Mouth care for dying patient

[nettie01]

lucida sans unicode3sienna

hello, i'm jeanette from new zealand and i've joined allnurses.com because i have some questions and also because i'm sure i'll learn some interesting things here.

i work on a general medical ward and we sometimes have people who are dying. i've had the experience a few times of starting my shift and finding the dying patient with a mouth thickly coated with dried secretions. i think some nurses are reluctant to be too invasive but i get my gloves on, get a hot/warm flannel and try to clean everything up. i believe the most important reason is that the dried secretions can become quite a lump and then an airway risk. (i've seen a person choke on material from their own mouth). these people are usually nil by mouth and mouth-breathing - especially when they become unconscious. i find a lot of nurses use big swabs to do mouth care but i think they are too soft for removing debris, although they are good for moistening the person's mouth.

recently i was cleaning a person's mouth and i was using tweezers to remove the layers (perhaps this is not recommended) and i unfortunately pulled on mucosa at one point and caused bleeding - this memory is still with me after several days.

should i have just left the man's mouth alone? after all, he was unconcscious - did his coated mouth bother him? i also made the previous nurses look bad because it seemed (to the man's son, who was watching me) that they hadn't been doing their job.

what do the experts think? (palliative care nurses and anyone who's looked after dying people).

any tips about better methods and good solutions to use would be appreciated.

i've been honest, hope that you're not too shocked.

thanks for reading my note.

jeanette

[soapynurse@adel]

"I've had the experience a few times of starting my shift and finding the dying patient with a mouth thickly coated with dried secretions. "

Of course in hospice, this is a very common problem. We usually use toothettes (pink swabby sponges) maybe moistened with water or water with a little drizzle of mouthwash to make their mouth feel better and smell better. This works fine if carried out on a regular basis. We also encourage chapstick as the lips do get very dry. Again, think of what you would want done for yourself or family members.

Good luck.

Alice in VA

[nettie01]

"I've had the experience a few times of starting my shift and finding the dying patient with a mouth thickly coated with dried secretions. "

Of course in hospice, this is a very common problem. We usually use toothettes (pink swabby sponges) maybe moistened with water or water with a little drizzle of mouthwash to make their mouth feel better and smell better. This works fine if carried out on a regular basis. We also encourage chapstick as the lips do get very dry. Again, think of what you would want done for yourself or family members.

Good luck.

Alice in VA

Thank you for your suggestions.

[bellcollector]

In LTC I too have come across this problem frequently. I am absolutely anal about oral care. I cannot stand a dry mouth or lips so I believe it would be uncomfortable for anyone else. I don't think I would use tweezers though I do understand your thinking. What I would reccommend and have done myself is to use a warm wash cloth and sort of soak it to soften the hardened crusty stuff. It sometimes takes a little time but I would want it done for me. I also make it known to the aids and other shift nurses that I find this unacceptable. Generally I just put it on the report sheet to double check that oral care is being provided frequently. I always try to be professional about it as you catch more flys with honey than with vinegar. A lot of time if you explain to your aids why oral care is so important they are more compliant in performing it. My hat is off to you for caring about this issue.

[nettie01]

In LTC I too have come across this problem frequently. I am absolutely anal about oral care. I cannot stand a dry mouth or lips so I believe it would be uncomfortable for anyone else. :chuckle

Hi, thanks heaps for your comments they're really useful. I'm encouraged. I also feel that I'm anal about mouthcare! I'm trying to calm myself down. Good comment about flies and honey.

[studious]

I am also anal about oral care, this feels like an AA meeting. Education is invaluable though, I'm thinking about getting a portfolio together of all the things that can go wrong systemically if oral hygiene isn't being attended to. After four years of the nice approach, I'm feeling a little bit of "in your face style" coming on.

[nettie01]

I'm thinking about getting a portfolio together of all the things that can go wrong systemically if oral hygiene isn't being attended to.

This sounds good! I'll look forward to that. :) Thanks for your reply.

[PumpkinsMami]

I completely understand how you feel! I cannot stand to walk into a pt's room and see dry crust on their lips & tongue. It just seems to me that as the tongue cracks and bleeds, it would be painful! The sponge toothettes work well if used often. When a mouth is in such terrible shape, it should be done hourly to loosen the layers of dried skin. Once you're on top of it, it can be done PRN....which is usually every couple of hours or so. When I do mouth care, I always end it with applying a moisturizer on the lips!

I also hate to see pts eyes with dried mucous and they can't open their eyes! I'm anal about all of that too!!

Good luck!

[Gompers, BSN, RN]

I don't work in hospice, but I work in NICU and am also anal about mouthcare...I can't stand seeing crusty mouths, especially when they get so bad the tongue is stuck to the lips! :angryfire

If I have a patient with a very crusty mouth, I'll apply vaseline as liberally as I can (depends on if there is an ETT in the mouth or not). After an hour or two, the secretions are usually much softer and very easy to remove without disturbing the patient too much. I just use gauze moistened with plain water to gently exfoliate the area. In really bad cases, I have to repeat this procedure a couple of times. We don't use toothettes because our babies are small, but if I had a larger patient of course I'd use those too. Once the mouth is clean, I still use some vaseline on the lips because it's so easy to apply, and it helps stop the crusty mouth cycle!

[nettie01]

If I have a patient with a very crusty mouth, I'll apply vaseline as liberally as I can (depends on if there is an ETT in the mouth or not). After an hour or two, the secretions are usually much softer and very easy to remove without disturbing the patient too much. I!

Hello Gompers

Thank you very much. I'm unsure about one thing though: do you mean you put vaseline IN the mouth on the debris? I didn't know it was ok for inside (i.e. OK to be consumed)

Thanks

This site is so cool! I'm glad I joined.

Jeanette

[Gompers, BSN, RN]

I'm unsure about one thing though: do you mean you put vaseline IN the mouth on the debris? I didn't know it was ok for inside (i.e. OK to be consumed)

I just mean to put it on the lips, and tongue as well if that is very dry and stuck to the lips. I apply it with a gloved finger, with just enough vaseline to massage the dry area and get it nice and gooey. If a scant amount gets mixed with the saliva and swallowed, I really don't think it'd be a problem.

This is a great site, come back often!

[talaxandra]

If the patient isn't a biter, I sometimes wrap a piece of dampened gauze around a gloved finger and 'scrub' the tongue - taking care not to go too far back. I completely agree with other posters - once we anal-about-mouths nurses clean it up a little maintanance is all that's needed.

PS Welcome to the wonderful world of allnurses, fellow ANZAC