifestyle factors like coffee or tobacco use, could indicate poor oral hygiene or other issues.
  • Dry mouth: Reduced saliva production can lead to dry mouth, which increases the risk of tooth decay and gum problems.
  • Foul taste: A persistent foul taste in the mouth, even after brushing, can be a sign of underlying oral health problems.

Maintaining good oral hygiene practices, including regular brushing, flossing, and dental checkups, can help prevent these signs of poor oral health. Because many Americans lack access to oral care, it is important for nurses to perform routine oral assessment and identify needs for follow-up. If signs and/or symptoms indicate potential oral disease, the patient should be referred to a dental health professional for a more thorough evaluation.

Throat Abnormalities

The following are some common abnormalities that can be observed during a physical examination of the throat:

  • Enlarged tonsils: There are four main types of tonsils: the palatine tonsils (located laterally between the palatoglossal arch and the palatopharyngeal arch), pharyngeal tonsils (known as adenoids; located at the superior part of the nasopharynx), lingual tonsils (located at the posterior base of the tongue), and tubal tonsils (located posterior to the pharyngeal opening of the auditory tube in the nasopharynx). Infections like tonsillitis or chronic inflammation can cause enlarged tonsils. Tonsil grading involves a systematic evaluation of the tonsils’ size, ranging from 0 to 4+ (Figure 22.34). Grade 0 indicates previous tonsillectomy, grade 1 indicates normal size, grade 2 indicates mild enlargement, grade 3 indicates moderate enlargement, and grade 4 indicates severe enlargement.
    A diagram showing different sizes of tonsils.
    Figure 22.34 Tonsillar grading is based on the location of the tonsils in comparison to the uvula pillars. (attribution: Copyright Rice University, OpenStax, under CC BY 4.0 license)
  • Tonsillar exudates: White or yellow patches on the tonsils, called tonsillar exudate can indicate bacterial infections like strep throat.
  • Pharyngitis: Redness, swelling, and discomfort in the pharynx can be due to viral or bacterial infections. Common causes of pharyngitis are the cold viruses, influenza, strep throat caused by group A streptococcus, and mononucleosis. Strep throat typically causes white patches on the tonsils with a fever and enlarged lymph nodes. It must be treated with antibiotics to prevent potential complications in the heart and kidneys.
  • Peritonsillar abscess: A peritonsillar abscess is a collection of pus behind the tonsils that can cause severe sore throat, difficulty swallowing, and voice changes.
  • Laryngitis: In laryngitis, there is inflammation of the vocal cords causing hoarseness, loss of voice, or changes in voice quality.
  • Epiglottitis: The condition epiglottitis involves swelling of the epiglottis causing difficulty breathing, pain, and a muffled voice; it requires immediate medical attention.
  • Gastroesophageal reflux disease (GERD): Chronic acid reflux, gastroesophageal reflux disease (GERD) can lead to irritation of the throat, causing hoarseness, cough, and throat discomfort.
  • Throat cancer: Persistent throat pain, difficulty swallowing, hoarseness, or changes in voice can indicate throat cancer.

Other abnormalities of the throat include difficulty swallowing. Dysphagia is the medical term for difficulty swallowing that can be caused by many medical conditions. Nurses are often the first healthcare professionals to notice a patient’s difficulty swallowing as they administer medications or monitor food intake. Signs of dysphagia include coughing during or right after eating or drinking, wet or gurgly sounding voice during or after eating or drinking, extra effort or time required to chew or swallow, food or liquid leaking from mouth, food getting stuck in the mouth, and difficulty breathing after meals. Early identification of dysphagia, especially after a patient has experienced a cerebrovascular accident (e.g., stroke) or other head injury, helps to prevent aspiration pneumonia. Aspiration pneumonia is a type of lung infection caused by material from the stomach or mouth entering the lungs, and this can be life threatening. If dysphagia is suspected, a bedside swallow screening can be conducted to determine if clinical signs and symptoms that may be indicators of dysphagia are present. If the patient fails the bedside swallow screen, they should remain nothing by mouth (NPO) until further evaluation by a speech therapist.

