Oral health related nursing interventions are the treatments and actions performed to assist the elderly client attain set goals. Genetic disposition 11. Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study. Nursing Interventions and Supportive Care for the Prevention and Treatment of Oral Mucositis Associated with Cancer Treatment August 2004 Oncology Nursing Forum 31(4 Suppl):13-23 Excessive use of tobacco 8. This may also include excessive production of mucus. This reduces blood flow to the mouth and therefore decreases the amount of chemotherapy agent that reaches the oral mucosa. Home Care Interventions 1. This article reviews nursing interventions to increase adherence to oral cancer therapies, such as patient and care-partner education, side-effect and medication management, and safety issues. It is best gargled and spat out rather than swallowed, or may be applied with a swab directly to painful areas. Children’s Oncology Group, (2018) COG Supportive Care Endorsed Guidelines, Children’s Oncology Group (COG), Version date: August 22, 2018. Oxford: Wiley Blackwell. Cleft lip or palate 8. The prevalence of malnutrition has been extensively reported, but there is little empirical data on the prevalence of the underlying causes of reduced oral intake and the extent of nursing interventions that address malnutrition. RNAO is delighted to provide this key resource to you. DOI: 10.1111/j.1365-2702.2007.02051.x Corpus ID: 12632239. The care plan for impaired swallowing should contain therapeutic nursing interventions to help in managing the current condition and promote healing. Reduced nutritional intake in care-dependent patients is a risk factor for malnutrition. 74-83. The Royal College of Surgeons of England / The British Society for Disability and Oral Health, 50 Flemington Road Parkville Victoria 3052 Australia, Site Map | Copyright | Terms and Conditions, A great children's hospital, leading the way, Clinical Recommendations: Oral Care of the Paediatric Oncology Patient, Clinical Recommendations: Oral Management of the Paediatric Bone Marrow Transplant Patient, Pain Assessment and Measurement clinical guidelines (nursing), Pain Management clinical practice guidelines, Clinical Practice Guidelines (RCH): Antifungal prophylaxis for children with cancer or undergoing haematopoietic stem cell transplant, Clinical Practice Guidelines (RCH): Fever and suspected or confirmed neutropenia, Information for parents, Dentistry Department, Royal Children's Hospital, Information resources for families: Mouthcare (Paediatric Integrated Cancer Services), Clinical Practice Guidelines (RCH): Antifungal prophylaxis for children with cancer or undergoing haematopoitic stem cell transplant, Pain Assessment and Management clinical guidelines (nursing). This will have been identified from the oral assessment tool and could be daily, twice daily, four-hourly, two-hourly or hourly, depending on the patient’s individual circumstances (Dougherty and Lister, 2008). Inadequate oral hygiene 2. CCC of Nursing Interventions/Actions (V-2.5) consists of 804 Nursing Interventions/ Actions which represent 201 Core Nursing Interventions (77 major categories and 124 subcategories) that are expanded by four (4) Action Type Qualifiers: 1) Monitor/ Assess, 2) Perform/ Care, 3) Teach/ Instruct, or 4) Manage/ Refer) – totaling 804 Concepts. Dietary habits 5. Research output: Contribution to journal › Review article Chlorhexidine based gels and mouth rinses have a broad antimicrobial activity, with some antifungal and antiviral properties. The development of this nursing guideline was coordinated by  Lisa Barrow, Clinical Nurse Educator, Children's Cancer Centre and approved by the Nursing Clinical Effectiveness Committee. 29, 19, 44-50. doi: 10.7748/ns.29.19.44.e9383. Poor oral hygiene can lead to a range of problems including dry, sore lips; ulcers; plaque; dryness; dental caries; tumours; cracks; bleeding, white/yellow deposits of candidiasis (thrush). The Oral Assessment Guide (OAG) can assist in determining the patient’s oral health and function. This article reviews nursing interventions to increase adherence to oral cancer therapies, such as patient and care-partner education, side-effect and medication management, and safety issues. This technique is dependent on the patient being able to tolerate and manage the cryotherapy safely. It is recommended to use chlorhexidine based gels and mouth rinses that are alcohol free as the presence of alcohol may contribute to mouth dryness, irritation and brown staining to the teeth. The OAG Assessment tool should be added for all paediatric oncology and HSCT patients under the ENT assessment in the Focused Assessment flowsheet.  - brush teeth, gums and tongue using  soft toothbrush BD, ¹  Replace toothpaste in the morning with 0.5% chlorhexidine gel if child has dental decay (as verified by a dentist), Mouthcare for paediatric oncology & HSCT patients at risk of oral complications², - allogeneic HSCT (preconditioning to Day =+100), - brush teeth, gums and tongue using soft toothbrush TDS, ² Once the patient is no longer at risk of oral complications, mouthcare should continue as outlined in Level 1. While nurses should educate patients about their oral care needs, in some cases patients would benefit from the special advice that the dental hygienist can provide. Etiology The most common cause of epiglottitis is bacterial infection, […] Oral irritants can further damage the oral mucosa and increase the client's discomfort. Contextual factors, supportive and restraining mechanisms influence the intervention's success. presents this guideline, Oral Health: Nursing Assessment and Interventions to the health care community. Lalla, R.V., Bowen, J., Barasch, A., Elting, L., Epstein, J., Keefe, D.M., McGuire, D.B., Migliorati, C.,  Nicolatou-Galitis, O., Peterson, D. E., Raber-Durlacher, J.E., Sonis, S.T., Elad, S. (2014) MASCC/ISOO Clinical Practice Guidelines for the Management of Mucositis Secondary to Cancer Therapy. Dental caries, oral cancers, and sports-related craniofacial injuries are potentially preventable conditions. Evidence suggests that oral health deteriorates while people are in hospital (Terezakis et al, 2011) and it is generally acknowledged that mouth care in hospitals and care homes needs to be improved (Binks et al, 2017). Background: Reduced nutritional intake in care-dependent patients is a risk factor for malnutrition. Department of Health (2010) Essence of Care 2010: Benchmarks for Fundamental Aspects of Care. ORAL CARE REFERENCES FREER 09/01 1.Jones C. (1998) The importance of oral hygiene in nutritional support. 3. Oral Thrush Nursing Care Plan Features: Identifies the symptoms and issues experienced. MOATT is a resource to assist healthcare providers to assess and teach patients about oral chemotherapy treatment by addressing key assessment questions, generic education discussion points, drug-specific education, and evaluation questions to help ensure that patients and caregivers understand the information provided. Nursing Study Guide for Asthma. The Impaired Oral Mucous Membrane Care Plan Writing Help Online is about a lining on the inside of the mouth consisting of an oral epithelium and lamina propria an underlying connectivity tissue. There are several distinct categories of interventions that have been employed for patients with cancer, namely, education, emotional support, and psychotherapy. Children who are very young (between 18 months to 6 years) or having chemotherapy may not tolerate adult strength fluoride toothpaste. Oral assessment tools are designed to help nurses carry out a thorough assessment of the oral cavity and develop a care plan tailored to patients’ individual need. The patient should be referred to a dental hygienist if specialist advice is needed, but in the meantime it is important to proceed with oral care. This article reviews nursing interventions to increase adherence to oral cancer therapies, such as patient and care-partner education, side-effect and medication management, and safety issues. To provide a baseline, initial information about the condition of your patient’s oral cavity. The American Dental Association recommends brushing the teeth twice a day with a soft-bristled toothbrush and using floss or an interdental cleaner once a day. Head and neck cancer is the 10th most common cancer in the world, and in the United Kingdom, it accounts for 4% of all malignant cancers. There are a variety of tools, use the one selected by your trust. The evidence table for the Mouth Care – Oral Care of the paediatric oncology patient and haematopoieitic stem cell transplant patient can be found here. A recommended alternative is a toothpaste marketed for use from 6+ years of age (adult strength toothpaste with a mild taste that is suitable for young children)  or, A low fluoride toothpaste (0.11% fluoride) marketed for use below 6 years of age. Nursing Interventions -The nurse will assess the patients mouth discomfort every shift until patient reports less discomfort in her mouth. The OAG provides parameters for