Pateint Comfort - Lecture Notes

Patient comfort What You'll Learn After you finish this lesson, you will be able to: ● Describe the benefits of proper oral hygiene. ● Cite safety precautions that should be observed while administering oral care. ● Demonstrate daily oral care. Oral Care Oral care includes care of a patient's mouth and teeth. Oral care can also be called oral hygiene. Proper oral care can: ● Stimulate the appetite ● Provide comfort In addition, proper oral care can help prevent: ● Disease ● Tooth decay, caries ● Bad breath, halitosis Routine Oral Care Routine oral care should be done at least three times a day for most patients. Patients should be encouraged to do as much of their own oral care as possible. Some patients require oral care more often, at least every two hours. These patients include those that are: ● Unconscious ● Vomiting ● Dehydrated ● Have high temperature ● Mouth-breathing ● Tube-fed ● On oxygen ● On certain medications ● Dying Oral Care Precautions When performing oral care, assistants must follow all standard precautions. In addition, assistants should be aware of their agency's policy for other precautions, which may include: ● Wearing personal protective equipment, including a mask, face shield, and a gown, in addition to gloves. ● Covering and storing patient toothbrushes away from other items, such as hairbrushes. ● Observing details such as pain, bleeding, excess saliva, swelling, or signs of infection in the mouth. ● Giving special attention to any swelling of the tongue, which can block a patient's airway. Procedure for Oral Care Individual agencies may have specific procedures that their employees must follow. The following process is an example of an oral care procedure that might be found at any agency. Gather materials: 1. Cleanse your hands. 2. Assemble the equipment for the procedure. You will need: ○ Disposable gloves ○ Emesis basin ○ Toothbrush ○ Toothpaste ○ Cup of cool water ○ Mouthwash with cup ○ Face towel ○ Bed protector ○ Plastic bag or plastic-lined trash can Procedure for Oral Care (continued) Greet the patient: 1. Knock on the door before entering the room. 2. Address the patient by name and introduce yourself. 3. Identify the patient by checking the identification bracelet. 4. Explain the procedure to the patient. 5. Provide the patient with privacy. Procedure for Oral Care (continued) Prepare for the procedure: 1. Put on gloves. 2. If there is a chance of spraying or splashing of oral fluids, put on a face mask and eye protection according to agency policy and standard precautions. 3. Cover the overbed table with a protector and put the equipment on the table. 4. If permitted, elevate the head of the bed. Before beginning, verify with the nurse that the patient can tolerate this position. 5. If needed, help the patient into a comfortable position. 6. Raise the bed to a comfortable working height. 7. Lower the side rail on your side of the bed. 8. Position the overbed table in easy reach. If the patient will brush the teeth, position the overbed table across the patient's lap. 9. Place towels across the patient's chest, under the chin, and around the shoulders. Procedure for Oral Care (continued) Brush the patient's teeth and rinse the mouth: 1. Pour water over the toothbrush and put toothpaste on the brush. Ask the patient how much toothpaste to use. 2. If possible, allow the patient to brush teeth. 3. If the patient is not able to brush teeth: ○ Gently insert the toothbrush into the patient's mouth. ○ Starting at the back, upper teeth, turn the brush so the bristles are slightly angled towards the gums. ○ ○ Using a back-and-forth motion and tooth-wide strokes, brush all tooth surfaces. Using the end of the brush and gentle up-and-down strokes, clean the inner ○ surfaces of the front teeth. Brush the front of the tongue gently, if the patient can tolerate it. Avoid brushing the back of the tongue, which can cause the patient to gag and cough. 4. Give the patient a cup of water to rinse. Use a straw if necessary. 5. Hold the emesis basin under the patient's chin and ask the patient to expel. 6. Repeat rinsing as needed. Procedure for Oral Care (continued) Offer mouthwash and clean up: 1. If permitted, offer mouthwash to the patient. 2. Hold the emesis basin under the patient's chin and ask the patient to expel. 