MHPP 2013 Unit 3.1 Oral hygiene in professional practice and patient care.pptx

lecture of oral hygiene in professional practice and patient care

1. Professional practice & patient care MHPP 2013 UNIT 3.1; Oral hygiene

2. • Sta t e t he ca v ity State the Des c ribe mucosa State the parts th a t com p rises of oral • • purp o se of o ral hygie n e the n o rmal he a lt h y oral • types of p ati e nt a nd the i r risk factors for oral p roble m s O b jec t ives 2

3. li p s / cheeks T e e th Oral Cavity Hard & T o n g u e & its m u s c les soft p a la t e 3

4. M o uth (Oral Ca v it y ) Li p s Ging i va (gu m s) H a rd p a l a te Uv u la S o ft pa l ate P a l a tine tonsi l s T on g ue and its muscle T e e th 4

5. • • Lips sur r oun d ing the ope n ing of m outh Cheeks walls of T ong u e runni n g a l ong the side of the the ca v ity and its mus c les • • Hard and the ca v ity T eeth soft pal a te f orming the root of • 5 Oral c a vity

6. Mai n ta i n he a lt h y s t ate of mo u th, te e th, gums & lips Rel i e v es d i s c omf o rt r e s u lt i ng fr o m u n p l e a s a nt o d o r s & ta s tes 6 Brus h ing cl e an s es te e th from f o od p a rt i c l e s , p l a q ue & b a c t e r ia & ma s s a g e s g u m Purposes of oral hygiene

7. Flo s s i ng r e mo v es p l a q ue & ta r tar b e twe e n te e th to r e d u ce g u m i n fl a mmat i on & i n fe c ti o n 7 Giv e s a s e n se of wel l - b e i n g & th u s st i mul a tes a p p e ti t e Purposes of oral hygiene

8. rk * p i n k c o l o r (d a r k er in dark- s k i n n e d p a ti e nt) s mo o th * s of t , moi s t, Gu m s * P i n k (blu i sh or d a patches in dark ski n ned * 3 2 adu l t teeth * moist, firm te x ture * s mo o th, whi t e, s h i n y N o ret r action of g ums to o th e n am e l (pul l i n g aw a y f r om teeth) Out e r lip te x tu r e Nor m a l He a lt h y * M u cosa * P i n k (blu i sh or pati e nts * moist, firm tex N o ret r action of T e e th * 3 2 adu l t * s mo o th, whit to o th en Inn e r lip & buccal mucosa * Pink color (freckled brown pigmentation in dark skinned patient)

9. T yp e s of p a tie n t & risk facto r s for o r al p r o b l e ms • L a ck u p p e r e x tr e miti e s s t r e n g th or d e x t e r ity ( s k i ll to do th i n g s with Par a l y z e d Ser i o u s l y ill Phy s i c al r e s t ri c ti o ns to u p p e r ex t r e miti e s e. g . dre s si n g o n e ha n d)

10. T yp e s of p a tie n t & risk facto r s for o r al p r o b l e ms Un c o n s c i o u s , c o nf u s e d, c o mb a ti v e or depressed d i a b et i c 10 • Pro n e to d r y n e ss of mo u th, g i n g i v it i s, p e ri o d o nt a l d i s e a s e a n d lo s s of te e th • Una b le or u n will i ng to at t e n d to personal h y g i e n e n e e d s

11. T yp e s of p a tie n t & risk facto r s for o r al p r o b l e ms *Patient w h o c a n n ot take a n ythi n g by mo u th or are on fluid restriction *Have na s og a stric tub e s *Re c ei v e c o ntinu o us n a s a l o x y g en *Mouth breathers s wo l l e n mu c o s a, change s an d possib l e Pati e nt undergoing ra d ia t ion th e ra p y • Ra d i a ti o n t h e r a p y c a u s es s o r e n e s s , mild e r y t h e ma, dysphagi a , d r y n e ss , t a s te o r al i n f e c t i o n 11 • Prone t o dehydration and drying of mucous me m brane • T h ick secretion dev e l o p on tongue and gums • Li p s become cracked a n d redd e n e d

