Chapter 45: Management of Patients with Oral and Esophageal Disorders

A nurse is providing oral care to a patient who is comatose. What action best addresses the patients risk of tooth decay and plaque accumulation? • Irrigating the mouth using a syringe filled with a bacteriocidal mouthwash • Applying a water-soluble gel to the teeth and gums • Wiping the teeth and gums clean with a gauze pad • Brushing the patients teeth with a toothbrush and small amount of toothpaste - Answer - Ans: D Feedback: Application of mechanical friction is the most effective way to cleanse the patients mouth. If the patient is unable to brush teeth, the nurse may brush them, taking precautions to prevent aspiration; or as a substitute, the nurse can achieve mechanical friction by wiping the teeth with a gauze pad. Bacteriocidal mouthwash does reduce plaque-causing bacteria; however, it is not as effective as application of mechanical friction. Water-soluble gel may be applied to lubricate dry lips, but it is not part of oral care. An elderly patient comes into the emergency department complaining of an earache. The patient and has an oral temperature of 100.2F and otoscopic assessment of the ear reveals a pearly gray tympanic membrane with no evidence of discharge or inflammation. Which action should the triage nurse take next? • Palpate the patients parotid glands to detect swelling and tenderness. • Assess the temporomandibular joint for evidence of a malocclusion. • Test the integrity of cranial nerve XII by asking the patient to protrude the tongue. • Inspect the patients gums for bleeding and hyperpigmentation. - Answer - Ans: A Feedback: Older adults and debilitated patients of any age who are dehydrated or taking medications that reduce saliva production are at risk for parotitis. Symptoms include fever and tenderness, as well as swelling of the parotid glands. Pain radiates to the ear. Pain associated with malocclusion of the temporomandibular joint may also radiate to the ears; however, a temperature elevation would not be associated with malocclusion. The 12th cranial nerve is not associated with the auditory system. Bleeding and hyperpigmented gums may be caused by pyorrhea or gingivitis. These conditions do not cause earache; fever would not be present unless the teeth were abscessed. A patient who had a hemiglossectomy earlier in the day is assessed postoperatively, revealing a patent airway, stable vital signs, and no bleeding or drainage from the operative site. The nurse notes the patient is alert. What is the patients priority need at this time? • Emotional support from visitors and staff • An effective means of communicating with the nurse