3. Wipe the patient's mouth and chin with a tissue. Discard the tissue in the plastic bag or trash can. 4. Remove the towels from the patient's chest and shoulders. 5. Rinse the toothbrush with water. 6. When the patient is finished, return the overbed table to the foot of the bed. 7. Remove and discard gloves and other personal protective equipment according to facility guidelines. Procedure for Oral Care (continued) Complete the procedure: 1. 2. 3. 4. 5. Lower the bed. Position the side rails according to instructions. Check that the patient is comfortable and safe. Place the call signal within the patient's reach. Gather, clean, and store the equipment. Place soiled linen in the proper receptacle. 6. Cleanse your hands. 7. Report all actions taken and any observations. Lesson Summary In this lesson, you learned how to perform daily oral care for patients. In this lesson, you learned that: ● Proper oral hygiene can help prevent tooth decay and other diseases. ● Assistants should watch for signs of bleeding, swelling, pain, and infection while providing oral care. What You'll Learn After you finish this lesson, you will be able to demonstrate a proper technique for special oral care. Special Oral Care Special oral care is given to unconscious, semiconscious, or helpless patients. These patients typically breathe through their mouths. Special supplies and techniques are used to make sure all areas of the mouth get clean. Procedure for Special Oral Care Individual agencies may have specific procedures that their employees must follow. The following process is an example of a special oral care procedure that might be found at any agency. Gather materials: 1. Cleanse your hands. 2. Assemble the equipment for the procedure. You will need: ○ Disposable gloves ○ Toothettes® or prepared swabs ○ Tissues ○ Emesis basin ○ Cotton-tipped applicator sticks ○ Water-soluble lubricant for lips ○ Face towel or bed protector ○ Plastic bag or plastic-lined trash can Procedure for Special Oral Care (continued) Greet the patient: 1. Knock on the door before entering the room. 2. Address the patient by name and introduce yourself. 3. Identify the patient by checking the identification bracelet. 4. Explain the procedure to the patient. 5. Provide the patient with privacy. Procedure for Special Oral Care (continued) Wash the patient's mouth: 1. Put on gloves. 2. If there is a chance of spraying or splashing of oral fluids, put on a face mask and eye protection according to agency policy and standard precautions. Elevate the head of the bed. Raise the bed to a comfortable working height. Lower the side rail on your side of the bed. Place a towel or bed protector under the patient's head. Gently turn the patient's head toward you. Open the package of prepared swabs. Use the swabs to gently clean the patient's mouth, including the gums, teeth, roof of the mouth, and tongue. 10. Use as many swabs as needed until the mouth is clean. Dispose each used swab in the 3. 4. 5. 6. 7. 8. 9. plastic bag. Procedure for Special Oral Care (continued) Rinse and lubricate the patient's mouth: 1. Rinse the patient's mouth using clean, cotton-tipped applicator sticks dipped in water. Never give any fluids to unconscious or semiconscious patients. 2. Dry the outside of the mouth and chin with a towel. 3. Use cotton-tipped applicator sticks to apply water-soluble lubricant to the lips and tongue to keep them soft and hydrated. Procedure for Special Oral Care (continued) Clean up materials: 1. Lower the bed. 2. 3. 4. 5. Position the side rails according to instructions. Check that the patient is comfortable and safe. Gather, clean, and store the equipment. Place soiled linen in the proper receptacle. Remove and discard gloves and other personal protective equipment according to facility guidelines. 6. Place the call signal within the patient's reach. 7. Cleanse your hands. 