Self Directed Learning Package - University of Queensland

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40 • The Palliative Approach ToolkitSayReport your assessmentResidents get the best outcomes when you provide clearinformation about the resident.Thinking PointWhich of the following do you think will get the bestresponse?Nurse to GP:‘Alfred has a very dry mouth and oral candida. Itseems to have become worse since commencingopioid analgesics last week. He has candida on histongue and in the corners of her lips. Please reviewhim for some anti fungal medication. We will continuewith frequent oral care’.Is much better than:‘Alfred has problems with his mouth. You better takea look’.DoManage the problemThe best clinical outcomes will be achieved if care plansare developed after careful assessment of the resident’soral cavity.Thinking PointAlfred’s medications cause a dry mouth, heoccasionally uses oxygen and often sleeps with hismouth open. He has a ‘sore’ spot on his gum and histongue is coated. What could you do to help Alfredwith his dry mouth?Dry mouth (xerostomia)• moisten oral cavity with frequent rinsing and sipping of water• apply water-based moisturiser to lips• discourage strong cordials, juices or sugary drinks• reduce caffeine intake• stimulate saliva with tooth friendly lollies• encourage resident to drink water after meals, medicationsand other drinks and snacks• use saliva substitutes such as a water spray or an oral balancegel or liquid. 11Pain or ulceration• help the resident to rinse or swab their mouth with warmsaline three to four times a day until resolved• check the fitment of dentures• avoid spicy or acidic foods or food with sharp edges• offer cold, soft food• local or systemic analgesics may be required• medical review if not resolved within seven days. 11Coated tongue, mucosa or teeth• remove debris with a soft toothbrush or mouth swab• help the resident to rinse or swab their mouth with warmsaline three to four times a day until resolved• brush tongue gently with soft toothbrush. 11
41 • Self Directed Learning Package - Introductory Registered & Enrolled NurseOral care in the final days of lifeIn the final scenes of the “All on the same page” DVD, Alfred hasonly hours or days left to live. He cannot swallow food or fluids,is very drowsy, and breathes through his mouth. His tongue andlips are dry.Thinking PointThink about when you have a dry mouth. When youmoisten it with water, how long does it take untilthe dryness returns? Not very long? Perhaps fiveminutes?Imagine you are Alfred who relies on you to providethis comfort measure for him.As a resident approaches death they lose the ability to feedthemselves or have a drink. Eventually swallowing becomesdifficult and unsafe. Functionally they cannot clean their teethor oral cavity by themselves. Often this is when a ‘mouth care’trolley or tray is seen in the resident’s room.Key PointEvery time you attend to a resident:Apply dry mouth products: e.g. water spray, oral balance gel orliquid via mouth swabs.Apply water based lip moisturisers: Do not use petroleum basedproducts (e.g. vaseline) as they canincrease the risk of inflammationand aspiration pneumonia; alsocontraindicated during oxygentherapy. 11Key PointSome preparations may damage oral tissues orincrease the risk of infection.Do not use mouthwashes and swabs containing:• lemon and glycerine• sodium bicarbonate (high strength)• preparations containing alcohol (Listerinemouthwash) or hydrogen peroxide• pineapple or other acidic fruit juices. 11
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Self Directed Learning Package - University of Queensland

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