the assessment of each child's mouth and the implementation of a plan of care based on these findings. Pearson L. (1996) A comparison of the ability of foam swabs and toothbrushes to remove dental plaque: implications for nursing practice. You recently came across the term nursing intervention, which sounds like even more drama than the TV shows “Grey’s Anatomy” and “Intervention” combined!. Contextual factors, supportive and restraining mechanisms influence the intervention’s success. An effective oral health care plan will involve the documentation of assessment findings along with any barriers to effective hygiene. Healthy oral status is essential for the well-being of the patient, writes Anne Murphy. Maintaining patients’ oral hygiene is an essential nursing duty and is considered a fundamental aspect of care (Department of Health, 2010). The nurse care coordinator assessed and monitored the usual care patients, providing education on oral care to patients and/or their family members; coordinated with the interprofessional team on the management of pain, dysphagia, and other health care needs; and completed nursing documentation. Nursing interventions and supportive care for the prevention and treatment of oral mucositis associated with cancer treatment. Reasons to refer to a dental hygienist include excessive plaque, ill-fitting dentures, multiple ulcers. Nursing care plan for Impaired Oral Mucous Membrane Impaired Oral Mucous Membrane. Once outcomes have been developed and agreed, nursing interventions that facilitate their achievement are planned and implemented. They should also be given privacy to carry out the procedure. Chlorhexidine based gels and mouth rinses can also inhibit plaque formation on the teeth and decrease the risk of dental caries and long term dental complications. All patients being treated for childhood cancer or undergoing a HSCT require daily assessment of the oral mucosa. Consult the, Systemic analgesics (as examples paracetamol or opioids) may be required, and should be administered according to the degree of pain (as stated by the child), the presence of drooling, and/or difficulty in swallowing, talking, eating or opening the mouth. 2004 Jul 1;31(4 Suppl):13-23. doi: 10.1188/04.ONF.S4.13-23. Journal of Advanced Nursing Practice. / Eilers, June. To describe changes in oral health behaviors following implementation of a nursing intervention targeting children at risk for early childhood caries at an urban 2-site primary care practice. Care of the mouth is considered to be one of the most basic nursing activities, yet nurses’ knowledge of oral health problems is often limited 1 and in clinical practice is not always regarded as a priority. It can, however, cause irritation and may be unacceptable for some patients, Application of a moisturising cream to the lips is recommended. The skills needed by a nurse working in aged care are extremely diverse, but probably the most important attributes are being a good listener and having true empathy for older people and their families and carers. Ask the child to swallow or observe the swallowing process. Oral mucositis is a common complication of chemotherapy and radiotherapy. Relevance to clinical practice Paraffin based lubricants should be used with caution with oxygen therapy or babies with phototherapy as it is highly flammable, Better Health Channel (State Government of Victoria), Nursing Specialty Competency Assessment Form: Mucositis (Oncology). The impaired oral mucous membrane is a disruption of the soft tissue of oral cavity and or lips. Symptoms usually start 14 days after radiotherapy; the duration of radiotherapy associated mucositis may last for several weeks, Encourage patients to rinse the mouth after vomiting with water (this will remove any stomach acid in the mouth; left in contact with the teeth, stomach acid can contribute to tooth decay and irritate the mouth), Sodium bicarbonate mouth rinses may be useful and effective in dissolving mucus and loosening debris, raising pH and preventing overgrowth of aciduric bacteria, Rantidine or a proton pump inhibitor such as omeprazole or pantoprazole may be useful for the prevention of epigastric pain after treatment with cyclophosphamide, methotrexate and 5-FU, The use of hydrogen peroxide is not recommended as it increases dryness, contributes to the breakdown of newly formed tissue, disrupts normal oral flora and may increase the risk of aspiration and foaming, Chewing sugarless gum or lozenges has been shown to increase saliva flow and thus reduce