Nursing Skills and Interventions. Nursing interventions and supportive care for the prevention and treatment of oral mucositis associated with cancer treatment. presents this guideline, Oral Health: Nursing Assessment and Interventions to the health care community. 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. 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. Asthma is a chronic condition that involves the narrowing and/or swelling of the airways, causing difficulty of breathing and triggering of cough. 2. Dougherty L, Lister S (2008) The Royal Marsden Hospital Manual of Clinical Nursing Procedures. 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). 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. intensive care patients’ oral care frequency. Australian and New Zealand Children’s Haematology/Oncology Group (2015) Minimum Requirements for Mouthcare for Paediatric Patients with Cancer. The 13 high‐quality trials investigated interventions for improving self‐care of nutrition (n = 2), catheter care (n = 5), self‐care of elimination (n = 1), risk reduction in mobility (n = 1), oral health (n = 3) and interventions addressing two or more fundamental care areas (n = 1). Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study. 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. 2.3 Oral health related nursing interventions Oral hygiene is an essential aspect of nursing care and is methodically planned using nursing interventions. During the course of the pandemic, a tree has sprouted in the…, South Eastern Health and Social Care Trust, Please remember that the submission of any material is governed by our, EMAP Publishing Limited Company number 7880758 (England & Wales) Registered address: 7th Floor, Vantage London, Great West Road, Brentford, United Kingdom, TW8 9AG, We use cookies to personalize and improve your experience on our site. The financial and human costs associated with these conditions, including mortality, indicate the need for interventions that promote oral health and prevent disease for all persons, regardless of … For example, patients who are unable to go to the bathroom should be given water and a bowl. planning Establish the care plan goals, incorporating the resident’s wishes and preferences. 74-83. (Renton, 2007). Swelling can occur quickly and requires immediate intervention. 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. 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). Chemical (e.g., alcohol, tobacco, acidic foods, regular use of inhalers) 5. Maintain privacy as required. You recently came across the term nursing intervention, which sounds like even more drama than the TV shows “Grey’s Anatomy” and “Intervention” combined!. 4 Suppl, 07.2004, p. 13-23. Reduced nutritional intake in care-dependent patients is a risk factor for malnutrition. Edinburgh: Churchill Livingstone. A multidisciplinary approach to oral care (nurse, medical officer, dentist, pain management team, procedural pain management team, dietician, pharmacist and others) will assist in providing appropriate supportive care to the paediatric oncology patient Several therapy and patient specific factors, including the chemotherapy drug, the type of malignancy, age, neutrophil count and level of oral care are important in the pathogenesis of oral mucositis 1. Inadequate support for oral care. Background. 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). Elective dental treatment should be delayed until the child is either in remission or on maintenance chemotherapy, During immunosuppression all elective dental procedures should be avoided, Fixed orthodontic appliances and space maintainers should be removed if the patient has poor oral hygiene or the treatment protocol carries a risk of developing moderate to severe mucositis, Chemotherapy agents such as methotrexate, cytarabine, doxorubicin, etoposide, bleomycin, mercaptopurine and fluorouracil (5FU) are particularly associated with the development of mucositis. Improve appetite and enjoyment of food and drink, as poor oral hygiene can affect taste; Improve social acceptability and social interaction by preventing halitosis. Ask the child to swallow or observe the swallowing process. Dietary habits 5. 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. To monitor progress of oral care/treatments. It is important to provide the equipment to do this. Overuse of Xylocaine 2% Viscous has the potential to decrease a patient’s gag reflex if swallowed. @article{Wrdh2009NursingSU, title={Nursing staff's understanding of oral health care for patients with cancer diagnoses: an intervention study. London: DH. Nursing interventions and supportive care for the prevention and treatment of oral mucositis associated with cancer treatment. Extreme intake of fluorides 10. Decreased platelets 9. 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. 3. Fawzy suggested that psychosocial interventions provide an overall positive effect on quality of life, although some interventions have failed to achieve the desired results. Ask the parent if there are any notable changes, Observe the appearance of the tongue using a pen torch to illuminate the oral cavity, Coated or loss of papillae with shiny appearance with or without redness, Observe consistency and quality of the saliva, Observe the appearance of mucous membranes using a pen torch to illuminate the oral cavity, Ulceration or sloughing, with or without bleeding, Observe the appearance of gingivae using a pen torch to illuminate the oral cavity, Observe the appearance of teeth using a pen torch to illuminate the oral cavity, Generalised plaque or debris along gum line, Ask parent if there are any notable changes, *Oral Assessment Guide- adapted from Eilers et al (1988) by the mouth care working party, Great Ormond Street Hospital for Children NHS Trust (2005), Recommended management for oral hygiene in paediatric oncology and HSCT patients, Standard mouthcare for paediatric oncology & HSCT patients, Patients in this group should; 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. Children who are very young (between 18 months to 6 years) or having chemotherapy may not tolerate adult strength fluoride toothpaste. 74-83. 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. 2004 Jul 1;31(4 Suppl):13-23. doi: 10.1188/04.ONF.S4.13-23. Citation: Wilson A (2011) How to provide effective oral care. For example, it can: These benefits will all help patients to recover from illness. 