Abnormalities of the Nose and Sinuses

In epistaxis, commonly known as a nosebleed, there is bleeding from the blood vessels within the nasal passages. It is a relatively common condition that can occur in people of all ages. Nosebleeds can range from mild to more severe and can be caused by various factors, such as dry air, nasal trauma, nasal irrigation (such as allergies, sinus infections, exposure to irritants like smoke or chemicals), overuse of nasal decongestant sprays, blood-thinning medications (like aspirin, anticoagulants, and antiplatelets), nasal polyps, hypertension, or foreign objects being inserted into the nose. To treat a nosebleed, encourage the individual to stay calm (as anxiety can worsen the bleeding), have them sit upright and lean forward slightly (to avoid swallowing blood), pinch the soft part of the nostrils together, and instruct them to breathe through the mouth for about ten to fifteen minutes. Applying a cold compress to the nose and forehead can help constrict blood vessels and slow bleeding. Using a humidifier can help prevent nasal dryness, reducing the risk of further bleeding. Advise the individual to avoid activities that can further irritate the nose, such as picking or blowing the nose forcefully. Continued bleeding may require vasoconstrictor nose spray, cautery with silver nitrate, topical sealants or glue, nasal packing, or balloon catheters.

A deviated septum is a common medical condition where the thin wall (nasal septum) that separates the two nasal passages is displaced or shifted to one side. This displacement can be present from birth or can result from injury or trauma to the nose. A deviated septum can cause one nasal passage to be narrower than the other, potentially affecting airflow through the nose. Symptoms of a deviated septum include nasal obstruction (one side of the nose may have reduced airflow), nasal congestion (chronic nasal congestion on one side), recurrent sinus infections (due to poor drainage), nosebleeds (due to dryness and irritation caused by airflow imbalance), and sleep disturbances (disruption in sleep and snoring). For mild cases with minimal symptoms, treatment may not be necessary. However, for more severe cases that cause significant discomfort or breathing difficulties, treatment options may include over-the-counter decongestants or nasal sprays or surgical correction, known as septoplasty.

Real RN Stories

Nasogastric Tube Issue

Nurse: Marcia, RN
Clinical setting: Medical-surgical inpatient unit
Years in practice: 9
Facility location: Seattle, Washington

I was caring for a patient with a small bowel obstruction who needed a nasogastric (NG) tube placed for bowel decompression. I checked patency of both nares and found the right nare to be the most patent. I got all of my supplies ready and went to insert the NG tube in the right nare, without success. After a second failed attempt, I attempted to insert it into the left nare. Another failed attempt. We let the patient rest for a little bit, and then I asked my charge nurse to try to insert it, who was also unsuccessful. After consulting with the provider, an order was placed for the NG tube to be placed by the radiology department. Come to find out, the patient had an undiagnosed deviated septum, making it extremely difficult to insert the NG tube.

The medical diagnosis for inflamed sinuses that can be caused by a viral or bacterial infection is sinusitis. When the nasal membranes become swollen, the drainage of mucous is blocked and causes pain. There are several types of sinusitis:

  • acute sinusitis: infection lasting up to four weeks
  • chronic sinusitis: infection lasting more than twelve weeks
  • recurrent sinusitis: several episodes of sinusitis within a year

Symptoms of sinusitis can include fever, weakness, fatigue, cough, and congestion. There may also be mucus drainage in the back of the throat, called postnasal drip. Healthcare providers diagnose sinusitis based on symptoms and an examination of the nose and face. Treatments include antibiotics, decongestants, and pain relievers.

Other abnormalities of the nose include the following:

  • Nasal polyps: A nasal polyp is a noncancerous growth that develops inside the nasal passages or sinuses. Nasal polyps can cause nasal congestion, difficulty breathing, and reduced sense of smell.
  • Rhinitis: Allergic rhinitis and nonallergic rhinitis involve inflammation of the nasal passages, leading to symptoms like sneezing, runny or stuffy nose, and itching.
  • Nasal fractures: Trauma to the nose can result in a nasal fracture, causing deformities, pain, and breathing difficulties.
  • Nasal congestion: Chronic nasal congestion can be caused by various factors, including allergies, infections, or structural issues.
  • Nasal obstruction: Any nasal obstruction or blockage that hinders airflow through the nasal passages can cause breathing difficulties.
  • Nasal discharge: Unusual or persistent nasal discharge can be a sign of infections, allergies, or other underlying conditions.
  • Nasal deformities: Various congenital or acquired conditions can lead to structural nasal deformity

Treatment options for these conditions vary depending on the specific condition and its impact on breathing, comfort, and overall health.

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