Transcript Mouth Care - University of Nebraska Medical Center

Description: Mouth Care
This module is going to review some key
things Care Partners need to know about
mouth care.
Estimated time to complete: 30 Minutes
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Introduction:
People who receive high doses of cancer therapy may develop
changes in their mouths. One of the changes is mucositis or
redness and sores in the mucous membranes of the mouth.
One of the most important things the patient can do to minimize
the effects of mouth sores and help prevent infections is frequent
mouth care.
This module is going to review some key things Care Partners
need to know about mouth care.
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Mouth
Care click on your response.
For the following
questions,
please
Care Partner Health Education & The Nebraska Medical Center
How often should the patient complete mouth care?
A) 4 times daily to decrease mouth problem.
B) As long as the patient's mouth is okay, don't worry about it.
C) Before breakfast and before going to bed in the evening.
D) Once or twice a day, but stop if there is pain or bleeding.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct - The patient should do oral care at least 4 times a day. If
the patient’s mouth becomes tender or mouth sores develop, the
patient should do mouth care even more often.
If the patient is using Mycelex, the anti-fungal drug to prevent
“Thrush”, a yeast infection in the mouth, we recommend doing
mouth care after breakfast, after lunch, after dinner, and before
bed so that
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Incorrect - The patient needs to do mouth care at least 4 times a
day. If the patient’s mouth becomes tender or mouth sores
develop, the patient should do mouth care even more often.
If the patient is using Mycelex, the anti-fungal drug to prevent
“Thrush”, a yeast infection in the mouth, we recommend doing
mouth care after breakfast, after lunch, after dinner, and before
bed so that the Mycelex is not washed away with food.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Incorrect - The patient should do mouth care at least 4 times a day. If
the patient’s mouth becomes tender or mouth sores develop. The
patient should do mouth care even more often.
If the patient is having pain, be sure he/she takes pain medication
regularly.
If the patient is having problems with bleeding, he/she should stop
using the toothbrush and floss, but continue to do mouth care,
brushing the teeth with a toothette.
If the patient is using Mycelex, the anti-fungal drug to prevent
“Thrush”, a yeast infection in the mouth, we recommend doing mouth
care after breakfast, after lunch, after dinner, and before bed the
Mycelex is not washed away with food.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Incorrect - The patient should do mouth care at least 4 times a day. If
the patient’s mouth becomes tender or mouth sores develop. The
patient should do mouth care even more often.
If the patient is having pain, be sure he/she takes pain medication
regularly.
If the patient is having problems with bleeding, he/she should stop
using the toothbrush and floss, but continue to do mouth care,
brushing the teeth with a toothette.
If the patient is using Mycelex, the anti-fungal drug to prevent
“Thrush”, a yeast infection in the mouth, we recommend doing mouth
care after breakfast, after lunch, after dinner, and before bed so the
Mycelex is not washed away with food.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Let's see how you do with some True/False questions about mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
The tongue should be cleaned during mouth care.
TRUE
FALSE
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the tongue needs to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the tongue needs to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
The teeth should be cleaned during mouth care.
TRUE
FALSE
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the teeth need to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the teeth needs to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
The inside of the cheeks should be cleaned during mouth care.
TRUE
FALSE
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the inside of the cheeks
need to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the inside of the cheeks
need to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
The roof of the mouth should be cleaned during mouth care.
TRUE
FALSE
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the roof of the mouth needs to be
cleaned during mouth care.
All areas of the mouth including the tongue,
teeth, inside of the cheek, and roof of the mouth
need to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the roof of the mouth needs to be
cleaned during mouth care.
All areas of the mouth including the tongue,
teeth, inside of the cheek, and roof of the mouth
need to be cleaned during mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Now let’s see if you can identify the correct
products your family member may use for
mouth care. We’ll list the product, you tell us if
the patient may use it for mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can a soft toothbrush be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the patient is to use a new soft-bristled toothbrush
unless bleeding becomes a problem.
If bleeding becomes a problem, the patient should switch to
toothettes to brush his/her teeth until their platelets have
recovered.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the patient does need to use a new soft bristled
toothbrush unless bleeding becomes a problem.
If bleeding becomes a problem, the patient should switch to
toothettes to brush his/her teeth until their platelets have
recovered
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can toothpaste be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the patient can use any toothpaste he/she likes but they
should try to avoid toothpaste with too many extra chemicals
such as “Extra Whiteners.”
