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Oral Care on Dying Older Adult Essay

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Updated: Jun 21st, 2022

Improving the quality of dying old adults is essential. Dying older adults have diverse mouth problems. They experience dry, painful mouth, and have oromucosal infections. They may also experience salivary gland dysfunctions and dysphagia. Besides, their oral cavity may be affected by the side-effects of their treatment. Any form of swallowing disorders may cause aspiration pneumonia among the terminally ill. Dental professionals must implement proper and regular oral care for patients who are under palliative care. Terminally-ill patients should have regular health monitoring for both patients who exhibit oral distress. Oral care for dying adults prevents common oral hygiene problems such as periodontitis and tooth loss. It reduces tooth loss, halitosis, and caries development that may compromise the patient’s self-esteem. Venkatasalu et al. (2020) note that palliative care patients usually lose their ability to express their suffering and, therefore, may lead to underreporting of their oral health challenges and problems. Venkatasalu et al. (2020) also note that Xerostomia, oral candidiasis, and dysphagia are common oral conditions that affect patients undergoing palliative care. As a best practice, palliative patients should have an early diagnosis of their oral conditions to minimize the effects of pain and suffering that comes with it. This paper presents a teaching plan for Joe, an 84-year-old patient who has pancreatic cancer and is experiencing Xerostomia. The paper presents intervention measures, diagnosis, and an education plan for the patient.

Xerostomia among Cancer Patients

Cancer patients experience diverse side effects from their treatments. Radiotherapy and chemotherapy are common causes of Xerostomia among cancer patients. Furthers, prescriptions given to cancer patients may cause damage to the salivary gland and cause side effects of cancer treatment. Cancer patients, therefore, must seek remedy to the condition to stay hydrated (Nakajima, 2017). There are several ways to manage dry mouth. The patient may apply water frequently, always after 2 hours during the day and after waking up. Saliva substitutes and lip moisturizers are possible remedies for the condition.

The Case of Joe

The client, Mr. Joe, is a terminally-ill pancreatic cancer patient aged 85 years suffers from Xerostomia. He has a dry mouth and suffers from oral candidiasis. He also experiences stomatitis. Improving the dry mouth condition is an important intervention to managing the problems of stomatitis and oral candidiasis that affects Joe. In regular care, it is important to address the problem of dry mouth through standard oral care. Oral cavity screening would be similarly important to address Joe’s problems. Another intervention measure would be hydration therapy when Joe complains of thirst. The common cause of thirst is the drugs, and it can be resolved through hydration therapy. Oral care is also important to improve in improving oral cavity conditions. Joe does not know how to apply saliva substitutes. The saliva substitutes are effective in helping Joe keep his mouth hydrated. It would help Joe to swallow food and reduce the pain that can potentially occur in the throat. It is important to encourage Joe to consistently use the saliva substitute to avoid a dry mouth’s side effects. Saliva substitute would improve Joe’s oral hygiene and potentially help him reduce the effects of having a dry throat while speaking.

Intervention Session, Assessment, Diagnosis, and Planning

The patient teaching and education intervention session will involve explaining to Joe how to apply saliva substitute to the mouth without swallowing. It will be a 30 minutes intervention session with Joe and the patient. The patient suffers from Xerostomia, a condition that occurs when the salivary glands cannot produce sufficient saliva to ensure the mouth remains moist. The patient, therefore, lacks saliva for chewing, talking and taking in food through the esophagus. Joe has a dry feeling in the mouth, which feels sticky. He experiences pain in the tongue, which is dry and tough, and mouth. He has cracks in the lips and experiences difficulty talking. Further, he has mouth sores and infections that include thrush. Joe’s chemotherapy and the radiation therapy sessions he has undergone have affected his salivary glands. Besides, most of the medicines that Joe uses compromise the production of saliva from the glands. As a strategy to address the condition, Joe should use saliva substitutes. Several saliva substitutes are available for use.

The Scenario and Elements of Basic Learning

The patient education session occurs in a palliative care facility, which serves as the learning environment. The palliative care facility is the ideal learning environment because it has equipment applied to relieve the patient of pain and improve their quality of life. Although Joe is aged 84 years, he has the physical capacity to learn the stages of applying saliva substitute. He has the intellectual ability to learn how to apply the saliva substitute. He is not frail and, therefore, can apply the saliva substitute without extra assistance from a care giver.

Demonstration and return demonstration is the preferred learning style in Joe’s case. Saliva substitute should not be swallowed, and, therefore, Joe should keenly apply it. The demonstration is effective to show Joe how to apply a small volume of the substitute in the mouth. Joe’s feels uneasy having a dry mouth and is, therefore, motivated to learn how to apply the saliva substitute. He understands that the saliva substitute is important to enable him to maintain the desired saliva balance. Because of his motivation, he will undergo the training session. The necessary resources for learning in Joe’s case include the saliva substitute. A written instruction manual and the substitute’s direction for use are critical learning resources for Joe. Joe will understand the directions and follow through with the steps outlined in the label.

Teaching plan for Joe
Purpose: To provide patient with information necessary to address dry mouth problems (xerostomia).
Goal: The patient will be able to apply saliva substitutes to address dry mouth problems (xerostomia).
Learning Outcomes Content Outline Method of Instruction Time Allotted Resources Method of Evaluation
After a 30 min. session, the patient should be able to do the following
Demonstrate, in steps, the stages of applying a saliva substitute List the stages
Description of various items required
List the stages
Description of various items required
Instruction 5 minutes Description of the saliva substitute’s use Post-testing
• Verbal
• Written
• other
In the presence of the nurse, accurately open the saliva substitute package and demonstrate it application. Procedure for applying the saliva substitute to the mouth Demonstration and return demonstration 15 minutes The saliva substitute Observation of return demonstration.
Express to the nurse the challenges when applying the saliva substitute Discuss and explore the patient’s challenges. Discussion 10 minutes Video of patient explaining the challenges Question and Answer

References

Nakajima, N. (2017). Characteristics of oral problems and effects of oral care in terminally ill patients with cancer. American Journal of Hospice and Palliative Medicine, 34(5), 430-434. Web.

Venkatasalu, M. R., Murang, Z. R., Ramasamy, D., & Dhaliwal, J. S. (2020). Oral health problems among palliative and terminally ill patients: an integrated systematic review. BMC Oral Health, 20(1), 79. Web.

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