Learning objectives:
1 state the objectivesand precautions of oral hygiene.
2 discuss the variety andfunction of mouthwash for oral hygiene.
3 demonstrate theprocedures of providing special oral care.
4 provide client teachingwhen appropriate.
Toprovide increased comfort
Toallow the nurse to assess the client’s oral health status, knowledge, androutines of oral care. To provide client teaching when appropriate.
Toremove unpleasant tastes and odors from the oral cavity.
Todecrease the possibility of irritation or infection of the oral cavity. Such asto remove plaque and bacteria-producing agents from the oral cavity.
Assessment of client
Assess client’s ability to care for him orherself. Such as physicalcondition, consciousness, diagnoses and so on.
1. normal client: who can take care of themselves
2. special client: who can not be self-care because of coma,high fever, tube feeding, fasting禁食 and so on, or who can be self-care but can not do oralhygiene by themselves for special reason such as oral disease.
Assessclient’s oral health status.
1. routines of oral care. Method of brushing teeth or gargling漱口(time, times, way)
2. knowledge of oral care
Assessclient’s oral cavity condition, including lips, tongue,teeth, gum, odor, mucosa..
Choosing different methodaccording to client’s different situation
1. for normal client: give them advice about oralhealth
2. for special client: provide oral care for them
Choice of mouthwash
| Name | Concentration | Effect |
| Normal saline | ||
| Compound sodium borate solution复方硼砂, Dobell’s solution朵贝尔 | Anti-bacteria, deodorization除臭 | |
| Hydrogen peroxide solution过氧化氢 | 1~3% | Antisepsis, deodorization (ulceration溃烂, necrosis坏死) |
| Boracic acid硼酸 | 2~3% | Acid antiseptic |
| Baking soda碳酸氢钠 | 1~4% | Alkali碱, fungi真菌 infection |
| Acetum醋酸 | 0.1% | Pyocyanic infection绿脓杆菌 |
| Chlorhexidine洗必泰 | 0.01% | Broad-spectrum anti-bacteria广谱抗菌 |
| Furacilin 呋喃西林 | 0.02% | Broad-spectrum anti-bacteria |
| Metronidazole甲硝唑 | 0.08% | Anaerobe厌氧菌 |
| Traditional Chinese medicine |
Middle-sizedtherapeutic tray中治疗盘:
Flashlight手电筒, swab棉签, lubricant for lips润滑剂, gentian violet紫药水, mouth-gag开口器,tongue forceps舌钳 (if necessary),protective pad治疗巾, kidney basin弯盘 2 (tongue blades压舌板, forceps镊子, hemostaticforceps止血钳, gauze纱布, normal saline cotton ball26~30生理盐水棉球 [water incotton ball should be moderate to prevent aspiration吸.It’s extremely important for coma client])
Beforethe procedure there are some key points that should be known:
1 Top of hemostatic forceps should be wrapped in cotton ball in case of abradingthe gum牙龈 ororal cavity mucosa口腔黏膜.
2 there must be only one cotton ball onthe top of hemostatic forceps each brushing. Thus can prevent leaving cotton ballbehind in client’s cavity. It’s extremely important for coma client.
3 brushing order: the lip,one side of buccal颊 mucosa,external surfaces of upper gum, upper teeth, lower gum, lower teeth. And thenthe other side. Inner surfaces of upper gum, upper teeth, lower gum, lowerteeth. And then the other side. Occlusal surface咬合面 from one side to the other. Hard palate硬腭, tongue.
4 how to use hemostatic forceps during theprocedure? Firstly the bent弯曲的 top of it must be towardthe part you brush all the time. Secondly there are different brushingdirections when you brush different part of oral cavity: teeth, hard palate,tongue ----lengthwise; the other parts: breadthwise. All parts are from insideto outside.
1. gather equipment.
2. Identify the client.
3. Explain the rationale for the procedure to theclient.
4. if possible, position client on side in a lateralposition or supine position, turn client’s head to the side. Allows fluid todrain out of mouth and thus prevents aspiration.
5. place protective pad on client’s chest and near bychin.
6. inspect surface of mouth for any abnormalities.
7. put kidney basin under chin.
8. brushing order: the lip, one side of buccal颊 mucosa, external surfaces of upper gum, upperteeth, lower gum, lower teeth. And then the other side. Inner surfaces of uppergum, upper teeth, lower gum, lower teeth. And then the other side. Occlusalsurface咬合面 from one sideto the other. Hard palate硬腭, tongue.
9. assist client to rinse漱洗 mouth and expectorate into kidney basin.
10. remove basinand wipe off client’s mouth with gauze.
11.lubricate client’s lips withpetroleum jelly凡士林油 or swab wound with gentian violet ifnecessary.
12. dispose ofequipment.
13. return client to comfortable position.Clear up client’s bed.
14. place equipment in appropriate receptacle.
1. gently brush. Top of hemostwww.med126.com/kuaiji/aticforceps should be wrapped in cotton ball, especially for the client whose bloodcoagulation mechanism is not so good in case of abrading the gum or oral cavitymucosa.
2. brush thoroughly and have a rational brushing order.
3. water in cotton ball should be moderate to preventaspiration. Don’t leave cotton ball behind in client’s cavity for the samereason.
4. assess the client’s oral health status to see if there aredentures假牙, oral ulcer溃疡 or infection, and deal with it accordingly. If there are dentures,remove them before oral care, rinse dentures thoroughly in cold water. Ifdentures are to remain out of the mouth for a period of time, as at night,store them in a clearly container of cold water.
5. provideoral care frequently. Generally speaking, four times each day.