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, the patient will want to use toothpaste. The patient can use
any toothpaste he/she likes but should try to avoid toothpaste
with too many extra chemicals such as “Extra Whiteners.”
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can dental floss or dental tape used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Yes, the patient can use dental floss or tape. He/she should floss
gently but if pain, tenderness, or bleeding occurs, the patient
should stop using the dental floss or tape until the mouth
recovers.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the patient can use dental floss or dental tape. He/she
should floss gently but if pain, tenderness, or bleeding occurs,
the patient should stop using the dental floss or tape until the
mouth recovers.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can whitening strips be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, the patient should avoid using products that can irritate the
mouth or gums, such as whitening strips.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the patient should avoid using products that can irritate
the mouth or gums, such as whitening strips.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can normal saline be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, normal saline is our first choice for mouth care. If the
patient is unable to tolerate the salty flavor of the normal saline,
discuss this with your nurse. The nurse can switch the patient to
plain water.
Doing mouth care consistently is most important. The patient
should try to use the normal saline but there are other options.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, normal saline is our first choice for mouth care. If the
patient is unable to tolerate the salty flavor of the normal saline,
discuss this with your nurse. The nurse can switch the patient to
plain water.
Doing mouth care consistently is most important. The patient
should try to use the normal saline but there are other options.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can Amerigold® mouthwash with normal saline be used for
mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, patients can flavor the normal
saline mouthwash with and alcohol-free
mouthwash such as Amerigold®.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, patients can flavor the normal
saline mouthwash with and alcohol-free
mouthwash such as Amerigold®.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can Listerine® antibacterial mouth wash with normal
saline be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Sorry, patients should avoid using products
with high alcohol content such as
Listerine® and many other commercial
mouthwashes. The alcohol can burn and
dry the mouth.
If the patient wants a different product to
flavor the normal saline mouthwash, there
are many alcohol-free mouthwashes .
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, patients should avoid using
products with high alcohol content such as
Listerine® and many other commercial
mouthwashes. The alcohol can burn and
dry the mouth.
If the patient wants a different product to
flavor the normal saline mouthwash, there
are many alcohol-free mouthwashes
available at area stores .
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can toothettes be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, toothettes are used to swab the inside of the mouth.
They can be used to brush the teeth if the gums become too
tender for a toothbrush.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Toothettes are part of the routine mouth care supplies. They are
used to swab the inside of the mouth. They can be used to brush
the teeth if the gums become too tender for a toothbrush.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Can lemon-glycerin swabs be used for mouth care?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Sorry, lemon-glycerin swabs may make the mouth and lips look
moist and smell fresh, but the glycerin will dry and irritate the
mouth and should NOT be used.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, lemon-glycerin swabs may make the mouth and lips look
moist and smell fresh, but the glycerin will dry and irritate the
mouth and should not be used.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
We are now going to show you a short video clip and ask you a couple of questions.
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PROPERTIES
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For the following questions,
please
Mouth
Care select the best answer.
Care Partner Health Education & The Nebraska Medical Center
Did the patient in the video do mouth care correctly?
A) Yes
B) No.
C) Not Certain.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Do you really think we would show you a video and have
everything perfect? There was a mistake, look again.
Back
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct! Do you really think we would show you a video and
have everything perfect. Now let’s see if you were just
guessing, go on to the next question
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
THIS IS A DUPLICATE SLIDE OF 52?
Do you really think we would show you a video and have
everything perfect? There was a mistake, look again.
Back
Mouth
Care select the best answer.
For the following
questions,
please
Care Partner Health Education & The Nebraska Medical Center
What did the patient in the video do incorrectly?
A) “Re-dipped” the same toothette in the mouthwash.
B) Should have used a soft tootbrush to clean the inside of the
mouth.
C) Should have gargled with mouthwash first.
