Oral Care for Unconscious-Dependent Patient

Subject: Fundamentals of Nursing

Overview

Oral Care for Unconscious/Dependent Patient

A new approach to oral care is necessary for a patient who is asleep and unable to rinse his or her mouth.

Articles

  • Suction apparatus if necessary.
  • Screen.
  • A tray containing:
    • Mackintosh and towel.
    • Feeding cups with water.
    • Potassium permagnate/soda bi-carbonate/ chloride solution/betadine mouth gargle, etc.
    • Cotton swab as necessary.
    • Gauze piece.
    • Paper bag-2.
    •  Gallipot-2.
    • Solution for mouth wash.
    • Clean water with bowl.
    • Face towel-1.
    • Kidney tray.
    • Dissecting forceps.
    • Artery forceps.
    • Airway/tongue depressor or spatula (as needed).
    • Glycerin or cream.
    • Gloves.
    • Torch light.

Procedures

S.N. Nursing Action Rationale
1 Identify the patient and any specific instructions. Explain the procedure to the patient and/or relatives. Ensures that right procedure is performed for right patient. Unconscious patient may retain ability to hear.
2

Assess the condition of the patient, his mouth and level of consciousness.

Inspect the integrity of lips, teeth, buccal mucosa, gums, palate and tongue.

Assess patients risk for aspiration: impaired swallowing and reduced gag reflex.

 

 Helps to determine the type of oral hygiene, the patient requires.

Determines the status of the patient's oral cavity and extent of need for oral hygiene.

 

 
3 Close door and pull the screen. Maintain the patient's privacy.
4 Wash hands with soap and water. Reduces transfer of microorganisms.
5 Prepare and bring the articles to the bed side. Facilitate to perform procedure.
6 Raise bed to comfortable working level. Lower side rails on the working side. Raise side rails of bed on both sides. Use of good body mechanics prevents fatigue. Prevents the patient from falling.
7

Position the patient in such a way that patient's head is turned to one side with the face along the edge of the pillow at the near side of the nurse.

Promote patient's comfort. Tilting the head downward encourages fluid to drain out from patients's mouth and prevent aspiration.
8

Place a towel and mackintosh under the patients head and spread one towel over chest.

 Protect soakage to the patient's body and bed.
9 Wear gloves. Reduces transfer of microorganisms.
10

Prepare cleaning agent (sodabicarbonate) solution in gallipot. If the client is unconscious, use plain water.

Facilitate to perform procedure.
11

Keep the kidney tray close to the cheek or under the chin of the patient with concave side towards him.

Collects saliva and water that may drool from the mouth and prevents soiling of bed.
12 Ask the client to open the mouth or Separate the upper and lower teeth with a padded tongue depressor by inserting it quickly and gently if required. Provides access to oral cavity.
13 Examine the patient's mouth and tongue using the torch and spatula and test for presence of gag reflex by placing tongue blade on back half of tongue. (Reveals whether the patient is at risk of aspiration.) Inspection helps identify condition of oral cavity and determine individual needs.
14

Take the gauze/cotton piece with the dissecting forceps.

Wrap the gauze/cotton piece around the artery forceps covering its tip. Moisten the gauze piece with normal saline or dip in the cleaning agent.

 Covering tip of forceps prevents injury to the mucous membrane and gums.
15

Swab each tooth gently but firmly and clean all the sides of the tooth. Swab far upper chewing surface first by up and down circular strokes on both back and front of teeth (inner and outer surface from gum to crown) by using artery forceps.

Swab lower teeth on both sides followed by upper teeth on both sides by same process.

Gently swab roof of the mouth, gums and inner sides of cheeks.

Swab the tongue from back to front using artery forceps covered with gauze.

Provide plain water to gargle mouth and position kidney tray.

If client cannot gargle by her/himself Clean the teeth and tongue using moistened cotton ball in similar way.

Discard used cotton/gauze into small kidney tray.

 Ensure through cleaning and prevents injury to the oral mucous membranes and gums.
16 Clean the eyes using separate cotton swabs for each eye if necessary. Maintains cleanliness.
17

Wipe mouth and face with the wet face towel. 

Dry the patient's mouth/face with towels.

Apply lubricant to lip using foam swab gauze piece.

Remove the mackintosh and towel.

Keep the patient in comfortable position.

Remove screen.

 Promote comfort.
18 Clean the articles and replace them in proper place. Leaves the unit clean and articles ready for further use.
19 Wash hands and remove the gloves, if used. Prevents cross infection.ref
20 Give health education to the patient and relatives on oral hygiene. Provides information.
21

Record the procedure with date, time, and condition of the mouth, teeth, etc.

Reports the senior staff if find out abnormalities.

Provides accurate documentation.

Helps to manage condition  accordingly.

 

Notes

  • The mouth of a patient should never be touched. Bites from people may be harmful and unpleasant.
  • Always keep an eye on the state of the patient's mouth, tongue, lips, and gums when providing oral care.
  • The lateral posture with the head tilted to the side is the best position for a client who is immobile.
  • In addition to drainage, it also guards against unintentional aspiration.
  • Any anomalies, bleeding, ulcers, tooth decay, dryness, and odor should be reported.
  • Place the patient so as to prevent aspiration.
  • If a patient coughs or chokes excessively during or after oral hygiene, report it right away to the senior.
Things to remember

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