12. Sucti o n trach e ostomy 12

13. 13 Inse r ti n g cat h et e r in t o nos t ril

14. 14 P o tter & P er r y ( 1997 ) , p104 5 M A SC 201 4 NU R SING SCIENCE 1 M A 6 T yp e s of p a tie n t & risk facto r s for o r al p r o b l e ms b e c o me tr a um a ti z ed with i n fl a mma t i o n and p o s s i b le Pati e nt • Ch e mo d r u g s c a u s e r e c e i v i n g u l c e r a ti o n a n d i nf l amm a ti o n c h em o th e r a py of mu c o s a and p o s s i b le drug s o r al i n fe c ti o n Patie n t ex p erienc i ng oral s u rger y , trauma to mo u t h , pla c em e n t of oral endo - trach e al tub e s or • T i s s u es in o r al c a v i ty swe l li n g, ulc e ra t io n s, b l e e d i ng

15. • P o tter & T yp e s of p a tie n t & risk facto r s for o r al p r o b l e ms supressio n drugs may i n c r e a se ri s k Pati e nt with immu no - s u p r e s s i on eg HI V , o r g an tr a n s pl a nt Immu no - s u p r e s s i on and immu no - for o r al i n fe c ti o n

16. Com m on pro b le m s o f t he mo u th t h e g u m 16 Problem Des c ription Imp l ic a tion Ha l it o s i s Bad b r e a t h T e a ch or pr o vi d e r eg u lar o r al h y g i e n e Glo s s i tis I n fl a mmat i on of t h e t o n g ue Gin g i v it i s I n fl a mm a ti o n of Per i o d o n tal d i s e a s e Gum a p p e ar s p o n g y a nd b l e e d i ng

17. Co m m o n pr o b l e m s of t h e m o u t h 17 Problem Des c ription Imp l ic a tion Redd e ned or e x c o ri a ted muc o sa Che c k f or ill fi t ti n g de n tu r es Exc e s s i v e dr y n e ss of the bucca l In c r e a s e flu i d mu c o s a i n ta k e a s he a lth pe r mits

18. Co m m o n pr o b l e m s of t h e m o u t h 18 Problem Des c ription Imp l ic a tion L u b r i c ate l i p s , Cra c k i ng of l i ps u s e a nt i mic r o b i a l Chei l itis oi n tment as p r e s c r i b ed T e e th h a ve Adv i se p a ti e nt to Den t al darkene d areas , s e e p h y s i c i an c a r r i e s may be p a i n ful a n d/ o r d e n ti s t

19. Acc u mul a ti o n of mu c in ( a ty p e of muc u s) c a r b o h y d r a tes a n d la c tic bacilli in the saliva The a b o v e will b e c o me d e nt a l p l a q ue (i n v i s i b l e s o ft film t h a t ad h e r es to the e n am e l su r fa c es of the te e th, c o n s i s ts of b a c t e r i a , mol e c u l e s of s a li v a a n d r e mn a nts of e p it h e l i a l c e lls a n d le u c o c y tes 19 Pat h o p hysiol o gy of d e nt a l carri e s

20. D e ntal pla q ue a d h e res to teeth e s p e ci a lly t o the cro w n of the teeth. If is n o t rem o v e d will become hard and combine with dead bacteria 'V D e ntal pla q ue pre v e n ts dilution a n d n e utralizing of aci d . A c id will destroy the enamel of teeth go through till reaching the pulp of teeth J late r . D e ntal c a rr i es o c c u rs. T e e th will look w h ite initially y b u t b e c o mes bro w n or bla c k c o lor 20 L Pat h o p hysiol o gy of d e nt a l carri e s

21. Nursi n g Resp o nsi b il i ti e s *M a i n te n a n ce a n d pr e ve n tion of a l ter e d or a l muc o us mem b ra n e a n d to o th d e cay Inter v enti o ns Rationale INSP E CT all surfa c es of R e g u lar in s p e ctio n s allow oral c a vit y , in c ludi n g c o lor e a rly d e tection of p roble m s a n d moi s tne s s of mu c o s a, a n d pro m pt c o rrections pre s e n ce of le s ions (for p a tients w h o are at risk of de v eloping oral problems) ASSES S c u rrent oral Kn o wle d ge of c u rrent h y gie n e pra c tices pra c tices e n a b les n u rse to d e termine req u ired h e alth pro m oting b e h a vi o r

