{"id":304,"date":"2021-09-29T10:09:53","date_gmt":"2021-09-29T14:09:53","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/oral-cavity-inspection-and-palpation\/"},"modified":"2024-06-06T16:41:45","modified_gmt":"2024-06-06T20:41:45","slug":"oral-cavity-inspection-and-palpation","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/oral-cavity-inspection-and-palpation\/","title":{"raw":"Oral Cavity - Inspection and Palpation","rendered":"Oral Cavity &#8211; Inspection and Palpation"},"content":{"raw":"<p style=\"text-align: left\"><span style=\"color: #000000\">Usually the client is positioned sitting upright; newborns or young children can be held by their parent\/caregiver. Wear gloves because this assessment involves contact with body fluids from the mucus membranes. You will also need a tongue depressor and a penlight.<\/span><\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>I<span style=\"color: #000000\">nspection of Lips<\/span><\/strong><\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Inspect the lips for swelling, colour, lesions, or <strong>[pb_glossary id=\"480\"]malformations[\/pb_glossary]<\/strong>.\u00a0Also inspect the lips for moisture and texture, which are interrelated.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">The steps for this are as follows:<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Identify any <strong>presence<\/strong> and <strong>location<\/strong> of <strong>swelling<\/strong> and <strong>redness<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">These two findings are often associated. You must respond immediately if you suspect the swelling is associated with anaphylaxis. For example, do they have allergies, such as food or bees, or have they recently had a vaccine? Do they have other signs of anaphylaxis (e.g., hives, pruritus, dyspnea, dysphagia, tachycardia, hypotension)?<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Note the <strong>colour<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Lip colour varies based on the client\u2019s skin colour. It can range from pink to brown tones. Note any lip discolouration (e.g., redness, cyanosis, pallor).\u00a0Cyanosis\u00a0<span style=\"font-size: 1em\">can appear as a grey\/white shade in people with darker skin (Lewis, 2020; Sommers, 2011) or as a dusky bluish\/purple shade in people with lighter skin (Lewis, 2020). <\/span><span style=\"font-size: 1em\">Pallor\u00a0<\/span><span style=\"font-size: 1em\">can appear as a grey shade in people with darker skin (Lewis, 2020) or as a generalized pale discolouration in people with lighter skin.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Identify the <strong>presence, location, size<\/strong>, and <strong>description<\/strong> of any <strong>lesions<\/strong> and <strong>malformations<\/strong>, including the <strong>colour<\/strong> and <strong>presence of any discharge<\/strong>.<\/span><\/p>\r\n\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">If you identify a lesion, ask the client whether they have noticed it, how long they have had it, whether they know the cause, and if they have treated it with anything.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\"><span style=\"font-size: 1em\">A common lesion on the lips is herpes simplex virus (cold sore) which appear as small, fluid-filled blisters, see <strong>Figure 2<\/strong>. Another common malformation of the lip is a <strong>[pb_glossary id=\"482\"]cleft lip[\/pb_glossary]<\/strong> (<\/span><\/span><span style=\"text-align: initial;font-size: 1em\"><span style=\"font-size: 1em\">which is sometimes associated with a <strong>[pb_glossary id=\"484\"]cleft palate[\/pb_glossary]<\/strong>). These\u00a0<\/span><\/span><span style=\"text-align: initial;font-size: 1em\">are important to assess and act upon because they can affect a client\u2019s breathing, speaking, and sucking and swallowing associated with eating. They are often surgically repaired at a young age. Further information and images for cleft lip and palate can be found at: <\/span><\/span><a href=\"https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/cleftlip.html\" target=\"_blank\" style=\"font-size: 1em\" rel=\"noopener\">https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/cleftlip.html<\/a><\/li>\r\n<\/ul>\r\n<div style=\"text-align: left\"><span style=\"color: #000000\">4. <span style=\"font-size: 1em\">Note\u00a0<\/span><span style=\"font-size: 1em\">the <strong>moisture<\/strong> and <strong>texture<\/strong>.<\/span><\/span><\/div>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Are\u00a0<span style=\"font-size: 1em\">the lips moist or dry? Moist lips are smooth with no cracking. Dry lips are chapped and\/or may have fissures. Chapped lips are flaky and sometimes red, with \u201cflakes\u201d or \u201cscales\u201d of skin peeling away from the lips. Fissures are usually called \u201ccracked lips.\"<\/span><\/span><\/li>\r\n<\/ul>\r\n<div style=\"text-align: left\"><span style=\"color: #000000\">5. Note <span style=\"font-size: 1em\">the <strong>findings<\/strong>.<\/span><\/span><\/div>\r\n<ul>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Normal\u00a0findings: \u201cLips are moist with no cracking, lesions, or swelling, pink in colour with generalized brown tones, no discolouration.\u201d<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings: \u201cLips are dry with cracking, a red lesion on upper lip left of midline 3mm x 3 mm with a slight serous discharge.\u201d<\/span><\/li>\r\n<\/ul>\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2021\/09\/HerpesPHIL_1573_lores.jpeg\" alt=\"A person with herpes (cold sore) on the left side of their lower lip.