D) Should have used toothpaste on the toothette.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, patients should never re-dip used toothettes into the
mouthwash. The patient should use as many of the
disposable toothettes as needed to do mouth care.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, the mistake was dipping the toothette into the mouthwash
twice. Patients should never dip a used toothette back into
the mouthwash. Toothettes are disposable and should be
tossed after removing them from the mouth the first time.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, the mistake was dipping the toothette into the mouthwash
twice. Patients should never dip a used toothette back into
the mouthwash. Toothettes are disposable and should be
tossed after removing them from the mouth the first time.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, the mistake was dipping the toothette into the mouthwash
twice. Patients should never dip a used toothette back into
the mouthwash. Toothettes are disposable and should be
tossed after removing them from the mouth the first time.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
We are now going to have you look at some pictures of
mouths and then ask a question or two about each picture.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
If the patient's mouth looked like this, would you report it?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the nurse should be informed of
changes in the patient’s condition including
the condition of the mouth.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, there are changes that need to
reported. Have another look before going on
to the next question.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Why would you report this patient’s
mouth to the nurse?
A) Sores on the inside of the lower lip.
B) Mouth is very dry.
C) Tartar on the lower teeth.
D) I wouldn't report it.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, sores on the lips and in the
mouth are a common problem after highdose cancer treatment. These sores are a
potential source of pain and infection and
your nurse needs to be made aware of the
problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient’s mouth is quite
moist. The patient has sores on the
inside of his lower lip.
Sores on the lips and inside the mouth
are a common problem after high-dose
cancer treatment and are a potential
source of pain and infection. Your nurse
needs to be made aware of the problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, this patient has sores on the inside of
his lower lip. His teeth are in fairly good
condition.
Sores on the lips and inside the mouth
are a common problem after high-dose
cancer treatment and are a potential
source of pain and infection and your
nurse needs to be made aware of the
problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, this patient has sores on the inside of
his lip.
Sores on the lips and inside the mouth
are a common problem after high-dose
cancer treatment and are a potential
source of pain and infection and your
nurse needs to be made aware of the
problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Let’s take a look at this next picture.
Are there problems with this patient’s mouth that should be
reported to the nurse?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient’s mouth is in pretty
good shape and there are no obvious
changes to report at this time. If the
patient had specific complaints of pain or
burning, you would need to report these
symptoms to the nurse.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, this patient’s mouth is actually in
pretty good shape and there are no
obvious changes to report at this time.
If the patient had specific complaints of
pain or burning, you would need to report
these symptoms to the nurse.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
We have a couple more. Look at this third picture. Are there
problems with this patient’s mouth that you would report to the
nurse?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the nurse should be informed of
changes in the patient’s condition
including the condition of the mouth.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, there are are changes that need
to be reported. Look again and go on to
the next question.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Why would you report this patient’s
mouth to the nurse?
A) Sores on the lower lip.
B) Sores on the side of the tongue.
C) Dry Tongue.
D) I wouldn't report it.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the patient in this picture has
sores on the side of his tongue that need
to be reported. His lips may look a little
dry, but there are no obvious sores on the
lips. If the patient does develop sore on
the lips, the nurse should be informed of
this change in his mouth.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, this patient has sores on the side
of his tongue. Sores on the lips and
inside the mouth are a common problem
after high-dose cancer treatment and are
a potential source of pain and infection
and your nurse needs to be made aware
of the problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient’s tongue does not
look dry. This patient has sores on the
side of his tongue that need to be
reported.
Moisture changes are not uncommon
after chemotherapy, but the critical
finding here is the sore on the patient’s
tongue.
Sores inside the mouth and on the lips
are a common problem after high-dose
cancer treatment and are a potential
source of pain and infection and your
nurse needs to be made aware of the
problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient has sores on the
side of his tongue that should be reported
to the nurse. Sores inside the mouth and
on the lips are a common problem after
high-dose cancer treatment and are a
potential source of pain and infection and
your nurse needs to be made aware of the
problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Now let’s look at one last picture. Are there problems with this
patient’s mouth that should be reported to the nurse?
YES
NO
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the nurse should be informed of
changes in the patient’s condition
including the condition of the patient’s
mouth.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, the nurse should be informed of
changes in the patient’s condition
including the condition of the patient’s
mouth.
Have another look before going on to the
next question.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Why would you report this mouth to the
nurse?
A) Sores on the inside of the lower lip.
B) Sores on the side of the tongue.
C) White patches on the top of the tongue.
