Head-To-Toe Assessment (M. Nose and Paranasal Sinuses)

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The external portion of the nose is inspected for the following:

1.     Placement and symmetry.
2.    Patency of nares (done by occluding nosetril one at a time, and noting for difficulty in breathing)
3.    Flaring of alaenasi
4.    Discharge

The external nares are palpated for:

1.    Displacement of bone and cartilage.
2.    For tenderness and masses

The internal nares are inspected by heperextending the neck of the client, the ulnar aspect of the examiner’s hard over the fore head of the client, and using the thumb to push the tip of the nose upward while shining a light into the naris.

Inspect for the following:

1.     Position of the septum.
2.    Check septum for perforation. (can also be checked by directing the lighted penlight on the side of the nose, illumination at the other side suggests perforation).
3.    The nasal mucosa (turbinates) for swelling, exudates and change in color.
Paranasal Sinuses

Examination of the paranasal sinuses is indirectly. Information about their condition is gained by inspection and palpation of the overlying tissues. Only frontal and maxillary sinuses are accessible for examination.

By palpating both cheeks simultaneously, one can determine tenderness of the maxillary sinusitis, and pressing the thumb just below the eyebrows, we can determine tenderness of the frontal sinuses.

Normal Findings:

1.    Nose in the midline
2.    No Discharges.
3.    No flaring alae nasi.
4.    Both nares are patent.
5.    No bone and cartilage deviation noted on palpation.
6.    No tenderness noted on palpation.
7.    Nasal septum in the mid line and not perforated.
8.    The nasal mucosa is pinkish to red in color. (Increased redness turbinates are typical of allergy).
9.    No tenderness noted on palpation of the paranasal sinuses.

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• Head-To-Toe Assessment A. Head (Skull, Scalp, Hair) 1. Observe the size, shape and contour of the skull. 2. Observe scalp in several areas by separating the hair at various locations; inquire about any injuries. Note presence of lice, nits, dandruff or lesions. 3. Palpate the head by running the pads of the fingers over the
• Head-To-Toe Assessment (L. Ears) 1. Inspect the auricles of the ears for parallelism, size position, appearance and skin color. 2. Palpate the auricles and the mastoid process for firmness of the cartilage of the auricles, tenderness when manipulating the auricles and the mastoid process. 3. Inspect the auditory meatus or the
• Head-To-Toe Assessment (Q. Breast) Inspection of the Breast There are 4 major sitting position of the client used for clinical breast examination. Every client should be examined in each position. The client is seated with her arms on her side. The client is seated with her arms abducted over the head. The
• Head-To-Toe Assessment N. Cranial Nerve I (olfactory Nerve) To test the adequacy of function of the olfactory nerve: The client is asked to close his eyes and occlude. The examiner places aromatic and easily distinguish nose. (e.g. coffee). Ask the client to identify the odor. Each side
• Head-To-Toe Assessment (D. Eye lids and Lacrimal Apparatus) 1. Inspect the eyelids for position and symmetry. 2. Palpate the eyelids for the lacrimal glands. a. To examine the lacrimal gland, the examiner, lightly slide the pad of the index finger against the client’s upper orbital rim. b. Inquire for any pain or tenderness. 3.