\" width=\"300\" height=\"208\" class=\"alignnone size-medium wp-image-2150\" \/>\r\n\r\n<span style=\"color: #000000\"><strong>Figure 2<\/strong>: Herpes simplex virus (cold sore) on the lower lip.<\/span>\r\n<p style=\"font-weight: 400\"><span style=\"color: #000000\">(Attribution: Photo Public Domain,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=8011415\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=8011415<\/a>)<\/p>\r\n\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspection of Oral Mucosa<\/strong><\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Systematically inspect all parts of the mucosa. Shine a penlight in the mouth to illuminate the area. You can ask the client to pull their top lip up and then their bottom lip down, or use a gloved hand or tongue depressor to perform this action so you can inspect the mucosa on the inside of the lips.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Most clients can open their mouth wide and tip their head back so that you can observe the palate and also put the tip of their tongue behind their front teeth so that you can observe the floor of the mouth and under the tongue. You can use a tongue depressor to expose the buccal mucosa. To expose the pharynx, ask the client to stick their tongue out and say \u201cahhh\u201d or pretend to yawn. You may need to use the tongue depressor to press the tongue down. If so, avoid using it in the middle of the tongue as this may elicit a gag reflex.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection of the mucosa of the oral cavity includes observing the insides of the lips and the buccal mucosa (inside of checks), the tongue, the floor of mouth (under the tongue) and the hard and soft palate, the pharynx, and salivary glands. See <strong>Figure 3<\/strong>\u00a0for anatomical locations of the oral cavity.<\/span><\/p>\r\n<img src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2022\/01\/Mouth-by-Jennifer-Lapum-and-Arina-Bogdan-1024x560.jpeg\" alt=\"Inside side of an individual's mouth.\" width=\"1024\" height=\"560\" class=\"alignnone size-large wp-image-1957\" \/>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 3<\/strong>: Anatomical locations of oral cavity.<\/span><\/p>\r\n&nbsp;\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Use the following steps:<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Note <strong>moisture<\/strong> or <strong>dryness<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">whole oral cavity should be moist. Dry mucous membranes are often a sign of dehydration. However, you should also assess if the client may be a person who breathes through their mouth and not their nose. You will notice tiny ductal openings (about 1 mm in size) of the salivary glands. These glands produce saliva for the mouth and include the parotid (ductal opening on the buccal mucosa near the upper second molar), the submandibular (ductal opening at the base of the ventral surface of the tongue on both sides of the frenulum), and the sublingual (several ductal openings on both side of the floor of the mouth).<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Inspect\u00a0the <strong>mucosa of the lips<\/strong> and <strong>buccal mucosa<\/strong> for <strong>colour, lesions, swelling<\/strong>, and <strong>[pb_glossary id=\"486\"]nodules[\/pb_glossary]<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">The\u00a0mucous membranes, including the mucosa of the lips and buccal mucosa, are pink in colour. Any discolourations (e.g., cyanosis or pallor) should be described and the location noted. Cyanosis can appear as a grey\/white shade in people with darker skin (Lewis, 2020; Sommers, 2011) or as a dusky bluish\/purple shade in people with lighter skin (Lewis, 2020). Pallor appears as a grey shade in people with darker skin or as a generalized pale discolouration in people with lighter skin.<\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">mucosa of the lips and buccal mucosa are intact with a smooth surface. Note the description and location of any lesions, swelling, or nodules. Palpate any lesions, swelling, or nodules and identify the consistency (e.g., soft or hard).<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Inspect\u00a0the <strong>tongue, floor of the mouth<\/strong>, and <strong>hard<\/strong> and <strong>soft palate<\/strong> for <strong>colour, lesions, swelling, nodules<\/strong>, and <strong>malformations<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Note\u00a0<span style=\"font-size: 1em\">the colour and any discolourations along with the location. The tongue is normally pink with a dotted surface that is most readily seen on the dorsal and posterior side. The small and hard palate are a lighter pink in which the hard palate (directly behind the upper front teeth) has a slight white shading. The ventral surface of the tongue is highly vascular, and you will observe veins under the tongue.<\/span><\/span><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">The\u00a0<\/span><span style=\"font-size: 1em\">mucosa is normally intact with a smooth texture except the hard palate, which has a ridged surface. Note the description and location of any lesions, swelling, nodules, or malformations. Palpate any lesions, swelling, or nodules and identify the consistency (e.g., soft or hard). One of the most common malformations at birth is a cleft palate.<\/span><\/span><\/li>\r\n \t<li><span style=\"color: #000000\">While doing so, observe for halitosis, which refers to a bad odour. It is important to recognize that \"stale\" smelling breath is not necessarily a concern and also to understand that this can be embarrassing for clients. Therefore, it is important to approach the situation in a sensitive manner. There are many causes of halitosis that should be assessed. For example, common causes are dehydration, bacteria associated with poor oral care, diabetes, tobacco, and recent ingestion of foods such as garlic, onion and coffee.