Assessment Procedure Normal Findings Abnormal Findings

NOSE: Inspection and Palpation

Inspect and palpate the external

nose. Note nasal color, shape, Color is the same as the rest of the Nasal tenderness on palpation
consistency, and tenderness. face; the nasal structure is smooth accompanies a local infection.
and symmetric; the client reports
no tenderness.
Check patency of air flow through
the nostrils by occluding one
nostril at a time and asking client Client is able to sniff through each Client cannot sniff through a
to sniff. nostril while other is occluded. nostril that is no occluded, nor can
he or she sniff or blow air through
the nostrils. This may be a sign of
swelling, rhinitis, or a foreign
object obstructing the nostrils. A
line across the tip of the nose is
common in clients with chronic
allergies.
Inspect the internal nose. To
inspect the internal nose, use an The nasal mucosa is dark pink,
otoscope with a short wide-tip moist, and free of exudate. The Nasal mucosa is swollen and pale
attachment ( or you can also use a nasal septum is intact and free of pink or bluish gray in clients with
nasal speculum and penlight). Use ulcers or perforations. Turbinates allergies. Nasal mucosa is red and
your nondominant hand to are dark pink ( redder than oral swollen with upper respiratory
stabilize and gently tilt the client's mucosa), moist, and free of infection. Exudate is common with
head back. Insert the short wide lesions. The superior turbinate will infection and may range from
tip of the otoscope into the not be visible from this point of large amounts of watery dischage
client's nostril without touching view. A deviated septum may to thick yellow-green purulent
the sensitive nasal septum. Slowly appear to be an overgrowth of discharge. Purulent nasal
direct the otoscope back and up tissue. This is a normal finding as discharge is seen with acute
to view the nasal mucosa, nasal long as breathing is not bacterial rhinosinusitis. Bleeding
septum, the inferior and middle obstructed. ( epistaxis ) or crusting may be
turbinates, and the nasal passage noted on lower anterior part of
(the narrow space between the nasal septum with local irritation.
septum and the turbinates). Ulcers of the nasal mucosa or a
perforated septum may be seen
with use of cocaine, trauma,
chronic infection, or chronic nose
picking. Small, pale, round , firm
overgrowths or masses on mucosa
( polyps ) are seen in clients with
chronic allergies.
SINUS: Palpation

Palpate the sinuses. When an
infection is suspected, the nurse
can examine the sinuses, through
palpation, percussion and
transillumination.
Palpate the frontal sinuses by
Frontal and maxillary sinuses are
nontender to palpation, and
crepitus is evident.
Frontal or maxillary sinuses are
tender to palpation in clients with
allergies or acute bacterial
rhinosinusitis. If the client has a
large amount of exudate, you may
feel crepitus upon palpation over
the maxillary sinuses.
using your thumbs to press up on
the brow on each side of the nose.

Palpate the maxillary sinuses by

pressing with thumbs up on the
maxillary sinuses.

SINUS: Percussion

Percuss the sinuses. Lightly tap The frontal and the maxillary
(percuss ) over the frontal sinuses The sinuses are not tender on sinuses are tender upon
and over the maxillary sinuses for percussion. percussion in clients with allergies
tenderness. or sinus infection.

SINUS: Transillumination

Transilluminate the sinuses. If Absence of a red glow usually

sinus tenderness was detected A red glow transilluminates the indicates a sinus filled with fluid or
during palpation and percussion, frontal sinuses. This indicates a pus.
transillumination will let you see if normal, air-filled sinus.
the sinuses are filled with fluid or
pus. Transilluminate the frontal
sinuses by holding a strong,
narrow light source snugly under
the eyebrows ( the room should
be dark ). Use your other hand to
shield the light. Repeat this
technique for the other frontal
sinus.

Transilluminate the maxillary

sinuses by holding a strong,
narrow light source over the
maxillary sinus and asking the
client to open his or her mouth.
Repeat this technique for the
other maxillary sinus.
Absence of a red glow usually
A red glow transilluminates the indicates a sinus filled with fluid,
maxillary sinuses. The red glow pus or thick mucus (from chronic
will be seen on the hard palate. sinusitis).