Lec04 - Assessing Mouth, Throat, Abdomen and Rectum

Trinity University of Asia - St.
Luke’s College of Nursing Batch 2026 - Luminaris
HEALTH ASSESSMENT | 2ND SEM - A.Y. 22-23 LEC04

MOUTH, THROAT, ABDOMEN AND RECTUM
Prof. Janelle Tayo, MD, RNl | ADAPTED FROM: PPT/LECTURE/BOOK | TRANS BY: 1NU02
LEARNING OBJECTIVES
● Identify structures and functions of the

Gastrointestinal System
● Identify anatomic landmarks that will serve as a
guide in physical examination
● Describe normal and abnormal findings using
appropriate nursing assessment
● Correlate clinically common diseases in
Gastrointestinal System.
ANATOMY OF THE MOUTH
Gingiva
● gums
● Covered by mucous membrane
● Holds 32 permanent teeth (adult)
Teeth
1. Crown - white enameled part
2. Root - embedded in the gums
3. Neck - connects crown & root
ANATOMY OF THE THROAT
Uvula
● Extension of the soft palate
● Hangs in the posterior midline of oropharynx
Salivary Glands
● secretes saliva Nasopharynx
- watery serous fluid containing salts, ● Upper part of the throat
mucus, & salivary amylase Oropharynx
1. Parotid glands ● Below the nasopharynx
- below & in front of the ears Laryngopharynx
- empty through Stensen ducts ● Below the oropharynx
○ Located inside the cheek across
from the 2nd upper molar Tonsils
2. Submandibular glands ● part of lymphatic system
- in the lower jaw ● help protect against infection
- open under the tongue on either side of
the frenulum through openings called 1. Palatine tonsil
Wharton ducts - Located on both sides of oropharynx at the
3. Sublingual glands end of the soft palate between anterior and
- under the tongue posterior pillars
- visible
2. Lingual tonsil
1NU02 HA TEAM / TRANSCRIBED ON [ 25.04.2023] 111 I 01: MOUTH, THROAT, ABDOMEN AND RECTUM
TRANS: MOUTH, THROAT, ABDOMEN AND RECTUM
- Lie at the base of the tongue

3. Pharyngeal tonsil INSPECT
- Adenoids
- Found in nasopharynx
PALPATE
- Can lead to airway obstruction when
enlarged
COLLECTING SUBJECTIVE DATA: LIPS

THE NURSING HEALTH HISTORY
History of Present Health Concern

● Tongue or mouth sores or lesion (COLDSPA)
● Redness, swelling, bleeding, or pain of the gums or
mouth? How long? Toothache? Lost any permanent
teeth?
● Difficulty or painful swallowing? Sore throat?
Hoarseness? How long?
Personal Health History

● Oral surgery? Lip color depends on the race
● Use any treatments or medications for conditions - light skinned : pinkish lip
that affect the mouth or throat or to control pain in - Dark skinned : darker lip
the mouth and throat?
ABNORMAL FINDINGS:
LIPS
Family History
● Is there a history of mouth or throat cancer i your CYANOTIC
family? ● low oxygen level
Lifestyle and Health Practices

● Smoking? ( how much? Interested in quitting?)
● Alcohol intake ( how much and often?)
- Alcohol & Smoking : risk for cancer (oral
cancer)
● Grinding of teeth
- Bruxism
● Dental care? Dentures? ANEMIA
- Visit dentist the every 6 months ● pale in color
● Braces?
● Sunlight exposure
- High exposure to sunlight = high risk of
skin cancer / lip cancer
● Diet
COLLECTING SUBJECTIVE DATA:

PHYSICAL EXAMINATION SWOLLEN
● Has trauma or allergic reaction
PREPARE THE CLIENT
REDDISH / CHERRY RED DISCOLORATION

● Carbon Monoxide Poisoning
- Fire victims
1. Sitting position
2. Explain procedure
3. Remove any dentures, bands of braces, etc.
EQUIPMENT
● Non Latex gloves
● 4 x 4 inch gauze pad
● Penlight
● Tongue depressor
HERPES SIMPLEX TYPE 1 ABNORMAL FINDINGS:

● Common in weak immune system TEETH AND GUMS
Yellowish Teeth Color

● Chronic Smoker
● Coffee Lover
● Side effect of medicine
● Soft drinks
CHEILOSIS OF LIPS
● Scaling painful fissures at corner of lips
● Low Vitamin B2 or Riboflavin Deficiency
NOTE
- Use straw in drinking coffee or soft drinks to
prevent yellowish teeth.
Cavity / Dental Caries

CARCINOMA OF LIPS ● Starts with small spot
● Round, indurated lesions becomes crusted and ● Can be prevented using fluoride
ulcerated with elevated border
● Cancer of lips
● Disrupts structure
● Malignant or Benign
Malocclusion
● Misalignment
● Braces are eligible to get when all teeth are
permanent and no baby tooth was left behind.
TEETH AND GUMS
● Inspect the teeth. Ask the client to open the mouth.

Note the number of teeth, color, and condition.
- Teeth : 32 (adult) ; dirty white or cream in
color
● Ask the client to bite down as though chewing on
something. Note the alignment of teeth.
● Retract the lips to inspect the color, moisture, Gingivitis
consistency, and any lesions in the gums. ● Inflammation of the gums
● Red swollen gums
● Vitamin C Deficiency or Ascorbic Acid Deficiency
Receding gums
● Gum tissue surrounding the tooth pulls back,
exposing more of tooth or root of tooth.
● Commonly to elderly patients due to aging
● Caused by extreme brushing of teeth (adult)
NOTE
- Use a soft bristle toothbrush for brushing teeth to
prevent damaging the teeth.
- Soft bristle toothbrush most recommended by the
dentist to use.
NOTE
- Pathognomonic sign means 99.9 % sure of the
Discoloration (Bluish / Black) of Gums medical condition or particular disease without
any doubt.
● Lead poisoning
Leukoplakia (Ventral Surface)

● Thick raised patch does not scrape off
● Precancerous lesion (high chance to lead to cancer)
● Commonly see to smoker
● Cannot be wiped off
● Need referral
Kaposi's Sarcoma Lesions

● Red / black gums
● Usually lead to complications of HIV or AIDS.
Candida Albicans Infection (Thrush)

● Whitish discoloration
● Fungal infection
● Wipe off then it will bleed. Afterwhile, it will be back
again.
BUCCAL MUCOSA ● Managed by anti-fungal medication
● Referred to the physician for further evaluation
Canker Sore (Singaw)

ABNORMAL FINDINGS:
BUCCAL MUCOSA ● Painful small ulcers inside the mouth
● Do not occur on lip surface
Stensen Duct ● Non-contagious
● Parotid gland ● Use Rowagel
Wharton’s Duct
● Seen in submandibular area
Koplik’s Spot
- Pathognomonic sign for Measles
Black Hairy Tongue

● Not hair but elongated filiform papillae seen with
use of antibiotics that inhibit normal bacteria.
● The distinct look usually results from a buildup of
dead skin cells on the many tiny projections
(papillae) on the surface of the tongue that contain
taste buds.
● Can lead to peptic ulcer disease
TONGUE - Bismuth - drug use in managing peptic
● Ask the patient to stick out tongue. Assess ventral ulcer disease
surface. Check for color, moisture, texture, size,
lesions, position (midline)
● Ask the patient to lift tongue. Assess the dorsal
surface and palpate
- Dorsal Surface - common site for oral
cancer
● Using gauze pad, assess the sides of the tongue
- Side - common site for tongue cancer
Beef Red Tongue
● Test strength of the tongue. Use resistance. Using
● Vitamin B12 Deficiency
the tongue, push the finger through the cheek
● Smooth, shiny, red
- Tongue is a muscle
- CN 12 - movement of tongue
- CN 9 or 7 - taste
Macroglossia
● Enlarged size of tongue
ABNORMAL FINDINGS: Atrophied