\u00a0<\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Inspect\u00a0the <strong>pharynx<\/strong> for <strong>colour, swelling, lesions<\/strong>, and <strong>nodules<\/strong>, and describe the <strong>tonsils<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Note\u00a0the colour and any discolourations (such as redness or white patches) along with the location.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the presence, location, and description of any swelling, lesions, or nodules.\u00a0<\/span><\/span><\/li>\r\n \t<li><span style=\"color: #000000\"><span style=\"font-size: 1em\">Note\u00a0<\/span><span style=\"font-size: 1em\">the size of both the left and the right tonsil. Sometimes tonsils have been surgically removed so they may not be present. But, usually tonsils are just visible to view. Many \u201cscales\u201d are used to grade tonsil size, but there is no one standardized scale. Therefore, it is better to describe the size such as:<\/span><\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Tonsils are not present.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Tonsil(s) is visible between the anterior and posterior pillar, but not enlarged.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Tonsil(s) is enlarged\u00a0<span style=\"font-size: 1em\">at halfway between the anterior pillar and the uvula.<\/span><\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Tonsil(s) is enlarged\u00a0<span style=\"font-size: 1em\">and touching the midline of the mouth or the uvula. (If both tonsils are enlarged, you may describe them as touching each other).<\/span><\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Note the <strong>findings<\/strong>.\u00a0<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cMoist oral cavity. Pink mucosa with no discolouration, lesions, nodules, or swelling. Tonsils are visible but not enlarged.\"<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings\u00a0<span style=\"font-size: 1em\">might be documented as: \u201cDry mucous membranes of oral cavity. White, raised patches on the tongue, buccal mucosa, soft palate, and pharynx.\"<\/span><\/span>\r\n<div><\/div><\/li>\r\n<\/ul>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Teeth and Gums<\/strong><\/span><\/h2>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the teeth and gums includes inspection and palpation. Use a penlight to illuminate the back of the mouth. Begin by asking the client to smile to expose the teeth, and use a tongue depressor or your gloved finger to expose the gums and the back teeth. Remember: your assessment of the teeth and gums does not replace a routine dental assessment.<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the teeth and gums involves the following steps:<\/span><\/p>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Inspect the <strong>colour of the teeth<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Tooth\u00a0<span style=\"font-size: 1em\">[pb_glossary id=\"610\"]enamel[\/pb_glossary] is white, so you should note any discoloration. When enamel begins to erode, teeth may have a yellowish colour, which reflects the underlying layer, and even a brown colour. Enamel erosion and tooth discolouration can be caused by many things including smoking, diet (e.g., red wine, coffee\/tea), bruxism, decay, and acids introduced into the mouth as a result of bulimia. Some mild erosion is associated with aging due to exposure to cultural factors such as diet.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Inspect\u00a0for <strong>missing<\/strong>, <strong>chipped<\/strong>, or <strong>broken<\/strong> <strong>teeth<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Note\u00a0<span style=\"font-size: 1em\">the presence and location.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">3. Inspect for missing or loose <strong>fillings<\/strong>.<\/span><\/span><\/p>\r\n\r\n<ul>\r\n \t<li>Note the presence and location.<\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">4. Inspect <\/span>the <strong>gums<\/strong> for <strong>colour<\/strong>, <strong>swelling<\/strong>, and <strong>bleeding<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the presence and location of any discolouration such as redness, swelling, or bleeding. Healthy gums have a pink colour similar to the buccal mucosa, with no swelling or bleeding.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Palpate for <strong>loose<\/strong> <strong>teeth<\/strong> and palpate the <strong>gums<\/strong> for <strong>pain<\/strong>.<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li><span style=\"color: #000000\">Use\u00a0<span style=\"font-size: 1em\">your gloved finger to palpate for the presence of any loose teeth, and note the location.<\/span><\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Next,\u00a0<span style=\"font-size: 1em\">use your gloved finger to palpate the gums for pain while using the tongue depressor to pull the buccal mucosa out. Ask the client if they feel any pain or tenderness and note the location.<\/span><\/span><\/li>\r\n<\/ul>\r\n<p style=\"text-align: left\"><span style=\"color: #000000\">6. Note the <strong>findings<\/strong>.\u00a0<\/span><\/p>\r\n\r\n<ul style=\"text-align: left\">\r\n \t<li style=\"text-align: left\">\r\n<div><span style=\"color: #000000\">Normal findings might be documented as: \u201cWhite teeth with no loose, missing, chipped or broken teeth. Gums are pink in colour with no swelling, bleeding, or pain.