22. 22 Int e rv e ntion Rati o n a le P R OVIDE h ea l th ed u cation as r eq u ired on the fol l ow i ng: 1 . Diet • Cha n ge e a ti n g h a b it s , Sweet or s t a r c h y re d u c e i nt a ke of fo o d adhere s to c a r b o h y d r a tes e s p. swe e t to o th s u rf a ce snack s b e twe e n me a ls • After eat i ng swe e ts, s h ou l d T o re d u c e a ct i on of b r u s h t e e th with i n 30 p l a g ue min u tes

23. 23 Inter v enti o n Ration a le PR O VIDE h e alth ed u c a tion as required on t he followin g : • Eat acid co n taining f r uits e.g. Ap p les a n d fibrous food s u ch as ve g eta b les T o red u ce pla g u e . T h e a c idic q u ality • Eat c o ars e , fibrous f o o d s u ch as f resh frui t s a n d raw v e g e tables • T a k e w e ll b a lan c ed diet

24. Inter v enti o n Ration a le 2. Bru s hing •T h oro u gh bru s hing of the teeth at lea s t 4 times a day ( after me a ls a n d b e fore bed) •Bru s h s h o u ld be s m all e n o u gh to rea c h all areas of the mo u th T o pre v e n t tooth d e c a y – me c h a ni c al a c tion of b rus h ing remov e s food particles that c an h a rbor a n d in c u b ate b a cteria. It al s o stimul a tes circ u lations to the g u ms thus maintaini n g their fi r mne s s. All t o o th s u rface s , inn e r outer a n d c h e w ing s u rfaces c a n be bru s h e d thoro u g h l y . 24

25. a n d tartar from tooth e n am e l. Int e rv e ntion Rati o n a le •An e v e n , rou n d e d Soft b ristles stimul a tes g u ms bru s hing s u rface is witho u t c a u s ing a b rasi o n a n d b e st ble e ding •T h oro u gh rinsing T o rem o ve di s lod g e food particles after brus h ing is and ex c ess toothpa s te imp o rtant 3. Flo s sing - m o s t F o r e f fective remo v al of plag u e e a sily d o ne a n d tartar b e twe e n teeth. T h e imm e diately after s e e s aw motion u s ed t o p u ll floss bru s hing b e twe e n teeth rem o v e s pla g u 2 5 e

26. Diagr a mm a tic s e ction through a typical adult tooth 26

27. 27 Int e rv e ntion Rati o n a le 4. Checkup – h a ve a c h e c k u p by d e nt i st e v e r y 6 mo n ths ( r e c omm e n d e d ) 5. Pati e nt with dent u re s : Those with d en t ur e s - if • If us i ng d e nt u r e s, n o t we a ri n g d e nt u r e s a r e c o nt i n u e t o use t h em p r o n e to s h ri n k a ge of gums whi c h re s ult in • Need to be c l e a n ed fu r th e r t o o th lo s s r e g u l a rly at l e a s t on c e a d ay

28. C o ntin u ed……. 28 Inter v enti o n Ration a le Can be r e mo v ed fr o m L i ke n a tu r al t e et h , art i fi c i a l the mo u th, s c r u b b e d d e nt u r e s c o ll e ct with a to o th b r u s h , mic r o o r g a n i s m a n d f o o d ri n s e d a nd r e i n s e rt e d

29. Inter v enti o n Ration a le 1 . Exp l a i n t o p at i e n t et i o l o g y of the p r o b l e m * In a d e q u ate o r al h y gi e ne, p h y s ic a l inju r y or d r y i ng e f fe c t ( e .g. Mo u th b r e a th i n g , o x y g en t h e r a p y , e x tr e me t em p e r at u r e , NP O ) Und e r s ta n d i ng the u n d e rl y i n g c a u s e i n c r e a s e s the p a ti e nt ’ s awar e ne s s and may enhanc e m otivat i o n to imp r o v e o r al h y g i e n e or to fo l l o w a th e r a p e ut i c r e g i me Nursing Respo n sibil i ti e s * Altered m uc o us membranes