TONGUE ● Crumpled tongue
● Decrease of muscle
Deep Longitudinal Fissures ● Nerve damage
● Dehydrated - CN 12 - Hypoglossal
● Managed by giving IV fluids ● Common to stroke patient
Varicose Veins (Ventral surface)
Torus palatinus
Candida albicans infection (thrush) ● Bony growth on roof of mouth
ABNORMAL FINDINGS:
PALATE
Leukoplakia
● Cancer Oral Thrush
● Ventral surface
● Whitish discoloration
● Curd-like patches
Yellowish Palate
Hairy Leukoplakia ● Jaundice
● Cancer
● Lateral surface
NOTE
- Not because yellowish ang patient jaundice na
Carcinoma of Tongue agad, you have to see the palate of the patient if
yellow, if yes, confirmed na jaundice
- Tongue cancer
- Needs immediate surgery
Cleft Palate
● No uvula & soft palate / hard palate
● It also be cleft lip or combination
PALATE AND UVULA
Odor
Ammonia Odor Kidney disease
Fruity or acetone breath Diabetic ketoacidosis
Foul odors Oral or respiratory

infection tooth decay
Alcohol or tobacco use

- Observe color,texture, and alignment
Fecal breath odor Bowel obstruction
Sulfur odor (fetor End-stage liver disease

hepaticus)
UVULA
● Use tongue depressor to inspect the uvula. Put half
way the tongue to avoid stimulation of gag reflex.
Bifid uvula
● Heart shape uvula (variation)
● common to native americans POSTERIOR PHARYNGEAL WALL
TONSILS
● Use tongue depressor to inspect the tonsil. Assess
for the color, size, symmetry, lesions & swelling
ABNORMAL FINDINGS:
Tonsillectomy - removal of tonsill
TONSILS & POSTERIOR PHARYNGEAL WALL
Grading Scale
ACUTE TONSILITIS AND PHARYGINITIS
1+ Tonsils are visible
2+ Tonsils are midway between tonsillar pillars

& uvula
3+ Tonsils touch uvula
4+ Tonsils touch each other
- A: 3+ B: 4+ C: 3+ D: 3+ or 4+
NOTE
- Tonsillitis exudates like a puss or nana due to bacterial
and can be threatened by drinking antibiotics
- Tonsillitis may be due to viral
ANATOMY OF THE ABDOMEN
ABNORMAL VISCERA
● Solid - maintain shape
● Hollow - unmaintained shape
NOTE
- Some visceral organs are not palpable
VASCULAR STRUCTURES
● Costovertebral Angle
- Angle between T12 vertebra & spine
PERSONAL HEALTH HISTORY

● GI disorders
● Urinary tract diseases
● Viral hepatitis
● Abdominal surgery or truma
● OTC medication
FAMILY HISTORY
LIFESTYLE AND HEALTH PRACTICES

● Alcohol
● Food, caffeine intake
● Exercise
● Stress
● Perception/ view regarding their condition
COLLECTING SUBJECTIVE DATA:
THE NURSE HEALTH HISTORY
OBJECTIVE DATA:
HISTORY OF PRESENT HEALTH CONERN PHYSICAL EXAMINATION
● Abdominal pain PREPARE THE CLIENT

- COLDSPA
● Indigestion
● Nausea and vomiting
● Appetite
● Bowel elimination
ABDOMINAL PAIN
● Visceral - NOT LOCALIZ
● Parietal
● Referred
REFERRED PAIN
EQUIPMENT
● Small pillow or rolled blanket
● Centimeter ruler
● Stethoscope ( warm the diaphragm and bell)
● Marking pen
Inspect
Auscultate
PErcussion
PAlpation
INSPECTION
● Coloration, vascularization, scars, rashes, and
lesion of the skin
● Observe umbilicus
● Abdominal contour and symmetry
● Aortic pulsation and peristatic waves
AUSCULTATION: VASCULAR SOUND
MEASURING THE ABDOMINAL GIRTH

● Assessed periodically to evaluate progress
● Recommended to screen for cardio vascular factors
- Measures same time
- Position: standing, supine
- Disposab;e or easily cleaned tape
measure
- Place tape measure behind the client and
measure at the umbilicus
- Record
- Take future measurements from the same
location
INSPECTION
● Abdominal movement ( when client breathes)
● Aortic pulsation
● Peristaltic waves
—------------kulang ng slide 101-103—-------
AUSCULTATION
● Bowel sounds
● Vascular sounds
● Venous hum
● Friction rub over the spleen and liver
AUSCULTATION: BOWEL SOUND

