Clinical Skills · Assessment of the Head and Neck

Mouth, Throat, Nose, and Sinuses

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On this page 9 sections

In 30 seconds
Why this matters
The college version
Eli explains
Worked example
Key takeaway
Check yourself
Study tools
Sources & references

In 30 seconds

The mouth, throat, nose, and are the entranceway of two vital systems: the airway (breathing) and the digestive tract (eating and drinking). They also do important jobs in speech, taste, smell, and facial expression. For nurses this assessment is a daily event: checking oral hygiene, screening for infection, evaluating hydration, assessing the ability to chew and swallow, and looking for clues to systemic illness. The oral cavity is one of the few places where you can directly see mucous membrane, which makes it a useful gauge of hydration and of conditions that affect the whole body.

The exam is mostly inspection with a good light source, plus gentle palpation where indicated, and it relies heavily on patient report — ask what people notice themselves: pain, bleeding gums, difficulty swallowing, a change in smell or taste, or a hoarse voice.

Why this matters

Airway and nutrition: these structures are the entry point for breathing and eating; problems here can affect oxygenation, hydration, and nutrition.
Hydration clues: dry, sticky mucous membranes are a quick, visible sign that may point to dehydration or medication effects.
Infection screening: redness, swelling, , and lesions in the mouth and throat are common presenting findings — early recognition supports early care.
Cranial nerve screening: chewing, facial movement, the gag reflex, tongue movement, and swallowing involve cranial nerves V, VII, IX, X, and XII.
Dignity and daily care: oral care is a nursing responsibility, especially for people who are (nothing by mouth), on oxygen, or unable to brush their own teeth — it prevents infection and preserves dignity.

The college version

Core Concepts

Mouth: lips, mucosa, gums, tongue, and palate

Inspect the lips for color, moisture, cracking, or lesions. Using a penlight and (if permitted by your program) a tongue blade, look at the (the lining of the inside of the cheeks), the gums, the teeth (or dentures), the tongue (top, sides, and under-surface), the hard and soft palate, and the floor of the mouth. Note color, moisture, ulcers, white patches, redness, bleeding, or growths. A dry, sticky mouth can be a sign of dehydration or a side effect of some medications; white patches may be food debris or may indicate conditions like oral thrush (candidiasis). You describe what you see and report — you do not diagnose. Ask about pain, sensitivity, bleeding, denture fit, and oral care routines. People with dentures should remove them for the exam (with privacy and assistance as needed) so you can see the underlying tissue.

Throat and tonsils

With the person's mouth open and head slightly back, ask them to say "ah" — this lifts the soft palate and lets you see the , the tonsillar pillars, and the back of the throat. The should rise in the midline. are commonly graded on a 1+ to 4+ scale by how far they protrude into the oropharynx, from visible within the pillars to meeting at the midline — a description of size, not a diagnosis. Look for redness, swelling, exudate (white or yellow patches), asymmetry, or a deviation of the uvula, which are reportable findings. Do not force a tongue blade into a person who gags or resists; be gentle and brief.

Nose: external inspection and patency

Inspect the outside of the nose for shape, symmetry, redness, or lesions, then gently tilt the head back and look inside each nostril with a light (using a nasal speculum only if you are trained and it is within your scope). Check the nasal mucosa for color, moisture, swelling, discharge, or bleeding. Test patency by occluding one nostril and asking the person to sniff or breathe through the other, then repeat on the other side. Ask about congestion, discharge, nosebleeds, sneezing, and changes in smell.

Sinuses

The sinuses are air-filled cavities in the bones around the nose: frontal, maxillary, ethmoid, and sphenoid. You cannot see inside them, so assessment relies on palpation and patient report: gently press over the frontal sinuses (above the eyes) and maxillary sinuses (below the cheekbones) and ask about tenderness or pain, and ask about facial pressure, headache, congestion, and thick nasal discharge. Sinus tenderness is a finding to report — it can accompany conditions like sinusitis, which a provider diagnoses and treats.

Function and connections

The structures here work as a unit: the nose warms, filters, and moistens inhaled air; the sinuses lighten the skull and give the voice resonance; the mouth and throat start digestion, protect the airway during swallowing, and produce speech; and smell and taste work together to flavor food. Cranial nerves V, VII, IX, X, and XII are involved in chewing, facial movement, swallowing, the gag reflex, and tongue movement — so this assessment also screens several cranial nerves. Special populations: young children explore with their mouths and are prone to upper respiratory infections; older adults often have dry mouth and dentures that need checking; people who are immunocompromised are at higher risk for oral infections; and a person who is NPO after surgery still needs regular oral care. Oral care is a nursing responsibility — good hygiene prevents infection and supports dignity.