\u201d<\/span><\/div><\/li>\r\n \t<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal\u00a0<span style=\"font-size: 1em\">findings might be documented as: \u201cSlight yellow discolouration of the teeth. Second molar on upper right side loose with swelling of the gum and mild bleeding.\"<\/span><\/span><\/li>\r\n<\/ul>\r\n<div style=\"text-align: left\">\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"color: #000000\">Respond immediately if a client has swollen lips consistent with other signs of anaphylaxis (e.g., hives, pruritus, dyspnea, dysphagia, tachycardia, hypotension). If so, did they just receive a vaccine or were they exposed to an allergen (e.g., a food or bee sting) that they are allergic to? If so, call for help and notify the physician\/nurse practitioner immediately. If you are permitted to do so, administer epinephrine. Continue to monitor the client because anaphylaxis is life-threatening.<\/span>\r\n\r\n<span style=\"color: #000000\">If the client shows signs of cyanosis or pallor, perform a primary survey to assess for clinical deterioration. Usually a client with discolourations in lips or mucous membranes will have other respiratory- or cardiovascular-related cues such as dyspnea, low oxygen saturation, tachypnea, and\/or angina.<\/span>\r\n\r\n<span style=\"color: #000000\">If the client has dry and cracked lips and dry mucous membranes with no other signs of dehydration, increasing fluid intake will usually resolve the issue. This could involve administering a rehydration solution that contains electrolytes; other forms of fluid intake can include ice chips (or popsicles for children), especially if the client is nauseated.<\/span>\r\n\r\n<span style=\"color: #000000\">Further assessment and intervention may be needed if signs of more advanced dehydration are observed: poor skin turgor, <strong>[pb_glossary id=\"488\"]oliguria[\/pb_glossary]<\/strong>, dark urine, altered level of consciousness, tachycardia, and hypotension. With newborns and infants, you should assess for sunken fontanelles, decreased wet diapers, and drowsiness. An infant may also show reduced or absent tears when crying. For a hospitalized client with signs of advanced dehydration, perform a primary survey to assess for signs of clinical deterioration, increase intravenous fluids to rehydrate, and treat any other related symptoms such as diarrhea, vomiting, and fever. Report any cues that suggest clinical deterioration to the physician\/nurse practitioner.<\/span>\r\n\r\n<span style=\"color: #000000\">Lesions, nodules, discolourations, and enlarged tonsils are not usually urgent priorities for treatment, but you should complete a focused assessment (subjective and objective) to document them and report your findings to the physician\/nurse practitioner. If tonsils are enlarged, you should assess the colour and the presence of exudate. If tonsils are touching the uvula or each other, you should assess for any breathing or swallowing issues. These associated symptoms require prompt intervention. Any issues associated with teeth (particularly loose, broken, or chipped teeth or missing or loose fillings) and gums usually require referral to a dentist. You should be concerned when the client indicates they have a lesion in their mouth that will not heal or a lump. These can sometimes be associated with oral cancers, which are commonly found on the floor of the mouth, inferior side of tongue, the buccal mucosa or the soft palate. A common cause of oral cancers is tobacco use.\u00a0<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox textbox--exercises\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Knowledge Bite<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n\r\nThis image shows a throat infection called tonsillitis. Evidence of the infection is shown through swelling, redness and white patches (pus) on the tonsils. This pus consists of dead bacteria, white blood cells, and cellular debris\r\n\r\n<img src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis-300x229.jpg\" alt=\"\" width=\"300\" height=\"229\" class=\"size-medium wp-image-303 alignnone\" \/>\r\n\r\nImage from: This work has been released into the public domain by its author, Michaelbladon at English Wikipedia. This applies worldwide. Michaelbladon grants anyone the right to use this work for any purpose, without any conditions, unless such conditions are required by law.\r\n\r\n<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Activity: Check Your Understanding <\/strong><\/span><\/h2>\r\n<div style=\"text-align: left\"><span>[h5p id=\"133\"]<\/span><\/div>","rendered":"<p style=\"text-align: left\"><span style=\"color: #000000\">Usually the client is positioned sitting upright; newborns or young children can be held by their parent\/caregiver. Wear gloves because this assessment involves contact with body fluids from the mucus membranes. You will also need a tongue depressor and a penlight.<\/span><\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>I<span style=\"color: #000000\">nspection of Lips<\/span><\/strong><\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Inspect the lips for swelling, colour, lesions, or <strong><button class=\"glossary-term\" aria-describedby=\"304-480\">malformations<\/button><\/strong>.\u00a0Also inspect the lips for moisture and texture, which are interrelated.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">The steps for this are as follows:<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Identify any <strong>presence<\/strong> and <strong>location<\/strong> of <strong>swelling<\/strong> and <strong>redness<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">These two findings are often associated. You must respond immediately if you suspect the swelling is associated with anaphylaxis. For example, do they have allergies, such as food or bees, or have they recently had a vaccine? Do they have other signs of anaphylaxis (e.g., hives, pruritus, dyspnea, dysphagia, tachycardia, hypotension)?