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- Ears
- During the tympanic membrane exam:
- In infants – Pull pinna down and back
- In children older than 3 – Pull pinna up and back
- The ear canal should be pink with fine hairs
- The tympanic membrane should be pearly pink, or gray
- The light reflex should be visible
- Alignment
- The top of the auricles should meet in an imaginary horizontal line that extends from the outer canthus of the eye
- External ear
- The external ear should be free of lesions and nontender
- The ear canal should be free of foreign bodies or discharge
- Cerumen is an expected finding
- Hearing
- Newborns
- Have intact acoustic blink reflexes to sudden sounds
- Infants
- Turn towards sound
- Older children
- Can be screened by whispering a word from behind to see whether they can identify the word
- Newborns
- During the tympanic membrane exam:
- Nose
- The position should be midline
- Patency should be present for each nostril without excessive flaring
- Smell can be assessed in older children
- Internal structure
- The spectrum is midline and intact
- The mucosa is deep pink in light-skinned clients and various shades of brown or gray in dark-skinned clients
- The mucosa should be moist without evidence of discharge
- Mouth and throat
- Lips
- Darker pigmented than facial skin
- Smooth, soft, moist, and symmetrical
- Gums
- Coral pink in light-skinned clients, and various shades of brown or gray in dark-skinned clients
- Tight against the teeth
- Mucous membranes
- Without lesions
- Moist, smooth, and glistening
- Pink in light-skinned clients and various shades of brown or gray in dark-skinned clients
- Tongue
- Infants can have white coating on their tongues from milk that can easily removed
- Oral candidiasis coating is not easily removed
- Children and adolescents should have pink, symmetric tongues that they are able to move beyond their lips
- Teeth
- Infants should have six to eight teeth by 1 year of age
- Children and adolescents should have teeth that are white and smooth, and begin replacing the 20 deciduous teeth with 32 permanent teeth
- Hard and soft palates
- Intact, firm, and concave
- Uvula
- Intact and moves with vocalization
- Tonsils
- Infants: Might not be able to visualize
- Children: Barely visible to prominent, same color as surrounding mucosa
- Voice
- Infants: Strong cry
- Children and adolescents: Clear and articulate
- Atraumatic Care
- Encouraging Opening the Mouth for examination
- Perform the examination in front of a mirror.
- Let the child first examine someone else’s mouth, such as the parent, the nurse, or a puppet, and then examine the child’s mouth.
- Instruct the child to tilt the head back slightly, breathe deeply through the mouth, and hold the breath; this action lowers the tongue to the floor of the mouth without the use of a tongue blade.
- Lightly brushing the palate with a cotton swab also may open the mouth for assessment.
- Encouraging Opening the Mouth for examination
- Lips
- Ears
Healthy Eating and the Holidays
KEY POINTS ‘Tis the season for family, festivity, and food—lots of food. How do you manage diabetes during the holidays when food temptations are just