AUSCULTATION: FRICTION RUB OVER THE LIVER
AND SPLEEN
PERCUSSION: LIVER SIZE

PERCUSSION
● Tone
● Liver size
● Spleen size
● Blunt percussion of liver and kidneys
PERCUSSION: TONE
ABNORMAL FINDINGS
ENLARGE LIVER
ENLARGE SPLEEN
LIVER LOWER THAN NORMAL BLUNT PERCUSSION: LIVER AND KIDNEY
PALPATION
LIVER HIGHER THAN NORMAL
● Light palpation
● Deep palpation
● Palpate aorta, liver, spleen, kidneys, urinary bladder
CONSIDERATION UPON PALPATION

1. Painful area last
2. Light palpation first before deep palpation
3. Some areas of the abdomen may be tender–
xiphoid process, lover aorta, lower pole of the
kidney, cecum, sigmoid colon and ovaries
4. Overcome ticklishness and self-guarding by
self-palpation, warm stethoscope
5. Promote relaxation:
PERCUSSION: SPLEEN - Pillow under the clients knees
- Slow, deep breaths through the mouth
- Light pressure over the clients sternum
with the left hand, palpate with right
LIGHT PALPATION
ABNORMAL FINDINGS
DEEP PALPATION
● Use your thumb and first finger or use two hands

and palpate deeply in the epigastrium, slightly to the
left midline. Assess the pulsation of the abdominal
aorta.
NORMAL
The normal aorta is approximately 2.5 to 3.0 cm wide with

a moderately strong and regular pulse.
ABNORMAL
A wide, bounding pulse may be felt with an abdominal

aortic aneurysm.
PALPATION: LIVER
PALPATION
● Note consistency and tenderness. To palpate
● Mass
bimanually, stand at the client’s right side and place
● Umbilicus and surroundin area for swelling, bulges,
your left hand under the client’s back at the level of
or masses
the eleventh to twelfth ribs. Lay your right hand
parallel to the right costal margin (your fingertips
should point toward the client’s head). Ask the client
to inhale then compress upward and inward with
PALPATION: AORTA
your fingers.
NORMAL
The liver is usually not palpable, although it may be felt

in some thin clients. If the lower edge is felt, it should be
firm, smooth, and even. Mild tenderness may be normal
ABNORMAL
A hard, firm liver may indicate cancer. Nodularity may ABNORMAL

occur with tumors, metastatic cancer, late cirrhosis, or
syphilis. Tenderness may be from vascular engorgement A palpable spleen suggests enlargement (up to three
(e.g., congestive heart failure), acute hepatitis, or abscess. times the normal size), which may result from trauma,
A liver more than 1 to 3 cm below the costal margin is mononucleosis, chronic blood disorders, and cancers. The
considered enlarged (unless pressed down by the splenic notch may be felt, which is an indication of splenic
diaphragm). enlargement.
PALPATE: LIVER BY HOOKING
● Alternatively asking the client to turn onto the right

side may facilitate splenic palpation by moving the
spleen downward and forward. Document the size
of the spleen in centimeters below the left costal
margin. Also note consistency and tenderness.
● To palpate by hooking, stand to the right of the
client’s chest. Curl (hook) the fingers of both hands
PALPATION: KIDNEY
over the edge of the right costal margin. Ask the
client to take a deep breath and gently but firmly
pull inward and upward with your finger.
PALPATION: SPLEEN
● To palpate the right kidney, support the right

posterior flank with your left hand and place your
right hand in the RUQ just below the costal margin
at the MCL.
● To capture the kidney, ask the client to inhale. Then
compress your fingers deeply during peak
inspiration. Ask the client to exhale and hold the
breath briefly. Gradually release the pressure of
● Stand at the client’s right side, reach over the your right hand. If you have captured the kidney,
abdomen with your left arm, and place your hand you will feel it slip beneath your fingers. To palpate
under the posterior lower ribs. Pull up gently. Place the left kidney, reverse the procedure.
your right hand below the left costal margin with the
fingers pointing toward the client’s head. Ask the
NORMAL
client to inhale and press inward and upward as you
provide support with your other hand. The kidneys are normally not palpable. Sometimes the
lower pole of the right kidney may be palpable by the
capture method because of its lower position. If palpated,
NORMAL it should feel firm, smooth, and rounded. The kidney may
or may not be slightly tender.
The spleen is seldom palpable at the left costal margin;
rarely, the tip is palpable in the presence of a low, flat ABNORMAL
diaphragm (e.g., chronic obstructive lung disease) or with
deep diaphragmatic descent on inspiration. If the edge of
Tenderness accompanied by peritoneal inflammation or
the spleen can be palpated, it should be soft and non
capsular stretching is associated with splenic
tender.
enlargement.
PALPATION: URINARY BLADDER
Fig. Abdominal Distention
● Performed to know if the distention is fluid-filled or