<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Note the <strong>colour<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Lip colour varies based on the client\u2019s skin colour. It can range from pink to brown tones. Note any lip discolouration (e.g., redness, cyanosis, pallor).\u00a0Cyanosis\u00a0<span style=\"font-size: 1em\">can appear as a grey\/white shade in people with darker skin (Lewis, 2020; Sommers, 2011) or as a dusky bluish\/purple shade in people with lighter skin (Lewis, 2020). <\/span><span style=\"font-size: 1em\">Pallor\u00a0<\/span><span style=\"font-size: 1em\">can appear as a grey shade in people with darker skin (Lewis, 2020) or as a generalized pale discolouration in people with lighter skin.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Identify the <strong>presence, location, size<\/strong>, and <strong>description<\/strong> of any <strong>lesions<\/strong> and <strong>malformations<\/strong>, including the <strong>colour<\/strong> and <strong>presence of any discharge<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">If you identify a lesion, ask the client whether they have noticed it, how long they have had it, whether they know the cause, and if they have treated it with anything.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\"><span style=\"font-size: 1em\">A common lesion on the lips is herpes simplex virus (cold sore) which appear as small, fluid-filled blisters, see <strong>Figure 2<\/strong>. Another common malformation of the lip is a <strong><button class=\"glossary-term\" aria-describedby=\"304-482\">cleft lip<\/button><\/strong> (<\/span><\/span><span style=\"text-align: initial;font-size: 1em\"><span style=\"font-size: 1em\">which is sometimes associated with a <strong><button class=\"glossary-term\" aria-describedby=\"304-484\">cleft palate<\/button><\/strong>). These\u00a0<\/span><\/span><span style=\"text-align: initial;font-size: 1em\">are important to assess and act upon because they can affect a client\u2019s breathing, speaking, and sucking and swallowing associated with eating. They are often surgically repaired at a young age. Further information and images for cleft lip and palate can be found at: <\/span><\/span><a href=\"https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/cleftlip.html\" target=\"_blank\" style=\"font-size: 1em\" rel=\"noopener\">https:\/\/www.cdc.gov\/ncbddd\/birthdefects\/cleftlip.html<\/a><\/li>\n<\/ul>\n<div style=\"text-align: left\"><span style=\"color: #000000\">4. <span style=\"font-size: 1em\">Note\u00a0<\/span><span style=\"font-size: 1em\">the <strong>moisture<\/strong> and <strong>texture<\/strong>.<\/span><\/span><\/div>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Are\u00a0<span style=\"font-size: 1em\">the lips moist or dry? Moist lips are smooth with no cracking. Dry lips are chapped and\/or may have fissures. Chapped lips are flaky and sometimes red, with \u201cflakes\u201d or \u201cscales\u201d of skin peeling away from the lips. Fissures are usually called \u201ccracked lips.&#8221;<\/span><\/span><\/li>\n<\/ul>\n<div style=\"text-align: left\"><span style=\"color: #000000\">5. Note <span style=\"font-size: 1em\">the <strong>findings<\/strong>.<\/span><\/span><\/div>\n<ul>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Normal\u00a0findings: \u201cLips are moist with no cracking, lesions, or swelling, pink in colour with generalized brown tones, no discolouration.\u201d<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal findings: \u201cLips are dry with cracking, a red lesion on upper lip left of midline 3mm x 3 mm with a slight serous discharge.\u201d<\/span><\/li>\n<\/ul>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2021\/09\/HerpesPHIL_1573_lores.jpeg\" alt=\"A person with herpes (cold sore) on the left side of their lower lip.\" width=\"300\" height=\"208\" class=\"alignnone size-medium wp-image-2150\" \/><\/p>\n<p><span style=\"color: #000000\"><strong>Figure 2<\/strong>: Herpes simplex virus (cold sore) on the lower lip.<\/span><\/p>\n<p style=\"font-weight: 400\"><span style=\"color: #000000\">(Attribution: Photo Public Domain,<\/span> <a href=\"https:\/\/commons.wikimedia.org\/w\/index.php?curid=8011415\">https:\/\/commons.wikimedia.org\/w\/index.php?curid=8011415<\/a>)<\/p>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Inspection of Oral Mucosa<\/strong><\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Systematically inspect all parts of the mucosa. Shine a penlight in the mouth to illuminate the area. You can ask the client to pull their top lip up and then their bottom lip down, or use a gloved hand or tongue depressor to perform this action so you can inspect the mucosa on the inside of the lips.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Most clients can open their mouth wide and tip their head back so that you can observe the palate and also put the tip of their tongue behind their front teeth so that you can observe the floor of the mouth and under the tongue. You can use a tongue depressor to expose the buccal mucosa. To expose the pharynx, ask the client to stick their tongue out and say \u201cahhh\u201d or pretend to yawn. You may need to use the tongue depressor to press the tongue down. If so, avoid using it in the middle of the tongue as this may elicit a gag reflex.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Inspection of the mucosa of the oral cavity includes observing the insides of the lips and the buccal mucosa (inside of checks), the tongue, the floor of mouth (under the tongue) and the hard and soft palate, the pharynx, and salivary glands. See <strong>Figure 3<\/strong>\u00a0for anatomical locations of the oral cavity.