discomfort. Diminished hormone levels (women) 12. Point of Care Resources; Node Name Weight Weight Selector ; Oral care infection prevention and control: Algorithm for Oral Care: Oral Health History — Sample Questions: Risk Factors for Oral Disease and Poor Oral Health: Oral Hygiene Care Plan for Long-Term Care: Sample Oral Health Care Plan: Toothbrushing Techniques: Denture Care Each nursing intervention is carefully planned using knowledge, critical thinking and LLLT has been shown to improve therapeutic outcomes and reduce the prevalence and severity of oral mucositis in oncology patients by promoting healing, reducing inflammation and increasing cell metabolism. Symptoms usually start 5 to 10 days after chemotherapy and may resolve within a few days following completion of the chemotherapy (however this is dependent on various therapy and patient specific factors), Patients receiving targeted therapy agents such as epidermal growth factor receptor inhibitors or tyrosine kinase inhibitors (imatinib, dastanib, dabrafenib, trametinib, sorafenib) are more susceptible to the development of oral mucositis. Barriers to professional care 3. Edinburgh: Churchill Livingstone. Oral care and the promotion of good oral health can reduce the amount of microbial flora, reduce pain and bleeding, prevent infection and the risk of dental complications. Instruct client to avoid alcohol- or hydrogen peroxide-based commercial products for mouth care and to avoid other irritants to the oral cavity (e.g., tobacco, spicy foods). Impaired Swallowing Care Plan Diagnosis . Details the comprehensive plan of care. Aging-related loss of connective, adipose, or bone tissue 2. Integrating oral care interventions into nursing practice can be feasibly implemented to serve different community groups across a multitude of locations ranging from primary care and maternal child health centers, hospital-based clinics to home settings. Decreased platelets 9. Older patients in hospital may be unable to maintain hydration by drinking, leading to intravenous fluid replacement, complications and a longer length of stay. Severe mucositis can delay treatment and so limit the effectiveness of the child's cancer therapy. Clinical Practice Guidelines (RCH): Antifungal prophylaxis for children with cancer or undergoing haematopoietic stem cell transplant Wherever possible, patients should be encouraged and supported to carry out their own oral care. Results from the pilot study suggest that this workshop is a feasible intervention for a service-wide trial. @article{Wrdh2009NursingSU, title={Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study. Swelling can occur quickly and requires immediate intervention. Antifungal agents that are not absorbed by the GI tract, such as nystatin, are NO longer recommended as preventative anti-fungal agents for oral candida, Antifungal prophylaxis agents (oral or intravenous as tolerated) are recommended for paediatric oncology and HSCT patients at risk of invasive fungal infection (IFI). Pathophysiology The epiglottis is the flap of cartilage that covers the trachea when swallowing that blocks airflow and prevents food from entering the lungs. It is important to ensure the client feels comfortable while performing oral assessment and care. The nurse administers the oral medication to the patient as ordered. Updated December 2018. The Care Plan sets out a clear explanation of the resident’s issue, and will guide the nurse or carer through the process of preparing a comprehensive, individual person centred Care Plan. All children diagnosed with cancer or receiving a haemopoietic stem cell transplant should be reviewed by a paediatric dentist at least every 3-4 months during active treatment and then every 6-12 months after completion of treatment. 2. The shared oral care intervention supports an individual and multidisciplinary assessment of nursing home residents’ ability to self‐care concerning oral care. Excessive use of coffee, tea, and red wine 7. 3. The Shared Oral Care intervention supports an individual and multidisciplinary assessment of nursing home residents’ ability to self‐care concerning oral care. Nursing Writing Services offers the best Impaired Oral Mucous Membrane Care Plan Writing Help Online An azole antifungal agent, such as fluconazole, may be prescribed, Prophylaxis for fungal infections will be based on sensitivities of the proven or suspected organism, consideration of medication toxicity and consideration of the patient's clinical status, comorbidities and concomitant medications, Antifungal agents that are not absorbed by the GI tract, such as nystatin, are NO longer recommended for the treatment of oral candida in the immunocompromised patient, Oral anti-fungal agents (intravenous if not tolerated) should be used for the treatment of visible oral candidia. 