Oral Care/Mouth Care – Nursing is a profession within the healthcare sector focused on the care of individuals, families, and communities so they may attain, maintain, or recover optimal health and quality of life. Nurses may be differentiated from other healthcare providers by their approach to patient care, training, and scope of practice. Nurses practice in many specialisms with differing levels of prescriber authority.
Many nurses provide care within the ordering scope of physicians, and this traditional role has shaped the public image of nurses as care providers. However, nurses are permitted by most jurisdictions to practice independently in a variety of settings depending on training level. In the postwar period, nurse education has undergone a process of diversification towards advanced and specialized credentials, and many of the traditional regulations and provider roles are changing.
Nurses develop a plan of care, working collaboratively with physicians, therapists, the patient, the patient’s family, and other team members, that focus on treating illness to improve quality of life. Nurses may help coordinate the patient care performed by other members of an interdisciplinary healthcare team such as therapists, medical practitioners, and dietitians. Nurses provide care both interdependently, for example, with physicians, and independently as nursing professionals.
Oral Care/Mouth Care
Definition of Mouth Care/Oral Hygiene:
According to WHO (World Health Organization) Oral hygiene is the practice of keeping the mouth and teeth clean to prevent dental problems, most commonly, dental cavities, gingivitis, periodontal (gum) diseases and bad breath.
or
Oral hygiene is the practice of keeping the mouth clean and healthy by brushing and flossing to prevent tooth decay and gum disease. It is the process of cleaning and freshening the teeth, gums and mouth.
or
Oral hygiene is important because mouth is the portal of entry of food and digestion starts from mouth.. So, the condition of mouth directly affects health.
Purposes of Oral Hygiene:
A. For a conscious patient:
1. To prevent dental carries and tooth decay
2. To feel fresh, clean and socially acceptable
3. To stimulate salivation
4. To maintain the healthy state of mouth, teeth, gums and lips.
5. To clean the mouth off food particles, plaque and bacteria
6. To prevent sordes, caries and infection to oral tissues.
7. To prevent inflammation of gums and salivary glands
8. To prevent complications such as stomatitis, glossitis, pyorrhoea, parotitis, etc
B. For an unconscious patient:
1. To maintain integrity of the lips, tongue and mucous membrane of the mouth.
2. To prevent and treat oral infection.
3. To prevent injury from aspiration.
4. To maintain clean and moisturize of tooth surfaces, mouth and lips.
5. To prevent dental caries and tooth delay.
6. To prevent halitosis.
Indication of Oral Hygiene:
1. Unconscious patient.
2. Helpless patient.
3. Patient with fluid diet.
4. Mouth breathers.
5. Oral surgery patient.
6. Patient having local disease of mouth.
7. Patients on oxygen inhalation.
8. Patient on chemotherapy.
9. Paraplegic patients.
10. Actually ill and serious patients.
11. Patient who are unable to maintain adequate oral hygiene.
12. Patient with hyper-pyrexia.
13. Malnourished and dehydrate patient.
11. Sordes: Brown crust formed on teeth.
12. Dental caries: Cavities occurring in teeth due to bacillus acidophilus.
13. Tartar formation: Calcification of sticky colourless material containing streptococcus.
14. Bleeding gums.
15. Gastritis: Inflammation of stomach.
Measures to Prevent Complication Which May Arise due to Neglect Mouth Care:
Teach patient or family to do the following: Brush and floss the teeth as soon possible after each meal, using the following techniques:
1. Moisten the tooth brush and apply tooth paste.
2. Hold the tooth brush at a 45 degree angle to the teeth.
3. Brush the front and back of all the teeth from the gum line toward.
4. Tongue should be cleaned every morning by a tongue cleanser.
5. Teeth should be cleaned twice daily (morning, at night) 6. Consult with dentist every two month.
7. A good tooth paste or powder should be used.
8. Instruct the patient and his family members if any complication may arise, instruct him to meet with the dentist as soon as possible.
