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Assisting the Patient With Oral Care

Oral care is important not only to prevent dental caries but also to improve the patient`s self-image.

Oral care should be done at least twice a day for ambulatory patients.

Equipment: Toothbrush

Toothpaste Emesis basin Glass with cool water Disposable gloves Towel

Mouthwash (optional) Dental floss( optional) Denture-cleansing equipment( if necessary)

Denture cup Denture cleaner 4x4 gauze

Washcloth or paper towel Lip lubricant(optional)

ASSESSMENT: Assess patient`s oral cavity and dentition. Look for any caries,sore, or white patches. The
white patches may indicate a fungal infection called thrush. Assess patient`s ability to perform own
care.

NURSING DIAGNOSIS: Determine the related factors for the nursing diagnosis based on the patient`s
current status. Possible nursing diagnoses may include:

Ineffective Health Maintenance

Impaired Oral Mucous Membrane

Disturbed Body Image

Deficient Knowledge

OUTCOME IDENTIFICATION

AND PLANNING: The expected outcome to achieve when performing oral care is that patient`s
mouth and teeth will be clean; the patient will exhibit a positive body image; and the patient will
verbalize the importance of oral care.

IMPLEMENTATION RATIONALE

ACTION

1. Explain procedure to patient. Explanation facilitates cooperation


2. Performan hand hygiene. Don
3. Disposable gloves if assisting Hand hygiene deter the spread of
microorganis . Gloves protect the nurse from exposure to blood and bloodborne infections.
4. Assemble equipment on overbed table within patient`s reach. Organization facilitates
performance of task.
5. Provide privacy for patient. Patient may be embarrassed if cleansing involves
removal of dentures.
6. Lower side rail and assist patient to sitting position if permitted, or turn patient onto side. Place
towel across patient`s chest. Raise bed to a comfortable working position. The sitting or side-
lying position prevents aspiration of fluids into the lungs. The towel protects the patient from
dampness.
7. Encourage patient to brush own teeth, or assist if necessary:
8. A. Moisten toothbrush and apply toothpaste to bristles.
9. B. Place brush at a 45-degree angle to gum line and brush from gum line to crown of each
tooth. Brush back and forth across biting surface of each tooth.
10. C.Brush tongue gently with toothbrush.
11. D. Have patient rinse vigorously with water and spit into emesis basin. Repeat until clear.
Suction may be used as an alternative for removal of fluid and secretion from mouth.
12. A. water softens the bristles.
13. B . This facilitates removal of plague and tartar. The 45-degree angle of brushing permits
cleasing of all surface areas of the tooth.
14. C. This removes coating on the tongue. Gentle motion does not stimulate gag reflex.
15. D. The vigorous swishing motion helps to remove debris. Suction is appropriate if swallowing
reflex is impaired or absent.
16. E. Assist patient to floss teeth if necessary. E. Flossing aids in removal of plague and promotes
healthy gum tissue.
17. Offer mouthwash if patient prefers. F. Mouthwash leaves a pleasant taste in the
mouth.
18. Assist patient with removal and cleansing of dentures if necessary :
19. A. apply gentle pressure with 4x4 gauze to grasp upper denture plate and remove.Place it
immediately in denture cup. Lift lower dentures using slight rocking motion, remove, and place
20. In denture cup. A, Rocking motion break suction between denture and gum. Using 4x4 gauze
prevent slippage and discourages spread of microorganisms.
21. B. If patient prefers, add denture cleanser to cup with water and follow directions on
preparation,or brush all areas thoroughly with toothbrush and paste. Place paper towels or
washcloth in sink while brushing.
22. B. Dentures collect food and microorganism and require daily cleansing. Putting paper towels
or a washcloth in the sink protect against breakage.
23. C. Rinse thoroughly with water and return dentures to patient.
24. D. Offer mouthwash so patient can rinse mouth before replacing dentures.
25. D. Mouthwash leaves a pleasant taste in the mouth and removes food particle, thus permitting
proper fit.
26. E. Apply lubricant to lip if needed.
27. Flossing Teeth
28. Remove approximately 6’’ of dental floss from container or use a plastic floss holder. Wrap the
floss around the index finger, keeping about 1’’ to 1.5’’ of floss taut between the finger
29. The floss must be held taut to get between the teeth.
30. Insert floss gently between teeth , moving it back and forth downward to the gums.
31. Trauma to the gums can occur if floss is forced between teeth.
32. Move the floss up and down first on one side of a tooth surfaces are clean.
33. This ensures that the sides of both teeth are cleaned.
34. Repeat Action 9 and 10 in the spaces between all teeth.
35. Instruct patient to rinse mouth well with water after flossing.
36. Vigorous rinsing helps to remove food particles and plague that have been loosened by flossing.
37. Remove equipment and assist patient to a position of comfort. Record any unusual bleeding or
inflammation. Raise side and lower bed.
38. This promotes oral hygiene and provides for oral assessment. Elevated side rails and lowered
bed position maintain safety for bedridden patients.
39. Remove disposable gloves from inside out and discard appropriately. Perform hand hygiene.
40. This protects the nurse from contact with any microorganism. Hand hygiene deters spread
microorganism.

