assessment finding help- tongue appearance.

  1. 0
    Hi, I had a clinical the other day, and I noticed something strange when I was viewing my pt's mouth. I had never seen it before, although I have seen the tongue characteristic of anemia. This pt's oral mucosa was bright pink (very strange coloration). His tongue had longitudinal grooves in it (fissures) and his tongue was bubble-gum pink... almost like a hot pink. I know that findings associated with anemia and dehydration are often fissured, smooth tongue that is dark "beefy" red in coloration. Is it always beefy red, though? Futhermroe, Is there another condition in which the pt's mouth will appear bright pink with a fissured tongue? His tongue was not coated. The whole tongue was bubble-gum pink. The texture of his tongue reminded me of a piece of wood, and I could not see any taste buds. His lips and gingivae were the same way. I couldn't really evaluate his conjunctiva because he has open angle glaucoma and his conjunctiva and sclera were extremely dry and reddened. I had not given him his drops yet.

    Thank you for reading my question and attempting to help me!
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  3. 5 Comments so far...

  4. 0
    The literature describes several shades (Google "magenta tongue anemia") for the tongues of patients with anemia and nutritional deficiencies.

    Fissured tongue is likely to just throw you off, as that's a common, inherited normal variant.

    http://emedicine.medscape.com/article/1078536-overview

    Anything else that stands out about the patient's assessment or history?
  5. 0
    Well, He was admitted for dehydration and was later Dx'd with stage II chronic renal failure. I know that the side effects of several of the medications that he is on is anemia, and he is receiving a multivitamin because he is so malnourished. I also know that his RBC was low, his RDW was high, his absolute lymphocyte count was low, his MCHC was low, and his H&H was low. Yeah, I guess I could describe the inside of his mouth as magenta colored. The past few times that he has beeen to the hospital, he was admitted for dehydration or hypotension, but he has a Hx of HTN and takes medicine for it. He also has a Hx of colon cancer, but I feel like he is malnourished and dehydrated because he is not eating enough and drinking enough.

    Thank you for helping me!!
  6. 0
    Quote from RNstudentc/o2010
    Well, He was admitted for dehydration and was later Dx'd with stage II chronic renal failure. I know that the side effects of several of the medications that he is on is anemia, and he is receiving a multivitamin because he is so malnourished. I also know that his RBC was low, his RDW was high, his absolute lymphocyte count was low, his MCHC was low, and his H&H was low. Yeah, I guess I could describe the inside of his mouth as magenta colored. The past few times that he has beeen to the hospital, he was admitted for dehydration or hypotension, but he has a Hx of HTN and takes medicine for it. He also has a Hx of colon cancer, but I feel like he is malnourished and dehydrated because he is not eating enough and drinking enough.

    Thank you for helping me!!
    an elevated RDW can point to a bleed.
  7. 0
    Oh yeah... I totally forgot that the RDW points to internal bleeding. That's strange, I don't know what could be causing this value. Do you think that it may be r/t malnutrition and dehydration? he was ordered 10mL NS q24h, do you think that he was ordered the 10mL NS to aid in improvement of his hydration status?

    Thank you!
  8. 0
    it is not our job to diagnose the medical diseases or conditions that the patient has. this is impaired oral mucous membrane related to [the cause(s) of this nursing problem] as evidenced by bright pink oral mucosa and fissures in the tongue. your feelings are irrelevant unless they are based on your rational critical thinking as to how it has happened. you can see more about the definition, related factors and the signs and symptoms (defining characteristics) of this nursing diagnosis on this web page: impaired oral mucous membrane

    i have read several of your posts about this case. you really need to read about renal failure, dehydration and hypertension before you start jumping to any conclusions about this patient's symptoms.

    a nurses assessment of a patient when doing a plan of care consists of:
    • doing a health history (review of systems)
    • performing a physical exam
    • assessing their adls (at minimum: bathing, dressing, mobility, eating, toileting, and grooming)
    • reviewing the pathophysiology, signs and symptoms and complications of their medical conditions
    • reviewing the signs, symptoms and side effects of the medications/treatments that have been ordered and that the patient is taking


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