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. Treatment 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. Cryotherapy may be offered to cooperative children and adolescent patients receiving chemotherapy or HSCT preconditioning with regimens associated with a high incidence of mucositis. 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. Excessive use of tobacco 8. Chemical trauma (e.g., acidic foods, drugs, noxious agents, alcohol) 6. Dehydration 10. Inability to carry out oral care, for example due to stroke, arthritis, arm injury, head injury, surgery; Lack of money to afford equipment for oral care; Poor diet or reduced fluid intake;(not drinking enough); If the patient is nil by mouth due to surgery or has swallowing problems. It is important to ensure the client feels comfortable while performing oral assessment and care. Rello, Koulenti Blot et al (2007) and Chan (2005)) also concluded that their findings indicated that nurses oral care practices were not evidence based. 1.1.3 Relevance to clinical practice Clinical Practice Guidelines (RCH): Antifungal prophylaxis for children with cancer or undergoing haematopoietic stem cell transplant Chlorhexidine based gels and mouth rinses have a broad antimicrobial activity, with some antifungal and antiviral properties. Good oral hygiene has health and social benefits, and will help patients recover from illness, Nurses should carry out oral care for patients who cannot do it for themselves, Before oral care is started, the patient’s mouth should be assessed, Ensure patient privacy during oral assessment and care, Patients may need referral to a dental hygienist for specialist advice. Evidence-Based Approach for Oral Care If the nursing care is based on evidence, some important facts like improvement of care … 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. Maintaining patients’ oral hygiene is an essential nursing duty and is considered a fundamental aspect of care (Department of Health, 2010). Therefore, data which is obtained by assessment of daily assessment of oral mucosa will guide nurses to determine oral care frequency. Assess the oral cavity using an appropriate assessment tool. 3. This reduces blood flow to the mouth and therefore decreases the amount of chemotherapy agent that reaches the oral mucosa. - 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. 31, No. Contextual factors, supportive and restraining mechanisms influence the intervention’s success. Nursing Interventions - Assess respiratory rate pattern, lung sounds, lung expansion, signs of tissue hypoxia, cyanosis, pallor; presence of airway secretions; occlusion of oropharynx by epiglottis or tongue; aspiration of vomitus or oral secretions. There are a variety of tools, use the one selected by your trust. 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. This technique is dependent on the patient being able to tolerate and manage the cryotherapy safely. Sign in or Register a new account to join the discussion. Planning and using nursing interventions based on good quality evidence of effectiveness is of importance to ensure that the desired outcomes of care are achieved. Barriers to oral self-care 4. Consult the, prevent the development of oral mucositis, decrease the severity of established oral mucositis, provide an analgesic effect (patients have reported a ‘tingling’ sensation with the therapy; several adolescent patients have reported an immediate analgesia), Cryotherapy involves applying ice or ice chips to the mouth to cause vasoconstriction (ice-cold water, ice cream or icy poles may also be used). In: Oncology nursing forum, Vol. An azole antifungal agent such as fluclonazole may be prescribed. 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. 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. You may need a tongue depressor and a torch to carry out the assessment efficiently. Oral mucositis is a common complication of chemotherapy and radiotherapy. After using a chlorhexidine based gel or mouth rinse the patient should be instructed as follows; a patient should spit out excess gel or mouthrinse (do not swallow the gel or mouth rinse), a patient should not rinse out their mouth or eat and drink for 30 minutes post using the gel or mouth rinse (rinsing after using the chlorhexidine gel may remove it from the mouth and teeth and decrease effectiveness), Chlorhexidine based gels and mouth rinses need to be prescribed, If chlorhexidine 0.5% gel is unavailable, chlorhexidine 0.2% mouth rinse may be used; moisten the toothbrush with the chlorhexidine 0.2% mouth rinse and clean teeth as normal (a foam brush or super soft toothbrush may be used as a temporary alternative if the patient has significant mucositis, bleeding or pain in the oral cavity), Rinsing the mouth with chlorhexidine 0.2% mouth rinse should not be used as a substitute for tooth brushing, Flossing should be encouraged once daily if the child is older than 12 years of age, is used to regular flossing and it can be managed atraumatically, Interdental brushes may be used as an alternative, Flossing or the use of interdental brushes should be discontinued if mucositis is present, Non adherence to mouth care by the paediatric oncology or HSCT patient may be related to oral mucosa pain, Indications of pain associated with mucositis may include; difficulty swallowing, refusal to swallow, difficulty/refusal to talk, difficulty/refusal in opening mouth, drooling saliva, difficulty/refusal to attend to mouthcare and epigastric chest pain as examples, A regular pain assessment is required using a validated tool as per the, Effective analgesia should be provided prior to performing mouth care where there is evidence of mucositis. Rationale: provides data for planning care. 23, pp. The plan should also include which tools and products are to be used to maintain good oral health care. Immunocompromised 13. Children’s Oncology Group, (2018) COG Supportive Care Endorsed Guidelines, Children’s Oncology Group (COG), Version date: August 22, 2018. - if a patient develops significant mucositis, Further information on the prevention and management of fungal infections in the paediatric oncology and the HSCT patient can be found at: London: Hodder Arnold. The management plan should be clearly documented in the Electronic Medical Record. The Royal College of Surgeons of England / The British Society for Disability and Oral Health, Extreme use of abrasive cleaning agents 9. 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. 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