not.
● Palpate for a distended bladder when the client’s

history or other findings warrant (e.g., dull SHIFTING DULLNESS
percussion noted over the symphysis pubis). Begin
at the symphysis pubis and move upward and - If you suspect that the client has ascites because of
outward to estimate bladder borders. a distended abdomen or bulging flanks, perform this
special percussion technique. The client should
remain supine. Percuss the flanks from the bed
upward toward the umbilicus. Note the change from
NORMAL
dullness to tympany and mark this point. Now help
Normally the bladder is not palpable. the client turn onto his or her side. Percuss the
abdomen from the bed upward. Mark the level
ABNORMAL where dullness changes to tympany.
A distended bladder is palpated as a smooth, round, and

somewhat firm mass extending as far as the umbilicus; NORMAL
dull percussion tones.
The borders between tympany and dullness remain
relatively constant throughout position changes.
ABNORMAL
ABNORMAL FINDINGS OF THE ABDOMEN
When ascites is present and the client is supine, the fluid
assumes a dependent position and produces a dull
percussion tone around the flanks. This test is not always
reliable and definitive testing by ultrasound is necessary.
TEST FOR ASCITES
FLUID WAVE TEST
- Palpate deeply in the abdomen where the client has

pain then suddenly release pressure. Listen and
watch for the client’s expression of pain. Ask the
client to describe which hurt more—the pressing in
or the releasing—and where on the abdomen the
pain occurred.
- Patient remain supine. Ask the client or an assistant
to place the ulnar side of the hand and the lateral
NORMAL
side of the forearm firmly along the midline of the
abdomen. Firmly place the palmar surface of your No rebound tenderness is present.
fingers and hand against one side of the client’s
abdomen. Use your other hand to tap the opposite ABNORMAL
side of the abdominal wall.
The client has rebound tenderness when he or she
perceives sharp, stabbing pain as the examiner releases
NORMAL pressure from the abdomen (Blumberg’s sign).
No fluid wave is transmitted.

ROVSING’S SIGN (REFERRED REBOUND
ABNORMAL TENDERNESS)
Movement of a fluid wave against the resting hand

suggests large amounts of fluid are present (ascites).
Because this test is not completely reliable, definitive
testing by ultrasound is needed.
TEST FOR APPENDICITIS
NOTE
- Palpate deeply in the LLQ and quickly release
● Appendicitis is a MEDICAL/SURGICAL pressure.
EMERGENCY.
● Abdominal pain and tenderness may indicate NORMAL
peritoneal irritation.
No rebound pain is elicited.
MCBURNEY’S SIGN ABNORMAL
Pain in the RLQ during pressure in the LLQ is a positive

Rovsing’s sign. It suggests acute appendicitis.
- ⅔ from the umbilicus is the McBurney’s Sign.
REBOUND TENDERNESS (BLUMBERG’S SIGN) PSOAS SIGN
Pain in the RLQ indicates irritation of the obturator muscle

due to appendicitis or a perforated appendix.
HYPERSENSITIVITY TEST
- Stroke the abdomen with a sharp object (e.g.,

broken cotton tipped applicator or tongue blade) or
grasp a fold of skin with your thumb and index
- Raise the client’s right leg from the hip and place finger and quickly let go. Do this several times along
your hand on the lower thigh. Ask the client to try to the abdominal wall.
keep the leg elevated as you apply pressure
downward against the lower thigh.
NORMAL
NORMAL The client feels no pain and no exaggerated sensation.
No abdominal pain is present. ABNORMAL
ABNORMAL Pain or an exaggerated sensation felt in the RLQ is a

positive skin hypersensitivity test and may indicate
Pain in the RLQ (Psoas sign) is associated with irritation appendicitis.
of the iliopsoas muscle due to appendicitis (an inflamed
appendix).
TEST FOR CHOLECYSTITIS
OBTURATOR SIGN - Cholecystitis (RUQ - inflammation of the

gallbladder)
● (+) Murphy’s Sign

- Sharp pain causing inspiratory arrest.
- Arrest - means stopped.
- Support the client’s right knee and ankle. Flex the

hip and knee and rotate the leg internally and
externally.
NORMAL
No abdominal pain present.
ABNORMAL
ABNORMAL FINDINGS
RECTUM AND ANUS
COLLECTING OBJECTIVE DATA: PHYSICAL

