1. Care of Patients with Oral Cavity Problems
Chapter 56
Care of Patients with Oral Cavity Problems
Oral candidiasis.

2. Caring for Patients with Disorders of the Oral Cavity
Group work: Your patient has been diagnosed with leukoplakia.
What are the priorities of care?
How does care compare/contrast with other care for oral cavity concerns?
What teaching will the nurse provide to promote oral health?
What body image concerns could arise?
What community resources are available?

3. Hairy Leukoplakia
Hairy leukoplakia. These white plaques were the first visible sign of human immunodeficiency virus infection.

4. Squamous Cell Carcinoma

5. Squamous Cell Carcinoma vs Basal Cell
Begin on surface of epithelium on lips, tongue, buccal mucosa, & oropharynx
Cells vary in size & shape
Risk factors: age > 40, tobacco, alcohol use, sunlight, HPV, Poor oral hygiene
Occurs primarily on the lip. Basal cells fail to mature into keratinocytes
Lesions resemble a scab and evolve into an ulcer with a raised pearly border
Risk factors excessive sunlight exposure

6. Kaposi’s Sarcoma Located in blood vessels Malignant Usually painless
Appears as a raised, purple nodule or plaque
Can be found on the hard palate, gums, tongue, or tonsils.
Most often associated with AIDS

7. Stomatitis
Aphthous stomatitis.

8. Video: Oral Cancer

9. Case Study
You are assigned to visit a middle-aged adult who recently had a partial glossectomy to remove a cancerous tumor. He was formerly a professional baseball player who used chewing tobacco for many years. The patient is receiving parenteral nutritional and he reports being hungry all the time. He is on Humulin R insulin for his diabetes, and has been uncontrolled since he had his surgery. The patient is very angry and depressed and states to his wife that he “can live like this.” She is concerned that he will try to commit suicide unless his health improves.
cont….

10. How should you respond to the patient’s wife at the time?
She needs to be supportive & listen to his concerns.
Notify the healthcare provider of the patient’s statements.
Medication for depression and interventions to lesson anxiety may prevent suicidal thoughts and actions.
Ask wife to explore her husband’s emotional support network (family, friends, clergy).
Obtain other professional help as needed

11. What other healthcare professionals need to be included to manage this patient?
Psychiatrist or psychologist
Speech language pathologist (swallowing techniques or exercises)
Clergy
Nutritionist
Maxillofacial prosthodontist may fit him with a prosthetic to enable better speech

12. How will you coordinate his care with members of the health care team?
Case manager
Team conference
Plan of care should included team, patient, and family

13. What other priorities for care do you have the patient during this home visit?
A social worker or case manager can put family in touch with support group or the American Cancer Society, or the Oral Care Foundation for resources, supplies, and additional information.
They can also supply transportation to and from treatment appointments.

14. NCLEX Review

15. Question 1
A patient receiving chemotherapy for treatment of cancer is at greatest risk for developing:
Stomatitis
Xerostomia
Oral abscess
Candidiasis
Answer: A
Rationale: Secondary stomatitis generally results from infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised, or it results from drugs such as chemotherapy. Xerostomia is usually related to radiation in the oral cavity region. Candidiasis is an opportunistic stomatitis that can be seen in older adults and other immunocompromised patients. Oral abscess is a potential complication.

16. Answer
Answer: A
Rationale: Secondary stomatitis generally results from infection by opportunistic viruses, fungi, or bacteria in patients who are immunocompromised, or it results from drugs such as chemotherapy. Xerostomia is usually related to radiation in the oral cavity region. Candidiasis is an opportunistic stomatitis that can be seen in older adults and other immunocompromised patients. Oral abscess is a potential complication.

17. Question 2
A 26-year-old female patient informs the nurse that she has had red, raised lesions at the base of the tongue and on the inside of her mouth for the past 2 weeks. What question should the nurse ask the patient?
“Have you seen a dentist recently?”
“Do you smoke cigarettes?”
“Do you have a history of human papillomavirus?”
“What type of work do you do?”
Answer: C
Rationale: It is now confirmed that in younger age groups, including those who have never used tobacco products, mouth lesions can be caused by human papillomavirus (HPV). HPV, particularly version 16, has been shown to be sexually transmitted between partners and is conclusively implicated in the increasing incidence of young, nonsmoking oral cancer patients.
(Source: Accessed August 12, 2011, from -- see video feed at link for additional info)

18. Answer
Answer: C
Rationale: It is now confirmed that in younger age groups, including those who have never used tobacco products, mouth lesions can be caused by human papillomavirus (HPV). HPV, particularly version 16, has been shown to be sexually transmitted between partners and is conclusively implicated in the increasing incidence of young, nonsmoking oral cancer patients.

19. Question 3
An older patient with poor oral hygiene was admitted after a fall in which he sustained a fractured hip. What is the priority nursing intervention?
Initiate oral care every 6 hours
Implement aspiration precautions
Use lemon glycerin swabs to moisten the mouth as needed
Request a consult with a registered dietitian
Answer: A
Rationale: It is now known that older adults who have poor oral hygiene are at high risk for mouth infections and aspiration pneumonia. Implementing good oral care that avoids alcohol-containing oral solutions and lemon glycerin swabs is important. A consult with a registered dietitian may assist with determining the patient’s dentition and nutrient needs to assist with healing postoperatively.

20. Answer
Answer: A
Rationale: It is now known that older adults who have poor oral hygiene are at high risk for mouth infections and aspiration pneumonia. Implementing good oral care that avoids alcohol-containing oral solutions and lemon glycerin swabs is important. A consult with a registered dietitian may assist with determining the patient’s dentition and nutrient needs to assist with healing postoperatively.