Mouth Care for an Unconscious or Disabled Patient
A. Articles required:
A tray containing-
1. Artery forceps-1
2. Dissecting forceps-1
3. Face towel-1
4. Small mackintosh-1
5. Cotton swabs in bowl
6. Tongue depressor-1
7. A bowl with clean water.
8. Kidney tray-1
9. Paper bag-1
10. Gauge pieces in a bowl.
11. Feeding cup-1
12. Glycerine borax
13. Swab sticks
B. Solutions used for oral care:
1. Potassium permanganate 1: 5000 solution
2. Hydrogen peroxide 1: 8
3. Sodium chloride 1 teaspoon to 500ml of water
4. Sodium Chloride and lime juice mixture
C. Steps of the procedure
1. Explain the procedure to the patient
2. Provide privacy
3. Position the patient in side- lying position toward the dependent side.
4. Arrange the articles conveniently
5. Wash hands
6. Place the mackintosh and towel beneath the patients chin
7. Place the kidney tray close to the cheek 8. Use any dentifrice to clean teeth.
9. Do not pour water into mouth if the patient is unconscious
10. Wrap a swab around the forceps, covering the tips completely and clean the mouth systematically.
Figure: Placing kidney tray close to the cheek of the patient and cleaning process of teeth
11. Use tongue depressor, if needed and wipe the tongue from side to side
12. For a conscious patient, tooth brush and paste can be used; the patient can spit, and water can be purred for washing his mouth.
13. Use as many swabs as required till the mouth is clean.
14. Repeat the entire procedure with swabs dipped in fresh water.
15. When the teeth and tongue are cleaned well stop the procedure, wipe the lips and face with towel.
16. Apply glycerin borax on the cracked lip and tongue
D. After care of patient and articles
1. Remove the kidney tray, treatment mackintosh and towel
2. Make the patient comfortable
3. Take all articles to the utility room discard the wastes and clean them with soap and water. Boil the forceps and replace them in their usual places.
4. Wash hands.
E. Recording and reporting:
1. Record the procedure time and condition of the mouth in the nurses record
2. Report any abnormal condition to the ward sister and physician.
Procedure of Oral care for Conscious Patient:
A. Articles
A clean “mouth toilet tray” containing:
1. Face towel
2. Tumbler/ feeding cup containing water
3. Soft bristled tooth brush
4. Tooth paste/tooth powder/ available dentifrice
5. Mouth wash solution (according to the patients preference and availability)
i. Sodium chloride
ii. Thymol
iii. Diluted soluation of potassium permanganate 1: 1000
iv. Listerine
V. Clorhexidine
6. Cotton applicator/ cotton balls
7. Emollient in a continer-glycine, liquid paraffin, Vaseline, coconut oil.
8. K-basin/emesis basin-2
9. Small mackintosh
10. Clean gloves.
B. Procedure
1. Assess the condition of the patient, his mouth and level of consciousness.
2. Inspect the integrating of lips, tooth, buccal mucosa, gums, palate and tongue
3. Assess the patient ability to grasp and manipulated tooth brush.
4. Explain procedure to patient and encourage him to participate.
5. Pull the screen
6. Wash hand and don gloves
7. Bring patient to edge of the bed nearest to the nurse.
8. Position patient in high fowlers/ semi fowler’s position as tolerated.
9. Place the small mackintosh with the face towel on the chest
10. Place k-basin close the patients chin.
11. Apply tooth paste to brush. Holding brush over k- basin pour small amount of water over tooth paste.
12. Instruct patient to hold tooth brush bristles at 45 degree angle to gum line. Brush inner and Scan d outer surfaces of upper and lower teeth by brushing from gum to crown of each tooth.
13. Clean the biting surface back and forth; a further site first and then any nearer side and upper jaw first and then lower jaw.
14. Have the patient hold the brush at the same angle (45 degree) over tongue and brush lightly over surface horizontally taking care not to initiate gag space reflex.
15. Allow the patient rinse mouth thoroughly by taking mouthful of water and spitting into the k- basin.
16. Allow patient to rinse mouth with mouth wash as desired
17. Assist wiping mouth with the face towel.
18. Apply emollient to lips.
19. Assist patient to comfortable position
20. Discard the waste, clean the used articles and replace equipment as appropriate.
21. Wash hands.
22. Record the procedures including time, solution used and condition of mouth.
Procedure of the Care of Dentures
1. Remove the dentures and inspect the oral cavity for abnormalities, if any.
2. Explain the procedure to the patient, and let him observe the procedure; teach him to clean the dentures.
3. Articles required to clean are.
- Soft bristled tooth brush
- Denture tooth brush
- Dentifrice
- Warm and cold water in glasses
- Wash cloth
- Plastic denture cup
- Gloves
- Basin
4. Wash hands and keep the articles near the bed side sink
5. Take a basin and fill half of it with water
6. Put on gloves to reduce transmission of infection
7. Ask the patient to remove denture and place them in the basin
8. Brush the dentures, Use back and forth motion. Clean the inside and outside by brushing.
9. Rinse dentures thoroughly in running water.
10. Return them to the patient to keep them in a denture cup in cold water.
11. With a soft bristled tooth brush, brush the gums with tooth paste as well as the palate of tongue also.
12. Rinse the mouth thoroughly with cold water.
13. Wipe the face, and make the patient comfortable.
14. Replaced the used articles and record the procedure.
Read More…