62-69. planning Establish the care plan goals, incorporating the resident’s wishes and preferences. 31, No. London: Hodder Arnold. London: DH. Lack of knowledge regard… Imm… Where necessary nurses should facilitate/prompt patients who are able to carry out oral hygiene for themselves, at appropriate times, such as first thing in the morning and last thing at night, as well as after meals or after vomiting. There is a concern that the incidence is increasing, particularly in younger patients and in women. The literature suggests that other interventions are required to complement this approach if nurses are to make oral hygiene a priority in daily patient care. and care is unlikely to appear on the nursing / medical agenda11-13. 4 Suppl, 07.2004, p. 13-23. Studies have shown that LLLT may: All patients undergoing a HSCT or patients receiving high doses of chemotherapy agents such as COPADM should be referred by the treating team to the Dentistry department for LLLT prior to commencing chemotherapy. 1.1.3 Peer review Time analgesia administration to have maximum efficacy during mouth care procedures, Xylocaine 2% Viscous applied topically may be of use prior to mouth care. This shift in trend appears to result from changes in adult smoking prevalence, where the proportion of men who smoke has decreased and the proportion of young females who smoke has increased. After using toothpaste the patient should be instructed as follows; a patient should spit out excess toothpaste (infants may swallow very small amounts of toothpaste), a patient should not rinse out their mouth or eat and drink for 30 minutes post using toothpaste (rinsing or eating and drinking after using toothpaste may remove it from the mouth and teeth and decrease effectiveness), Normal saline or water should be used in babies who have no teeth instead of a toothpaste. We promise, you actually will use care plans while providing patient care as a practicing nurse. Chemotherapy alters the integrity of the mucosa, the normal microbial flora of the oral cavity, salivary quantity and composition, as well as epithelial maturation. This is more common when used in combination with other treatments such as chemotherapy, Radiotherapy to the head and neck or total body irradiation (TBI) before HSCT are particularly associated with the development of oral mucositis. & Soldani, F. (2012) The Oral Management of Oncology Patients Requiring Radiotherapy, Chemotherapy and/or Bone Marrow Transplantation: Clinical Guidelines. Dentures may be soaked occasionally – use specific soaking solution and follow manufacturer’s instructions. The male/female ratio is less than 2:1, and this gap is closing steadily. Maximizing what the patient can do for themselves will facilitate their care plan and you spend a lot of time every shift doing this! Not all chemotherapy-induced mucositis can be prevented but, with proper management, the severity and duration of oral complications can be minimised. As a result, the child receiving chemotherapy may experience pain, dysphagia, alteration in nutritional status, and risk of infection. However, when they are unable to do this maintaining patients’ oral hygiene is an essential nursing duty and is considered a fundamental aspect of care (Department of Health, 2010). Here are some factors that may be related to the nursing diagnosis Impaired Dentition: 1. 31, No. Keeping the mouth and teeth clean will protect a patient’s oral health and allow quicker recovery by preventing infections. All children diagnosed with cancer or receiving a haemopoietic stem cell transplant should be screened by a paediatric dentist prior to the commencement of treatment. Background. Dehydration 10. Methods. 7, (2), pp. Nursing Standard. Oral Health Care Education Sessions for Nursing Home Caregivers: Adults: All: Worksite: Provider Education, Environment & Policy: An Oral Health Counseling Intervention Targeted at Parents of Young Children: Infants/Toddlers, Children, Adults: All: Health care facility: Individual Education, Supportive Relationships, Environment & Policy Artificial saliva can be used to alleviate a dry mouth (Dougherty and Lister, 2008). Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. For example, it can: These benefits will all help patients to recover from illness. Always use a dedicated denture container, carefully labelled with the patient’s details. Use a gentle, rotational movement to clean the inner, outer and biting surfaces of the teeth. To identify any new problems (Dougherty and Lister, 2008). We undertook a systematic review to describe clinical assessment tools which identify patients at risk of insufficient oral fluid intake and the impact of simple interventions to promote drinking, in hospital and care home settings. In: Richardson R (ed) Clinical Skills for Student Nurses. As a national voice promoting interprofessional oral health integration, OHNEP advocates, educates, creates and promotes resources that educators and clinicians can use to improve the quality of oral health care in their patients. Mar 11, 2019 - This board is for our available nursing care plans and nursing diagnoses to help student nurses and registered nurses in writing care plans. For example, patients who are unable to go to the bathroom should be given water and a bowl. Nursing interventions and supportive care for the prevention and treatment of oral mucositis associated with cancer treatment. Oral hygiene is an essential aspect of nursing care and is methodically planned using nursing interventions. It is the responsibility of the nurse managing the patient’s care to assess the oral mucosa and decide on subsequent methods of oral hygiene in consultation with the medical team. intensive care patients’ oral care frequency. Nursing and Midwifery Council (2005) Guidelines for records and recordkeeping.London: NMC. The procedure should be undertaken with the patient’s head turned to the side, and suction equipment should be to hand); Wet the toothbrush head and apply a small amount of toothpaste only. You may also gently brush the surface of the tongue and the gums; If the patient cannot tolerate the use of a toothbrush (for example due to mouth tenderness) foam sticks and mouthwash can be used instead (Dougherty and Lister, 2008); Allow the patient to take mouthfuls of water, rinse the mouth and spit into the receiver. American Academy of Pediatric Dentistry, (2013) Guideline on Dental Management of Pediatric Patients Receiving Chemotherapy, Hematopoietic Cell Transplantation, and/or Radiation. A history of inadequate oral hygiene or poor nutrition. Data sources included peer-reviewed nursing and medical literature, healthcare Web sites, and published monographs. Providing effective mouthcare to patients has a range of benefits. Objective: This study aimed to analyze the effect of oral care intervention on oral health status of intubated patients in the ICU. Julia Buttermore, DMD, is Chief Dental Officer, Federal Medical Center, Carswell, Fort Worth, TX. The management plan should be clearly documented in the Electronic Medical Record. (Renton, 2007). implementation Identify the medical, nursing, respiratory therapy, and other interventions that will be implemented to care for the resident with COVID-19. Cryotherapy may be offered to cooperative children and adolescent patients receiving chemotherapy or HSCT preconditioning with regimens associated with a high incidence of mucositis. Nurses should undertake oral care for patients who cannot maintain a clean mouth for themselves. Maintaining patients’ oral hygiene is an essential nursing duty and is considered a fundamental aspect of care (Department of Health, 2010). Major C (2005) Meeting hygiene needs In: (2nd Ed) Baillie L (ed) Developing Practical Nursing Skills. The nurse care coordinator assessed and monitored the usual care patients, providing education on oral care to patients and/or their family members; coordinated with the interprofessional team on the management of pain, dysphagia, and other health care needs; and completed nursing documentation. Maintain privacy as required. Asthma Nursing Diagnosis Care Plan NCLEX Review. Citation: Wilson A (2011) How to provide effective oral care. : Reduced nutritional intake in care-dependent patients is a chronic condition that involves the narrowing and/or swelling of oral... Unlikely to appear on the nursing / medical agenda11-13 Contribution to journal › Review article oral hygiene and! Gag reflex if swallowed cooperative children and adolescent patients receiving chemotherapy may not adult... That a day in the Electronic medical Record cryotherapy may be related the. And medical literature, healthcare Web sites, and sports-related craniofacial injuries are preventable. 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