Common Confusions

Do Not Confuse	With	Difference
Exudate (white patches)	Food debris or milk residue	Exudate does not wipe away easily; describe what you see and let the provider interpret
Tonsil size (1+ to 4+)	A diagnosis of tonsillitis	Grading describes size only; redness, exudate, and symptoms are separate findings
Sinus tenderness	Toothache or headache	Both can cause facial pain; document location, quality, and what makes it worse
NPO status	"Just skip food for now"	NPO is an order with a reason; oral care and comfort measures continue but food and fluids do not
Gagging during throat exam	Poor cooperation	Gagging is a protective reflex — be gentle, brief, and never force
Dry mouth	Dehydration by itself	Dry mouth has many causes (medications, mouth breathing, NPO); report it as one finding among many

Eli explains

The same idea, in plain words

Explain it like I’m 10

Your mouth, throat, nose, and sinuses are like the front door of your body: food and air come in through them, and they help you talk, taste, and smell. The nurse shines a light inside to check that the "hallway" looks healthy — pink and moist, with no sore spots — and asks you to say "ah" so they can see the back of your throat.

Worked example

Mr. Okafor is 12 hours post-op and NPO until the morning. During rounds you assess his mouth: his lips are dry and cracked, his buccal mucosa is dry and sticky, and there is dried debris on his teeth. He tells you his mouth feels "like sandpaper" and he would like a drink, but he cannot have one yet. You check the NPO order first — NPO means NPO — so you do not give fluids. Instead you document the findings and provide mouth care: gentle toothbrushing or a moistened sponge swab per facility policy, lip moisturizer, and an ice chip if the order allows. You also notice a white patch on his inner cheek and describe it in the chart ("white, non-raised patch, left buccal mucosa, not wiped away by moistened swab") and report it to the provider. You turn the dryness into a hydration data point for the team and keep his mouth comfortable and clean — assessment plus care working together.

Key takeaways

The exam is mostly inspection with good lighting: lips → buccal mucosa → gums and teeth → tongue (including the under-surface) → palate → throat.
Ask the person to say "ah" to lift the soft palate and see the oropharynx; the uvula should rise in the midline.
Describe tonsil size with the 1+ to 4+ grading scale; document what you see rather than naming a diagnosis.
Mucous membrane appearance is a quick clue to hydration: dry, sticky mucosa is reportable.
Nasal patency is tested one nostril at a time.
Frontal and maxillary sinuses are assessed by gentle palpation for tenderness plus patient report of pressure or pain.
White patches could be debris or infection; exudate, asymmetry, bleeding, or uvular deviation are reportable findings.
Oral care is part of nursing care, especially for people who are NPO, on oxygen, or unable to brush their own teeth.
Scope: nurses screen, describe, educate, and report; diagnosis and treatment (including any medication) belong to the provider.

Check yourself

6 review questions from the chapter. Try each one, then open the answer.

List the order you inspect the mouth from outside to inside.
Show answer
Lips → buccal mucosa → gums and teeth → tongue (top, sides, under-surface) → palate → throat/oropharynx.
Why do you ask the person to say "ah" during the throat exam, and what should the uvula do?
Show answer
Saying "ah" lifts the soft palate so the oropharynx is visible; the uvula should rise in the midline.
What does tonsil grading 1+ to 4+ describe?
Show answer
How far the tonsils protrude into the oropharynx — a size description, not a diagnosis.
How do you test ?
Show answer
Occlude one nostril at a time and ask the person to breathe or sniff through the open side; compare sides.
Where are the frontal and maxillary sinuses, and how are they assessed?
Show answer
Frontal: above the eyes; maxillary: below the cheekbones. Assess by gentle palpation for tenderness plus patient report of pressure or pain.
A post-op patient who is NPO asks for water. What are your nursing considerations?
Show answer
Check the NPO order before giving anything, provide mouth care and comfort measures, document the dryness, and offer fluids only if the order permits.

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Study tools & related lessonsKey vocabulary · Related

Key vocabulary

Buccal mucosa: The moist lining of the inside of the cheeks
Oropharynx: The part of the throat visible when the mouth is open (back of the mouth, tonsils, pharyngeal wall)
Tonsils: Lymphoid tissue at the sides of the throat
Exudate: Pus-like white or yellow patches on the throat or tonsils
Uvula: The small fleshy structure hanging at the back of the soft palate
Nasal patency: Whether air can pass through each nostril
Sinuses: Air-filled cavities in the facial bones (frontal, maxillary, ethmoid, sphenoid)
Candidiasis (thrush): A fungal infection that can cause white patches in the mouth
NPO: "Nothing by mouth" — a person who cannot eat or drink

Sources & references

openstax.org — Clinical Nursing Skills

This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.

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