30. Inter v enti o n Ration a le C o ntinu e d……… U n d e rstan d ing the * m e c h a n ic a l trauma (e.g. u n d e rlying c a u s e Sur g er y , injury form ora l - in c rea s es the tub e , b rok e n teeth or il l - p a tient ’ s a w are n e s s fi t ting d entures) and may en h an c e motiv a tion to impro v e * c h e mic a l trauma (e.g. oral h y gie n e or to Side e f fects of m e di c ation) follow a thera p e u tic regime * ra d iation injury Nursing Respo n sibil i ti e s * Altered mu c ous m e mbr a nes

31. 31 Inter v enti o n Rationale 2. Acc e ss a l l s u r fa c es This a l l o w n u r s e t o of or a l muc o sa for de t e c t cha n ges a n d ir r it a ti o n, ul c e r at i on imme d i a te tr e atm e nt a n d i nf l amm a ti o n, d a ily c a n b e p r o v i d e d or e a ch s h i ft or 4 h o u r ly

32. 32 Int e rv e ntion Rationa l e 3.E s ta b li s h a m o uth Oral c a r e b ef o re me a ls c a re re g ime: rem o v e s e x u da t es a n d s t imu l at e s a p p e ti t e, * Bef o re me a ls if af t er me a ls a n d a t e x u d at e s is e x c e s s i v e b e dt i me, r e mo v es fo o d a n d a ft e r mea l s or d e b r is a n d p r e v e nt b e fo r e b e d time or mo r e i n fe c ti o n. of t en as c o n d i ti o n warr a nts ( e .g. 2 h ou r ly)

33. 33 Provide or use Rationale a p pro p r i ate s u p p l i es C h ild s o ft tooth b rush or if a toothbrush is c o ntraindi c ate d , u s e a glo v ed finger w rap p ed in g a u z e T h is a v oid further injury to the s o ft mu c o s a No n - abra s ive toothpa s te N o rmal s a line is n o n – N o rmal s a line or s o dium a b rasi v e w h ile s o dium bic a rbonate for rinsing bic a rbonate helps to rem o ve thick mu c us

34. 34 Provide or use Rationale a p pro p r i ate s u p p l i es Floss e x c e pt where Dent a l fl o s s ing is th e re is e x c e s s i v e necessar y fo r e f fective b l e e d i ng r e mo v al of pl a g u e a n d ta r tar b e twe e n te e th L u b r i c ate wi t h l a n o l in or This m a i n ta i n te x tu r e p e tr o l e um j e lly a n d m o i s t u r e of li p s

35. 35

36. 36 In s truct p a ti e nt to: Rationa l e A v o id tob a c c o, al c o h ol, T h e s e s u b s tan c es are e x treme of temp e rature in ir r itat i ng to the oral foo d , e x c e s sive mu c o s a a n d may c a u s e s e a s o n ing, c o mm e rcial di s c o mfort a n d further mo u th wa s h e s with d a ma g e alc o hol, citrus f r uits and food high in rou g h a ge R e mo v e d e ntures as Il l - fi t ting d e ntures c a n neede d ir r ita t e the o ral tissue

37. Koz i er et al ( 1998) p756 In s tr u ct pa t ie n t t o : Rati o na l e Eat ble n d s o ft food if Non - ir r itat i n g , s o ft foo d s a b le mai n tain the c u rrent status of the mu c o u s me m bra n e Drink 2 – 3 li t ers of Ade q uate hy d rat i on maintains fluids a d a y the c u rrent status of the mu c o u s me m bra n e Co n sult with die t ician T o modify the diet as ne e d e d Ad m inister pre s crib e d T o relieve p a in a n alg e si c s or c o n s ult with phy s ician to o b tain one

38. Pos i ti o n pa t i e nt in s i d e l y i n g p o s i ti o n (l a te r a l ) to min i mize ri s k of as p ir a ti o n M o uth ca r e for u n conscio u s pati e nt