EVALUATION
The expected outcomes are met when the patient receives oral care, experiences little to no
discomfort, states mouth feels refreshed,and demonstrates understanding of reason for proper
oral care.

UNEXPECTED SITUATIONS AND


ASSOCIATED INTERVENTIONS
WHILE cleaning the teeth, you notice a large amount of bleeding from the gum line; Stop
brushing . Allow patient to gently rinse mouth with water and spit into emesis basin. Before
brushing again, check most recent platelet level.
Patient has braces on teeth: Brush extra thoroughly. Braces collect food particles.

INFANT AND CHILD


CONSIDERATIONS
When assisting small children with oral care do not use a toothpaste that contains fluoride if
the child cannot spit out excess, Excessive amounts of ingested fluoride can lead to a
discoloration of the teeth.

PROVIDING ORAL CARE FOR THE DEPENDENT PATIENT


Some patients cannot perform their own oral care. When assisting the dependent
patient,the nurse may have to protect the patient`s airway while performing oral care.
Equipment: Toothbrush toothpaste Emesis basin Glass with cool water Disposable gloves towel
Mouthwash (optional) Normal saline solution Dental floss (optional) Denture –cleansing
equipment (if necessary) Denture cup Denture cleaner
4x4 gauze Washcloth or paper towel Lip lubricant (optional)
Sponge toothette or tongue blades padded with 4x4 gauze sponges Irrigating syringe with
rubber tip(optiona) Suction catheter with suction apparatus (optional)

ASSESSMENT:
Assess the patient`s level of consciousness and overall ability to assist with oral care and
respond to directions. Inspect the patient`s oral cavity and teeth. Look for any caries,sores, or
White patches. The white patches may indicates a fungal infection called thrush. Assess the
patient`s ability to perform care.

NURSING DIAGNOSIS:
Determine the related factors for the nursing diagnosis based on the patient`s current status.
Possible nursing diagnoses may include:
Ineffective Health Maintenance
Impaired Oral Mucous Membrane
Disturbed Body Image
Deficient Knowledge

OUTCOME IDENTIFICATION
AND PLANNING
THE expected outcome to achieve when performing oral care is that the patient`s mouth
and teeth will be clean; the patient will participate as much as possible with oral care; the
patient will demonstrate improvement in body image; and the patient will verbalize an
understanding about the importance of oral care.

IMPLEMENTATION
ACTION
1. Explain procedure to patient.
2. Explanation facilitates cooperation.
3. Perform hand hygiene and don disposable gloves.
4. Hand hygiene and disposable gloves deter the spread of microorganisms.
5. Assemble equipment on overbed table within reach .
6. Organization facilitates performance of task.
7. Provided privacy of patient. Adjust height of bed to a comfortable position. Lower one side
rail and position patient on the side, with head tilted forward. Place towel across patient`s
chest and emesis basin in position under chin.
8. The side-lying position with head forward prevent aspiration of fluid into lungs. Towel and
emesis basin protects patient from dampness.
9. Open patient`s mouth and gently insert a padded tongue blade between back molar if
necessary.
10. A padded tongue blade keeps the mouth open for easier cleaning and prevents the patient
from biting the nurse`s fingers.
11. If teeth are present,brush carefully with toothbrush and paste. Remove dentures if and
clean before replacing. Use a toothtte or gauze –padded tongue blade moistened with
normal saline or dilute mouthwash solution to gently cleanse gums, mucous
membranes,and tongue.
12. Toothbrush or padded blade provides friction necessary to clean areas where plaque and
tartar accumulate. Hydrogen peroxide is considered an irritant and is not longer
recommended.the mechanical action of cleansing is more important than the solution used.
13. Use gauze –padded tongue blade dipped in mouthwash solution to rinse the oral cavity. If
desired, insert rubber tip of the irrigating syringe into patient`s mouth and rinse gently with
a small amount of water. Position patient`s head to allow for return of water or use suction
apparatus to remove the water from oral cavity.
14. Rinsing helps cleanse debris from the mouth. Forcefull irrigation may cause aspiration.
15. Apply lubricant to patient`s lips.
16. This prevents drying and cracking of lips.
17. Remove equipment and return patient to a position of comfort. Raise side rail and lower
bed. Record any unusual bleeding or inflammation.
18. This promotes oral hygiene and provides for oral assessment. Raised side rail and lowered
bed maintain patient safety.
19. Perform hand hygiene.
20. Hand hygiene deters the spread of microorganisms.

EVALUATION:

The expected outcomes are met when the patient`s oral cavity is clean and patient states or
demonstrates improved body image. In addition, the patient verbalizes a basis understanding of
the need for oral care if alert and oriented.

UNEXPECTED SITUATIONS AND ASSOCIATED INTERVENTIONS:

Patient begins to cough and gag during oral care: Stop performing oral care. Assist patient onto
side and remove secretion from mouth with suction.

Patient begins to bite on padded tonque blade. Do not jerk tonque blade out. Wait for patient
to relax mouth before removing padded tongue blade.

SPECIAL CONSIDERATIONS
A patient receiving chemotherapy medication may have bleeding gums and extremely sensitive
mucous membranes. Use a soft sponge toothette for cleaning, or substitute a salt water rinse(.5
teaspoon salt I 1cup of warm water) for brushing of teeth.

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