nursing mgt oral cav cancer

8/12/2019 Nursing Mgt Oral Cav Cancer

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Minor irritations of the oral mucous membrane occur occasionally inall persons and are usually viral-related, self-limiting, and easily

treated. Patients who have severe stomatitis often have an underlying illness. Patients who are immunocompromised, such as the oncology patient

receiving chemotherapy, are often affected with severe tissuedisruption and pain.

Infections such as candidiasis, if left untreated, can spread through theentire gastrointestinal (GI) tract causing further complication andsometimes perineal pain.

Oral mucous membrane problems can be encountered in any setting,especially in home care and hospice settings.


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Nursing Diagnosis: Oral Mucous Membrane, Altered -

Stomatitis; Mucositis & Risk for infection

Nursing interventions:1. Assess oral hygiene practices.

2. Provides information on possible causative factors, andprovides guidance for subsequent education.

3. Assess status of oral mucosa; include tongue, lips, mucousmembranes, gums, saliva, and teeth.4. Remove dentures.

Lesions may be underlying and further irritated by the dentures.

5. Use a moist, padded tongue blade to gently pull back the

cheeks and tongue. In order to expose all areas of oral cavity for inspection.

6 Assess for extensiveness of ulcerations involving the intraoralsoft tissues, including palate, tongue, gums, and lips. Sloughing of mucosal membrane can progress to ulceration.


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7. Observe for evidence of infection and report to physician or homehealth nurse.

>Severe mucositis may manifest as any of the following: Candidiasis: Cottage cheese-like white or pale yellowish patches on

tongue, buccal mucosa and palate Herpes simplex: Painful itching vesicle (typically on upper lips) that

ruptures within 12 hours and becomes encrusted with a dried exudate Gram-positive bacterial infection, specifically staphylococcal and

streptococcal infections: Dry, raised wart-like yellowish-brown, roundplaques on buccal mucosa

Gram-negative bacterial infections: Creamy to yellow-white shiny,nonpurulent patches often seated on painful, red, superficial, mucosalulcers, and erosions

Fevers, chills

8. Assess nutrition status Malnutrition can be a contributing cause. Oral fluids needed for

moisture to membranes.

9. Assess for ability to eat and drink. Inability to chew and swallow may occur secondary to pain of inf lamed

or ulcerated oral and/or oropharyngeal mucous membranes.


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Candidiasis


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HERPES


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10. Implement meticulous mouth care regimen after eachmeal and every 4 hours while awake

To prevent buildup of oral plaque and bacteria.

11. Provide additional care If signs of mild stomatitis occur(sensation of dryness and burning; mild erythema andedema along the mucocutaneous junction) such as:

Increasing frequency of oral hygiene by rinsing with oneof the suggested solutions between brushings and onceduring the night.

12. Discontinue flossing if it causes pain.

13. Provide systemic or topical analgesics as ordered.

Increased sensitivity to pain is a result of thinning of oralmucosal lining.


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14. Instruct patient that topical analgesics can be administered as"swished and swallow" or "swish and spit" 15 to 20 minutes before

meals, or painted on each lesion immediately before mealtime.Topical analgesics include the following:

Dyclone 1%

Viscous lidocaine (10 ml per dose up to 120 ml in 24 hours).

These provide a "numbing" feeling. Xylocaine (viscous 2%)

Benadryl elixir (12.5 mg per 5 ml) and an antacid mixed inequal proportions.

15. Instruct patient to hold solution for several minutes beforeexpectorating, and not to use solution if mucosa is severelyulcerated or if drug sensitivity exists.

16. Caution client to chew or swallow after each doseAs numbness ofthroat may be experienced.


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17. Explain use of topical protective agent:

To coat the lesions and promote healing as prescribed Zilactin or

Zilactin-B Has benzocaine for pain and is painted on lesion and allowedto dry to form a protective seal.

Substrate of an antacid and Kaolin preparations. This substance isprepared by allowing antacid to settle. The pasty residue is swabbed ontothe inflamed areas and, after 15 to 20 minutes, rinsed with saline orwater. The residue remains as a protectant on the lesion.

18. For severe mucositis infection:Administer local antibiotics and/orantifungal agents as ordered.

Mycostatin, nystatin, are commonly prescribed.

19. Discontinue use of hard bristle toothbrush and flossing

As this will increase damage to ulcerated tissues. A disposable foamstickor sterile cotton swab are gentle ways to apply cleansing solutions.

20. Continue use of lubricating ointment on the lips.

21.For eating problems: Encourage diet high in protein and vitamins

To promote healing and new tissue growth.


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22. Serve foods and fluids lukewarm or cold

As this may feel soothing to the oral mucosa.23. Serve frequent small meals or snacks spaced throughout

the day

To maintain fluid balance and nutrition.

24. Encourage soft foods (mashed potatoes, puddings,custards, creamy cereals)

To avoid tissue trauma and pain.

25. Encourage use of a straw

To make swallowing easier.

26. Encourage peach, pear, and fruit drinks instead of citrusjuices

As these are not irritating and are easier to swallow.


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Instruct patient/caregiver to:

1. Gently brush all surfaces of teeth, gums, and tonguewith a soft nylon brush. To loosen debris.

2.Brush with a nonirritating agent such as baking soda.3. Remove and brush dentures thoroughly during and after

meals and as needed. To reduce risk of infection and improve appetite.

4. Rinse the mouth thoroughly during and after brushing. Removing food particles decreases risk of infection

related to trapped decaying food

5. Avoid alcohol-containing mouthwashes.As these may dry oral mucous membranes, increasing

risk for disruption of mucous membrane.


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6. Use recommended mouth rinses: Hydrogen peroxide and saline orwater (1:2 or 1:4). Peroxide solutions should be mixed immediately

before use and held in mouth for 1 to 1.5 minutes. Follow with arinse of water or saline. To maintain oxydizing property

7. Keep lips moist. Use a lip product or a water-soluble lubricant(K-Y jelly, Aquaphor Cream)

To prevent drying and cracking.8. Include food items with each meal that require chewing.As this

stimulates gingival tissue and promotes circulation.(i)

9. Minimize trauma to mucous membranes. Avoid use of tobaccoand alcohol.As these are irritating and drying to the mucosa.(i)

10. Avoid extremely hot or cold foods. Avoid acidic or highly spicedfoods.

11. Have loose-fitting dentures adjusted. Rubbing and irritation from ill-fitting dentures promotes disruption of

the oral mucous membrane.


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To further prevent infection:

Evaluate Laboratory results frequently

Check the pt.s temp. Every 4-8hrs

Protect skin from any trauma Provide an aseptic technique when changing dressing

Check for any signs of wound infection

Such as redness, swelling drainage and tenderness

Use topical antibiotics as prescribed


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Expected Outcomes Patient has intact oral mucosa. Patient demonstrates appropriate oral hygiene.

Patient verbalizes relief from stomatitis.

Patient reduces risk for infection

nursing mgt oral cav cancer

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