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"http:\/\/pressbooks.library.ryerson.ca\/assessmentnursing\/wp-content\/uploads\/sites\/192\/2022\/01\/Mouth-by-Jennifer-Lapum-and-Arina-Bogdan-1024x560.jpeg\" alt=\"Inside side of an individual's mouth.\" width=\"1024\" height=\"560\" class=\"alignnone size-large wp-image-1957\" \/><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><strong>Figure 3<\/strong>: Anatomical locations of oral cavity.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Use the following steps:<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Note <strong>moisture<\/strong> or <strong>dryness<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">whole oral cavity should be moist. Dry mucous membranes are often a sign of dehydration. However, you should also assess if the client may be a person who breathes through their mouth and not their nose. You will notice tiny ductal openings (about 1 mm in size) of the salivary glands. These glands produce saliva for the mouth and include the parotid (ductal opening on the buccal mucosa near the upper second molar), the submandibular (ductal opening at the base of the ventral surface of the tongue on both sides of the frenulum), and the sublingual (several ductal openings on both side of the floor of the mouth).<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Inspect\u00a0the <strong>mucosa of the lips<\/strong> and <strong>buccal mucosa<\/strong> for <strong>colour, lesions, swelling<\/strong>, and <strong><button class=\"glossary-term\" aria-describedby=\"304-486\">nodules<\/button><\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">The\u00a0mucous membranes, including the mucosa of the lips and buccal mucosa, are pink in colour. Any discolourations (e.g., cyanosis or pallor) should be described and the location noted. Cyanosis can appear as a grey\/white shade in people with darker skin (Lewis, 2020; Sommers, 2011) or as a dusky bluish\/purple shade in people with lighter skin (Lewis, 2020). Pallor appears as a grey shade in people with darker skin or as a generalized pale discolouration in people with lighter skin.<\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">The\u00a0<span style=\"font-size: 1em\">mucosa of the lips and buccal mucosa are intact with a smooth surface. Note the description and location of any lesions, swelling, or nodules. Palpate any lesions, swelling, or nodules and identify the consistency (e.g., soft or hard).<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">3. Inspect\u00a0the <strong>tongue, floor of the mouth<\/strong>, and <strong>hard<\/strong> and <strong>soft palate<\/strong> for <strong>colour, lesions, swelling, nodules<\/strong>, and <strong>malformations<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"text-align: left\"><span style=\"color: #000000\">Note\u00a0<span style=\"font-size: 1em\">the colour and any discolourations along with the location. The tongue is normally pink with a dotted surface that is most readily seen on the dorsal and posterior side. The small and hard palate are a lighter pink in which the hard palate (directly behind the upper front teeth) has a slight white shading. The ventral surface of the tongue is highly vascular, and you will observe veins under the tongue.<\/span><\/span><\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"font-size: 1em\">The\u00a0<\/span><span style=\"font-size: 1em\">mucosa is normally intact with a smooth texture except the hard palate, which has a ridged surface. Note the description and location of any lesions, swelling, nodules, or malformations. Palpate any lesions, swelling, or nodules and identify the consistency (e.g., soft or hard). One of the most common malformations at birth is a cleft palate.<\/span><\/span><\/li>\n<li><span style=\"color: #000000\">While doing so, observe for halitosis, which refers to a bad odour. It is important to recognize that &#8220;stale&#8221; smelling breath is not necessarily a concern and also to understand that this can be embarrassing for clients. Therefore, it is important to approach the situation in a sensitive manner. There are many causes of halitosis that should be assessed. For example, common causes are dehydration, bacteria associated with poor oral care, diabetes, tobacco, and recent ingestion of foods such as garlic, onion and coffee.\u00a0<\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">4. Inspect\u00a0the <strong>pharynx<\/strong> for <strong>colour, swelling, lesions<\/strong>, and <strong>nodules<\/strong>, and describe the <strong>tonsils<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Note\u00a0the colour and any discolourations (such as redness or white patches) along with the location.<\/span><\/li>\n<li><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the presence, location, and description of any swelling, lesions, or nodules.\u00a0<\/span><\/span><\/li>\n<li><span style=\"color: #000000\"><span style=\"font-size: 1em\">Note\u00a0<\/span><span style=\"font-size: 1em\">the size of both the left and the right tonsil. Sometimes tonsils have been surgically removed so they may not be present. But, usually tonsils are just visible to view. Many \u201cscales\u201d are used to grade tonsil size, but there is no one standardized scale. Therefore, it is better to describe the size such as:<\/span><\/span>\n<ul>\n<li><span style=\"color: #000000\">Tonsils are not present.<\/span><\/li>\n<li><span style=\"color: #000000\">Tonsil(s) is visible between the anterior and posterior pillar, but not enlarged.<\/span><\/li>\n<li><span style=\"color: #000000\">Tonsil(s) is enlarged\u00a0<span style=\"font-size: 1em\">at halfway between the anterior pillar and the uvula.