39. * W r a p tip of bryant fo r c e p with g a u z e - T oo t h s ur f a c e (u p per s i de to c e nt re ) - to n g u e a n d lower and Cle a n mou t h w i th g a u z e moi s ten with wat e r * Squ e e z e exc e ss water fr o m ga u ze with a d i s s e c t i n g fo r c e p * Cle a n (st a rt fr o m fu r th e r awa y ) – ro o f of mo u th - i n s i de of c h e e ks M o uth c a re f o r un c on s c i ous p a ti e nt

40. 40 For patient who tend to bite: Mo u th c a re for u n consc i o u s pat i ent * W a i t unt i l pat i e n t is rel a x e d with mo u th o p e n ed * I n s e r t p a d d ed to n g u e bl a de be t ween ba c k of mola r s and ge n tly wit h o u t usi n g fo r ce

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45. • Use t oo t h bru s h with d en t ure pa s te to c le a n • Soak in a c o n ta i n e r with wat e r aft e r cl e a n i n g 45 • W a s h m o uth b e fo r e p u tt i ng on d e nt u r e s • Remove d e nt u res be f ore sl e ep • Cle a n de n tu r es • W a s h d e n tu r es in a sm a ll b a s i n fi l l w ith wat e r • Use t oo t h bru s h with d en t ure pa s te to c lea the d e nt u r e s • Soak in a c o n ta i n e r with wat e r aft e r cl e an • Do n ot le a ve on top of the s i nk b e c a u s e it might dr o p Care of d e ntur e s

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48. LE ARN I N G OB JE C TIVE S State the c h a r a c t e r i s tic of n o rm a l u r i n e/ f e c e s . L i st the c omm o n e l imi n at i on p r o b l e ms. State the f a c t o r s th a t alt e r t he n o rm a l b o wel e l imi n at i o n . State the n ur s ing mea s ur e s in meet i ng the e l imi n at i on n e e d s. State the nursing responsibility while giving and removal of bedpan / urinal 2

49. 3 Cha r a c te r i s tic Norm a l Uri n e Col o r Y e l l o wish a n d c l e ar S m ell Paint ar o matic Amou n t Adu l t: 30 ml / h o ur or . 5 ml / kg b o d y wei g ht / ho u r Bab y : 2 – 3 ml / kg b o dy we i g h t / ho u r T od d ler / p r e s c h oo l : 1 – 2 ml / kg bo d y wei g ht / ho u r CH A R A C TE R I ST I C S O F NOR M A L UR I N E

50. ( CO MM O N E LIMI N A T I O N UR I N A R Y ) P RO B L E M S Poly u ria Dy s u r ia Anu r ia Olig u ria No c tu r ia Uri n a r y r e te n ti o n In c o n ti n e n ce Urge i n c o nt i n e n c e Hema t u r ia Pyur i a 4

51. NURS I N G M EASURE S - UR I N E 5 Gener a l Care - Hygi e ne c a re aft e r e limi n at i on is vit a l to pr e v e nt u r i n a r y tr a ct i n fe c ti o n (UTI). - Mai n ta i n e l imi n at i on h a b i t – do n o t hold on u r i n e too l o ng or too oft e n. - Mai n ta i n a d e q u a te fl u id i n ta k e 2 – 3 l it e rs / day for a h e a lt h y a d u l t

52. NURS I N G M EASURE S - UR I N E Gener a l Care - Promote c o mple t e b la d der empt y ing – wait u r i n e c om p l e te s t op fl o win g . un t il - Aci d if y i n g ur i ne – a c i d ic n a tu r e o f u ri n e i n h i b its mic r o - or g an i sm gr o wth. Prom o te fo o d s u c h as me a t, e g g s, a c i d it y . who l e g r a i n b r e a d t o i n c r e a s e u ri n e 6

53. NU R S I N G M E A SU R E S - U R I N E Stre n gt h e n ing of p e lvic fl o or m u scle - a l so k n o wn as Keg e l e x e r c i se to : - - to tre a t ove r a c ti v e - W om e n i n s tr e ss i n c o nt i n e n c e b la d der - l e a r n a nd e x e r c i se d u ri n g v o i d i n g t he t e c h n i q u e 7