EXAMINATION
Equipment:
● Stool
● Gown
● Disposable non-latex gloves
● Stethoscope (for possible auscultation)
● Water soluble lubricant
● Specimen card
INSPECTION
COLLECTING OBJECTIVE DATA: PHYSICAL

EXAMINATION
● Prepare the Patient
ABNORMAL FINDINGS
PALPATION: MALE
● Palpate the anus
PALPATION: FEAMALE
NORMAL
Brown-colored stool
ABNORMAL
Black-colored stool that indicates complication/ upper GI

ANALYSIS OF DATA:
bleeding. DIAGNOSTIC REASONING
Bile - gives color to stool and urine. ● Nursing Diagnoses

- Health promotion diagnosis
Abnormality: blockage/obstruction of the bile duct = - Risk diagnoses
gray-colored stool. - Actual diagnoses
Steatorrhea - pale, oily, foul smelling stools ● Collaborative Diagnosis

● Medical Problems
ABNORMAL FINDINGS

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Trinity University of Asia - St.

Luke’s College of Nursing Batch 2026 - Luminaris

HEALTH ASSESSMENT | 2ND SEM - A.Y. 22-23 LEC04

● Identify structures and functions of the

ANATOMY OF THE MOUTH

- Lie at the base of the tongue

COLLECTING SUBJECTIVE DATA: LIPS

History of Present Health Concern

Personal Health History

Lifestyle and Health Practices

COLLECTING SUBJECTIVE DATA:

REDDISH / CHERRY RED DISCOLORATION

HERPES SIMPLEX TYPE 1 ABNORMAL FINDINGS:

Yellowish Teeth Color

Cavity / Dental Caries

● Inspect the teeth. Ask the client to open the mouth.

Leukoplakia (Ventral Surface)

Kaposi's Sarcoma Lesions

Candida Albicans Infection (Thrush)

Canker Sore (Singaw)

Black Hairy Tongue

ABNORMAL FINDINGS: Atrophied

Varicose Veins (Ventral surface)

PALATE AND UVULA

Ammonia Odor Kidney disease

Fruity or acetone breath Diabetic ketoacidosis

Foul odors Oral or respiratory

Alcohol or tobacco use

Sulfur odor (fetor End-stage liver disease

1+ Tonsils are visible

2+ Tonsils are midway between tonsillar pillars

3+ Tonsils touch uvula

4+ Tonsils touch each other

ANATOMY OF THE ABDOMEN

PERSONAL HEALTH HISTORY

LIFESTYLE AND HEALTH PRACTICES

● Abdominal pain PREPARE THE CLIENT

AUSCULTATION: VASCULAR SOUND

MEASURING THE ABDOMINAL GIRTH

AUSCULTATION: BOWEL SOUND

PERCUSSION: LIVER SIZE

LIVER LOWER THAN NORMAL BLUNT PERCUSSION: LIVER AND KIDNEY

CONSIDERATION UPON PALPATION

● Use your thumb and first finger or use two hands

The normal aorta is approximately 2.5 to 3.0 cm wide with

A wide, bounding pulse may be felt with an abdominal

The liver is usually not palpable, although it may be felt

A hard, firm liver may indicate cancer. Nodularity may ABNORMAL

PALPATE: LIVER BY HOOKING

● Alternatively asking the client to turn onto the right

● To palpate the right kidney, support the right

PALPATION: URINARY BLADDER

Fig. Abdominal Distention

● Performed to know if the distention is fluid-filled or

● Palpate for a distended bladder when the client’s

A distended bladder is palpated as a smooth, round, and

TEST FOR ASCITES

FLUID WAVE TEST

- Palpate deeply in the abdomen where the client has