8. Report all actions taken and any observations. Regular Oral Care Use toothpaste Help the patient only if needed Use mouthwash, if permitted Use a toothbrush Both Elevate the head of the bed Wear personal protective equipment Special Oral Care Always perform all tasks for the patient Apply water-soluble lubricant Use swabs to clean the mouth Lesson Summary In this lesson, you learned how to provide special oral care. 00:03 00:00 00:05 What You'll Learn After you finish this lesson, you will be able to: ● Define dentures. ● Provide proper denture care. Dentures Dentures are removable, artificial teeth. Assistants help patients clean and care for their dentures. Dentures are fragile and must be handled very carefully. Assistants should look for damage and check the fit in the patient's mouth. If damage or a loose fit is observed, the assistant should report it immediately. Getting dentures fixed or fitted might require a visit to a dentist. Patients may also have partial plates, which are similar to dentures. Partials have small metal clips that hold them in place. In addition, assistants must use care in dealing with the patients themselves that have dentures. Some patients are sensitive or embarrassed about having them. Procedure for Denture Care Individual agencies may have specific procedures that their employees must follow. The following process is an example of a denture care procedure that might be found at any agency. Gather materials: 1. Cleanse your hands. 2. Assemble the equipment for the procedure. You will need: ○ Disposable gloves ○ Tissues ○ Emesis basin ○ Tongue depressor ○ Denture brush or toothbrush ○ Toothpaste or tooth powder ○ Mouthwash, if permitted ○ Gauze squares ○ Applicators ○ Cleansing tablet ○ Paper towels or washcloth ○ Denture cup Procedure for Denture Care (continued) Greet the patient: 1. Knock on the door before entering the room. 2. Address the patient by name and introduce yourself. 3. Identify the patient by checking the identification bracelet. 4. Explain the procedure to the patient. 5. Provide the patient with privacy. 00:03 00:00 00:04 Procedure for Denture Care (continued) Remove and soak dentures: 1. Put on gloves. 2. Line the denture cup with gauze squares. 3. If able, allow the patient to clean the dentures. If unable, ask the patient to remove dentures using a gauze square. If the patient needs help: ○ Remove upper dentures by grasping them firmly and easing down and forward out of the mouth. ○ Remove lower dentures by grasping them firmly and easing up and forward out of the mouth. 4. Gently place the dentures in the denture cup lined with gauze and take them to the bathroom. 5. Put a paper towel or washcloth in the sink to protect the dentures in case you drop them. 6. If instructed, soak the dentures. ○ Remove gauze from the denture cup. ○ Fill the denture cup with cool water. ○ Place a cleansing tablet in the denture cup. ○ Soak the dentures for the correct amount of time. Follow the cleansing tablet manufacturer's instructions Procedure for Denture Care (continued) Clean dentures: 1. Add toothpaste or powder to the toothbrush. 2. Holding the dentures carefully in the palm of one hand and under a stream of cool or lukewarm water, brush all surfaces clean. 3. Rinse the dentures with cool, clean water. Do not use hot or very cold water on dentures. Extreme temperatures can break them. 4. Rinse the denture cup. 5. Line the denture cup with clean gauze squares and add cool water. Add enough water to soak the dentures. 6. Place the dentures in the denture cup and return to the patient. 00:02 00:00 00:04 Procedure for Denture Care (continued) Provide oral care to the patient: 1. Lower the side rail on your side of the bed. 2. Help the patient rinse the mouth with cool water. Provide the emesis basin and tissues to the patient. Place the used tissues in the plastic bag. 3. If permitted and the patient wants to, help the patient rinse the mouth with mouthwash. 4. If permitted and the patient wants to, help the patient clean the gums with applicators moistened with mouthwash or foam "toothettes." Gently hold the mouth open with the tongue depressor. 5. Carefully observe and report the condition of the teeth, mouth, tongue, and lips. Procedure for Denture Care (continued) Restore dentures to the patient: 1. Using tissue or gauze, hand the wet dentures to the patient, or insert them if necessary. If the patient uses denture adhesive, apply it to the palates of the dentures first. 2. Check the fit of the dentures. They should fit securely in the patient's mouth. Changes in bones and gums can change the shape of the mouth. These changes can result in loose dentures. Loose dentures are a choking hazard and can cause sores in the mouth. Denture adhesives can help temporarily, but patient should see a dentist. Be sure to report loose or ill-fitting dentures.