<\/span><\/span><\/li>\n<li><span style=\"color: #000000\">Tonsil(s) is enlarged\u00a0<span style=\"font-size: 1em\">and touching the midline of the mouth or the uvula. (If both tonsils are enlarged, you may describe them as touching each other).<\/span><\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Note the <strong>findings<\/strong>.\u00a0<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cMoist oral cavity. Pink mucosa with no discolouration, lesions, nodules, or swelling. Tonsils are visible but not enlarged.&#8221;<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings\u00a0<span style=\"font-size: 1em\">might be documented as: \u201cDry mucous membranes of oral cavity. White, raised patches on the tongue, buccal mucosa, soft palate, and pharynx.&#8221;<\/span><\/span>\n<div><\/div>\n<\/li>\n<\/ul>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Teeth and Gums<\/strong><\/span><\/h2>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the teeth and gums includes inspection and palpation. Use a penlight to illuminate the back of the mouth. Begin by asking the client to smile to expose the teeth, and use a tongue depressor or your gloved finger to expose the gums and the back teeth. Remember: your assessment of the teeth and gums does not replace a routine dental assessment.<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">Assessment of the teeth and gums involves the following steps:<\/span><\/p>\n<p style=\"text-align: left\"><span style=\"color: #000000\">1. Inspect the <strong>colour of the teeth<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Tooth\u00a0<span style=\"font-size: 1em\"><button class=\"glossary-term\" aria-describedby=\"304-610\">enamel<\/button> is white, so you should note any discoloration. When enamel begins to erode, teeth may have a yellowish colour, which reflects the underlying layer, and even a brown colour. Enamel erosion and tooth discolouration can be caused by many things including smoking, diet (e.g., red wine, coffee\/tea), bruxism, decay, and acids introduced into the mouth as a result of bulimia. Some mild erosion is associated with aging due to exposure to cultural factors such as diet.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">2. Inspect\u00a0for <strong>missing<\/strong>, <strong>chipped<\/strong>, or <strong>broken<\/strong> <strong>teeth<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Note\u00a0<span style=\"font-size: 1em\">the presence and location.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">3. Inspect for missing or loose <strong>fillings<\/strong>.<\/span><\/span><\/p>\n<ul>\n<li>Note the presence and location.<\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\"><span style=\"text-align: initial;font-size: 1em\">4. Inspect <\/span>the <strong>gums<\/strong> for <strong>colour<\/strong>, <strong>swelling<\/strong>, and <strong>bleeding<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Identify\u00a0<span style=\"font-size: 1em\">the presence and location of any discolouration such as redness, swelling, or bleeding. Healthy gums have a pink colour similar to the buccal mucosa, with no swelling or bleeding.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">5. Palpate for <strong>loose<\/strong> <strong>teeth<\/strong> and palpate the <strong>gums<\/strong> for <strong>pain<\/strong>.<\/span><\/p>\n<ul style=\"text-align: left\">\n<li><span style=\"color: #000000\">Use\u00a0<span style=\"font-size: 1em\">your gloved finger to palpate for the presence of any loose teeth, and note the location.<\/span><\/span><\/li>\n<li><span style=\"color: #000000\">Next,\u00a0<span style=\"font-size: 1em\">use your gloved finger to palpate the gums for pain while using the tongue depressor to pull the buccal mucosa out. Ask the client if they feel any pain or tenderness and note the location.<\/span><\/span><\/li>\n<\/ul>\n<p style=\"text-align: left\"><span style=\"color: #000000\">6. Note the <strong>findings<\/strong>.\u00a0<\/span><\/p>\n<ul style=\"text-align: left\">\n<li style=\"text-align: left\">\n<div><span style=\"color: #000000\">Normal findings might be documented as: \u201cWhite teeth with no loose, missing, chipped or broken teeth. Gums are pink in colour with no swelling, bleeding, or pain.\u201d<\/span><\/div>\n<\/li>\n<li style=\"text-align: left\"><span style=\"color: #000000\">Abnormal\u00a0<span style=\"font-size: 1em\">findings might be documented as: \u201cSlight yellow discolouration of the teeth. Second molar on upper right side loose with swelling of the gum and mild bleeding.&#8221;<\/span><\/span><\/li>\n<\/ul>\n<div style=\"text-align: left\">\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title no-indent\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p><span style=\"color: #000000\">Respond immediately if a client has swollen lips consistent with other signs of anaphylaxis (e.g., hives, pruritus, dyspnea, dysphagia, tachycardia, hypotension). If so, did they just receive a vaccine or were they exposed to an allergen (e.g., a food or bee sting) that they are allergic to? If so, call for help and notify the physician\/nurse practitioner immediately. If you are permitted to do so, administer epinephrine. Continue to monitor the client because anaphylaxis is life-threatening.<\/span><\/p>\n<p><span style=\"color: #000000\">If the client shows signs of cyanosis or pallor, perform a primary survey to assess for clinical deterioration. Usually a client with discolourations in lips or mucous membranes will have other respiratory- or cardiovascular-related cues such as dyspnea, low oxygen saturation, tachypnea, and\/or angina.