54. NU R S I N G M E A SU R E S - U R I N E - Some men who h a ve ur i na r y i n c on t in e n c e a fter p r o s ta t e s u r g e r y - Peop l e who ha v e f e c a l i n c o nt i n e n c e - s t r e n g th e n the mu s c l es of the p e l v ic fl o or to imp r o v e u r et h r a l a nd r e c t al s p h i n c ter fu n c t i o n. 8

55. 9 PE L VIC F LOOR E X ER C ISE F O R PREGN A NT W OMEN KEGEL E X ER C ISE KEGEL EXER C ISE F O R MEN KE G E L E X E R C I S E

56. NURS I N G M EASURE S Stre n gt h e n ing of p e lvic f lo o r m u s c le - s t op the f l ow d u r i n g mi d - v o i d i n g a n d h o l d i n g for 5 – 10 s e c o n d s . - Once f a mil i ar on wh i ch mu s c l e t o c o n tr a c t , p a ti e nts c a n d o t he e x e r c i se e v en wh e n s i tt i ng d o wn in t h e l e c t u r e h a l l. - UR I N E 10

57. 11 CH A R A C TE R I ST I C S O F FE C E S Characteristic Normal feces Color Brown Odor Aromatic due to food & bacteria Amount Depends on individual rectum (2-5cm) Diet (100 – 400 gm/day) Consistency Soft, semisolid and moist, usually cylindrical in shape

58. MALE URINA L S MALE URINA L S 12 BED P AN FEMALE U R INA L S BE D P A N S / UR I N AL S

59. 14 Co n s t ipa t ion - Una b le to d e fe c ate at will, in f re q ue n t b o wel mov e ment, di f fi c ul t y in pa s si n g mot i o n , h a r d fe c es a n d e x c e s s i ve s t r a i n i n g. Impac t ion - imp a c t i o n o f s to o l is d ue to u n r e li e v e d c o n s ti p at i on, un a ble to pa s s mo t ion for s e v e ral days. Dia r rhea – i n c r e a s e d o f s to o l in l i q u i d or l o o s e fo r m. COMMO N EL I M I N A T I O N P ROB LE M S ( BO W EL )

60. C O MM O N EL I M I N A T I O N P R O B LE M S ( B O W EL ) 15 Incontinence – i n a b il i ty to c o nt r ol t h e pa s s i ng of fe c es a n d g as f r om t he a n u s , impa i r e d a n al s p h i n c ter mu s c l e. Fla t ulence – g a s ac c um u l a ti o n in t h e lum e n of i n te s ti n e s . Hemorrhoids – d i l a ted or e n g o r g e v e i n s in t he li n i n g o f r e c tum. Oft e n pa i n o r b l e e d i n g d u ri n g d e fe c at i o n .

61. 16 NURS I N G M EASURE S - B OW E L Deter m ine the usu a l bowel General ca r e e s ta b li s h ro u ti n e b owel h a b i t i n c r e a se v e g et a b l es i n ta k e and drink 2-3 L of water a d a y ta k e yo u r t ime, no s tr a i n i n g e n s u re d e fe c at i on p o s i ti o n i s comfortable Def e c a te at l e a s t on c e a d a y

62. I N SE R TI N G R E C T A L S U PP O SI T O R Y 17

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68. 23 NURS I N G RESPONS I B ILI T I E S I N G I V I N G AN D REMOV I N G BED P AN / UR I NA L Ass e ss n e e d s ( b e d p a n / u ri n a l ) Prov i des p r iv a c y . Ens u re p a ti e nt is p r ot e c t ed – n o t to e x p o s e the p a ti e nt Put patient in a comfortable position

69. 24 NURS I N G RESPONS I B ILI T I E S I N G I V I N G AN D REMOV I N G BED P AN / UR I NA L Ass e ss the s t o o l o r u ri n e b ef o re d i s c a r d i n g Disp o se at di r ty uti l ity ro o m and c l ean the e q u i pm e nt Clean perineum after urination or defecation Wash hand

70. HYG I EN E A FT E R E LIMI N A TI O N W a s h h a n ds a f ter e l imi n at i o n . W a s h h a n ds with wat e r or u s e t i s s u e Wipe or clean from clean to dirty area 25