D) I wouldn't report it.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient has white patches
on the tongue These white patches can
indicate a possible infection. The nurse
needs to be made aware of the problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient has white patches
on the tongue These white patches can
indicate a possible infection. The nurse
needs to be made aware of the problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, white patches on the tongue can
indicate a possible infection. The nurse
needs to be made aware of the problem
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, this patient has white patches
on the tongue These white patches can
indicate a possible infection. The nurse
needs to be made aware of the problem.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Regular mouth care is very important during treatment and
recovery. If the patient wanted to make a change in his/her mouth
care which could he/she do without talking to the nurse?
A) Skipping the anti-fungal medication because it tastes bad
B) Using an over-the-counter herbal mouth rinse to freshen the
breath and take the medicine flavor away
C) Changing to another alcohol-free mouthwash to flavor the normal
saline mouthwash.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
NO! The patient should never stop taking his/her anti-fungal
medication without letting the nurse or doctor know. Stopping
this medication may put the patient at risk for a fungal infection in
the mouth. If the patient is unable to tolerate the anti-fungal
medication it can be changed.
But DO NOT STOP IT WITHOUT TALKING WITH THE NURSE
FIRST!!
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, If the patient would like a different flavor or color, he/she
can change to different mouthwash to flavor the normal saline
mouthwash. But watch the alcohol content! The patient should
select a low or alcohol-free mouthwash. Alcohol can burn or dry
the patient’s mouth.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
During treatment and recovery the simplest of products can
cause dangerous complications including over-the-counter
medications and herbal products. The patient should never
take a medication or use any product without first talking to
the doctor and/or nurse.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Suppose your family member develops mouth pain. Let’s review some decisions
and possible changes you and the patient may have to make. Let’s start with food
selections.
What food product should the patient AVOID when he/she has mouth pain?
Pudding?
Popcorn?
Oatmeal?
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, when the mouth is sore or tender, soft foods such as
pudding may be better tolerated.
TRY
AGAIN?
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the patient may not be able to tolerate the rough
texture of popcorn. Try soft foods when the mouth is sore or
tender.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, when the mouth is sore or tender, soft foods such as
oatmeal may be better tolerated.
TRY
AGAIN?
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Use the "Medication Administration Guide" handout to answer the
question below. The guide is available via a printout or it can be
accessed online by clicking here.
What medications or products could the patient use to treat
mouth pain?
A) Ativan (lorazepam)
B) Darvon-N (propoxyphene)
C) Vicks Chloraseptic Sore Throat Spray
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, Ativan (lorazepam) is a prescription drug that may help
the patient’s nausea or anxiety. It will not help the patient’s
mouth pain, but it would not harm his/her mouth either and if
ordered by the physician, it can be taken - just don’t use it to
treat mouth pain.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Yes, Darvon-N (propoxyphene) is a drug given for pain and it
may be ordered to help treat the patient’s mouth pain.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, even though the Vick’s Chloraseptic Throat Spray® is an
over-the-counter product, the patient should never use
anything that the doctor or nurse is not aware of.
If the patient found Chloraseptic spray to be effective in the
past, you can discuss it with the patient’s doctor and the
doctor may order it, but DO NOT use it without consulting the
doctor first!
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
So, you’ve made some decisions about food and medications if the
patient develops mouth pain. Let’s consider the patient’s mouth
care routine.
If the patient develops mouth pain, what is an appropriate
decision concerning mouth care routines?
A) Rinse his/her mouth with numbing “Magic Mouthwash” or
“1-2-3 Mouthwash” instead of saline mouthwash.
B) Continue to use the saline mouthwash solution for oral
care.
C) Add a water-pick to the mouth care routine to improve
cleaning without rubbing.
Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Actually, the doctor may order a numbing mouth rinse such
as “Magic Mouthwash” or “1-2-3 Mouthwash” but products
like these should be used AFTER regular mouth care is done
using the saline mouthwash solution.
If the patient does develop a sore mouth, he/she may wish to
stop using the toothbrush and brush the teeth with a toothette
instead. When the mouth becomes sore, mouth care should
be done more that just 4 times a day.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Correct, the patient should continue to use the saline
mouthwash solution for oral care. If the mouth becomes sore
the patient should do mouth care more often than 4 times a
day but may wish to stop using the toothbrush and brush the
teeth with a toothette instead.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
No, water picks may actually push bacteria into the tender
tissues in the mouth. Water picks are not recommended.
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Mouth Care
Care Partner Health Education & The Nebraska Medical Center
Congratulations! You have successfully
completed the care partner health
education module on mouth care. Close this
window to exit the presentation.
Thank you for participating.