Mouth sores caused by Roxinol

Mommy&RN, BSN, RN · Mar 24, 2015

Oral mets?

ShesanRN · Mar 24, 2015

Can you tell us more about what the sore looks like? I've not yet seen that caused by Roxanol, either.

caroladybelle, BSN, RN · Mar 24, 2015

We cannot give medical advice but....

However, in 23 years of mostly oncology experience with some AIDS/ infectious disease nursing experience. I have never seen roxanol cause mouth sores in and of itself.

Has the pt had chemotherapy and/or radiation in the last 4-8 weeks? Is their nutritional status good? Are they taking in frequent fluids, they eating PO, or have a tube feed? And are they doing judicious and frequent mouthcare? What is the primary tumor/form of cancer? Is the pt immunosupressed and/or on any antimicrobial prophylaxis.

Many traditional chemo therapies have the potential for causing mucositis, or mouth sores and nursing generally puts the patient on frequent mouth rinses with saline or buffered saline. We also encourage frequent fluid sips/ice chips if not contraindicated. Keeping the oral mucosa clean and moist helps prevent these issues. Many drugs used also cause dry mouth. Radiation can often cause dry mouth, impaired GI mucosa, and impairment/damage of the glands that secrete saliva.

If they pt is not eating (PO, not tube feed) well, saliva is not as mobilized. And if nutrition is poor, GI mucosal cells which have rapid cellular turnover, cannot be replaced as well. While tube feeds help with the nutritional status, since it bypasses the mouth, saliva is not produced as much and mouth is not kept as moist.

All of these things contribute to development of mouth sores and mucositis.

During chemo, some oncologists (but not all) put the pt on antimicrobial prophylaxis to prevent them from becoming infected from their own flora that may "flare" up if the WBCs are too low and unable to control them. Whether this is done depends on the type chemo/rad and expected level of immunocompromise. And if the pt has had any infections, they may have gotten antibiotics that killed off some good flora, allowing overgrowth of bad flora.

Thus, there are many possible causes in the details that were provided.

And a question arises also, why they keep putting the roxanol in the same place? It probably is not helping the situation.

Y'all need to talk to the med team to determine cause, and correct for the cause. There are many things that be done, for mouth sores but the probable cause needs to be determined for proper intervention.

CoffeeRTC, BSN, RN · Mar 24, 2015

Thanks. Yep. Not really looking for medical advice and I took much of the above into consideration. No chemo, radiation to the spine, poor po intake and only mouth care done is by the family. Facility nurse was instant it was the Roxinol. I've never seen it alone cause the sores. I only have 20 yes in ltc with palliative care experience. Just wondering if I missed something. I'm thankful that he is leaving to come home on hospice.

ktwlpn, LPN · Mar 29, 2015

As a palliative care nurse in LTC who has been struggling to integrate palliative and hospice care within the facility I am really saddened to say I agree.It's been two years and I still have major issues with various staff members who just don't "get it".....Take your loved one home.And no,I have never seen Roanoke cause a sore,maybe a nurse nicked the spot ?

makeitwork, BSN, RN · Apr 7, 2015

He's not getting it but maybe 4-6 times a day.

May I add that with 4-6 administrations of short-acting pain medicine you may want to considered a long-acting analgesic? By getting in front of the pain you can reduce the Roxanol administrations and, if related, reduce the mouth sores (along with making your patient more comfortable).