<\/span><\/p>\n<p><span style=\"color: #000000\">If the client has dry and cracked lips and dry mucous membranes with no other signs of dehydration, increasing fluid intake will usually resolve the issue. This could involve administering a rehydration solution that contains electrolytes; other forms of fluid intake can include ice chips (or popsicles for children), especially if the client is nauseated.<\/span><\/p>\n<p><span style=\"color: #000000\">Further assessment and intervention may be needed if signs of more advanced dehydration are observed: poor skin turgor, <strong><button class=\"glossary-term\" aria-describedby=\"304-488\">oliguria<\/button><\/strong>, dark urine, altered level of consciousness, tachycardia, and hypotension. With newborns and infants, you should assess for sunken fontanelles, decreased wet diapers, and drowsiness. An infant may also show reduced or absent tears when crying. For a hospitalized client with signs of advanced dehydration, perform a primary survey to assess for signs of clinical deterioration, increase intravenous fluids to rehydrate, and treat any other related symptoms such as diarrhea, vomiting, and fever. Report any cues that suggest clinical deterioration to the physician\/nurse practitioner.<\/span><\/p>\n<p><span style=\"color: #000000\">Lesions, nodules, discolourations, and enlarged tonsils are not usually urgent priorities for treatment, but you should complete a focused assessment (subjective and objective) to document them and report your findings to the physician\/nurse practitioner. If tonsils are enlarged, you should assess the colour and the presence of exudate. If tonsils are touching the uvula or each other, you should assess for any breathing or swallowing issues. These associated symptoms require prompt intervention. Any issues associated with teeth (particularly loose, broken, or chipped teeth or missing or loose fillings) and gums usually require referral to a dentist. You should be concerned when the client indicates they have a lesion in their mouth that will not heal or a lump. These can sometimes be associated with oral cancers, which are commonly found on the floor of the mouth, inferior side of tongue, the buccal mucosa or the soft palate. A common cause of oral cancers is tobacco use.\u00a0<\/span><\/p>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"textbox textbox--exercises\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Knowledge Bite<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\">\n<p>This image shows a throat infection called tonsillitis. Evidence of the infection is shown through swelling, redness and white patches (pus) on the tonsils. This pus consists of dead bacteria, white blood cells, and cellular debris<\/p>\n<p><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis-300x229.jpg\" alt=\"\" width=\"300\" height=\"229\" class=\"size-medium wp-image-303 alignnone\" srcset=\"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis-300x229.jpg 300w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis-65x50.jpg 65w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis-225x171.jpg 225w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis-350x267.jpg 350w, https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-content\/uploads\/sites\/421\/2024\/05\/512px-Tonsillitis.jpg 512w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p>Image from: This work has been released into the public domain by its author, Michaelbladon at English Wikipedia. This applies worldwide. Michaelbladon grants anyone the right to use this work for any purpose, without any conditions, unless such conditions are required by law.<\/p>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>Activity: Check Your Understanding <\/strong><\/span><\/h2>\n<div style=\"text-align: left\"><span><\/p>\n<div id=\"h5p-133\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-133\" class=\"h5p-iframe\" data-content-id=\"133\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"Ch.14(5) - Oral Cavity - Inspection and Palpation\"><\/iframe><\/div>\n<\/div>\n<p><\/span><\/div>\n<div class=\"glossary\"><div class=\"glossary__tooltip\" id=\"304-480\" hidden><p>are faulty formations of a structure such as body tissue or organs.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"304-482\" hidden><p>is a congenital split in the lip.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"304-484\" hidden><p>is a congenital split in the palate.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"304-486\" hidden><p>are a general term referring to any lump.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"304-610\" hidden><p>is the hard and shiny surface that covers and protects the teeth.<\/p>\n<\/div><div class=\"glossary__tooltip\" id=\"304-488\" hidden><p>is decreased urine output.<\/p>\n<\/div><\/div>","protected":false},"author":34,"menu_order":5,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[49],"contributor":[72],"license":[56],"class_list":["post-304","chapter","type-chapter","status-publish","hentry","chapter-type-numberless","contributor-december-2021","license-cc-by-nc"],"part":292,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/304","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":5,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/304\/revisions"}],"predecessor-version":[{"id":2707,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/304\/revisions\/2707"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/292"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/304\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=304"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=304"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=304"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=304"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}