Refusing oral care!

maryshome8 · Aug 24, 2006

Just out of curiosity....is this a new behavior the resident is experiencing or did they always refuse oral care?

If it's new...time for a Psychological evaluation...I'll give you a good example.

My mother, who was the retired Director of Nursing at a hospital where I live...she was in renal failure...she suddenly became very obsessed with cleaning her ears...first with q-tips and then she only used bobby pins (which does a better job anyway, and this was not a new thing)...but she would sit for an hour, sometimes two..and it was awhile before any of us realized she was doing this for extended periods of time.

She has a zero history of mental illness.

She kept insisting "something" was in her ear...My father finally took her to the doctor...who referred her to a psychiatrist because she told the doctor that there was a minature conveyer in her ear and wanted to know if "they" could stop running it because it was irritating to her. When my father asked her point blank, "Kathleen, now you DO REALIZE that there cannot possibly be a conveyer system in your ear?"

Her answer: "Of course I do!"....and then my father about fainted at her next answer: "It's a minature one".

She died 3 months later. We feel that this was the beginning of dementia that was directly related to her renal failure.

Now that I have bored you with that story...has anyone asked the resident? There has to be a reason...are they taking any medications that may cause excessive dry mouth? Are the gums so sore that they are extremely painful and that is why the oral care is being refused? Has anyone else hurt the resident in the process? Does the resident UNDERSTAND (mentally) what is being done?

ktwlpn, LPN · Aug 24, 2006

I have an odd question... has anyone had difficulty with doing oral cares with residents who refuse to have them done? What have you done for this, what have you tried? Any suggestions would be appreciated.
I have a resident that refuses to have oral cares done. We were cited for it on our state survey. We have tried just about everything and all this person does is scream and hold our hands to keep them away from their mouth and clamps their mouth shut so tight that you can't budge it...
Any ideas would be appreciated!

Has this person been examined by a dentist (possibly while medicated?) If that has been done and pain has been ruled out you can try some of the methods that have worked for me. But-when dealing with dementia nothing always works for everyone and we do have residents that only ever allow mouth care with swabs and that is care planned.I have had success with helping the resident hold the brush themselves and then moving their hand for them.Only use a pea -sized amount of toothpaste and if you can get something with a really mild taste that may help.Use tepid water.Don't run the water hard and loudly in the sink while attempting the care...Keep calm-talk quietly.Give simple instructions.Sit facing them (at eye level) Try giving your resident a couple of warm damp wash clothes to hold. You may be able to get in there using 2 soft toothbrushes.One to open the lips and teeth and the other to actually brush the teeth. We are lucky to have a dentist now that comes to our LTC-we use alot of oral rinses on the residents that are really un-co-operative.She has also taught us some useful techniques and she seems to be able to get the most difficult residents to open up....If everything else fails try standing behind the resident with them sitting up in a chair.....Good luck

meownsmile, BSN, RN · Aug 24, 2006

I agree, ruling out dental problems first is important. If a patient still has their own teeth, they more likely havent neglected them through their youth and adulthood. If the dentist says there isnt a problem and there are no canker sores on the gums etc, then it may well be the patient has been traumatized by someone who forced the issue and is now just refusing totally to have anyone do oral care. Will or is the patient able to brush themselves? Even chewing on a toothbrush is better than nothing.

mickeypat · Aug 24, 2006

This resident has had a stroke, has to be fed all their meals and has a feeding tube. They open their mouth to eat, but won't to do oral cares. Wase stated today that a comment was made that their mouth hurt, but has no teeth or dentures. Is alert enough to know what they like and don't like, and to be able to refuse, but can not actually say that they refuse it.

We have tried to have a different person go in at attempt. When this person doesn't want something done, you can hear them at the other end of the facility! It's just really frustrating!

Quailfeathers · Aug 24, 2006

Perhaps the resident is feeling overhelmed by all the losses experienced. Can you explain and leave some pink tooth sponges so the resident can do it themselves? I have found in home health duty that by acknowledging the losses they're experiencing will bridge the gap, enough so you can find out what's happening and then address the oral care needs.

IcantThinkofaName · Aug 28, 2006

Go for a pysch Consult..from the pysch consult go from there. is the patient competent enough to understand why she needs oral care? etc. etc. then idt meeting..have the patient sign that they understand the consequences of not having oral care...monitor it in your MAR etc...but yeah go for that Psych Consult asap.

mickeypat · Aug 28, 2006

Would be interesting to do a psych consult with her... problem is, is that she is unable to talk, she makes noises and that's about it... Not real sure how a dental exam would go....it's just really tough!

all4schwa · Aug 28, 2006

if they are dentures, get them while the resident is asleep. (may be wrong, but from personal experience, sometimes that is the only time they get brushed. and you have to know how to effectively pop them out before you go in after them)

One Flew Over · Jul 14, 2008

Are they alert/able to make their own decisions?

If not. For those tough ones (mostly dementia patients), I use a little bit of toothpaste, just enough to lather up and brush as much as I can, holding the lips open. Then I go in with a couple of toothettes wet with water and a little bit of mouthwash, and swab off the paste. If go in the sides a little, they might open their mouths and let you get the tongue too. At least it's better than nothing.

Also, it might be best to do that first thing in the morning, before any washing or anything. That way, they may be still a little sleepy.

CapeCodMermaid, RN · Jul 15, 2008

First of all if it has been care planned and documented that this woman flat out refuses care, you shouldn't have been cited.

Second-when I was a brand new nurse on my first job in a SNF, the older nurses sent me down the hall to deal with the "Mean Cranky Rotten OLD woman' who lived in the last room. They told me she was mean and demented and would try to bite and hit anyone who tried to do mouth care. I went down to introduce myself....she didn't seem mean but was a bit demented. I looked in her chart and there it was....a diagnosis of Tic Doloreaux...it's an inflammation of one of the cranial nerves which can make even a puff of air feel like hot pokers going into your skin. I mentioned it to the charge nurse and she sarcastically said in a voice loud enough to be heard on the whole unit "Oh my aren't you smart for a new graduate." :nono: So I explained what the disease was and she said no one had ever heard of it and again said 'You think you're so smart and you've only been a nurse a few days' :nurse:I might have been the tiniest bit fresh :saint:when I replied "Yes I am smart since I graduated at the top of my class and even a new grad would know to look something up if they didn't know what it was."

So my long winded point....investigate the source of the pain before writing the patient off as demented and non-compliant.

hippylady7211 · Jul 21, 2008

Don't know if this will help but. . .

Will this person gargle or rinse their mouth out? If so start off with this, and get a dental and psych consult.

I read not to long ago that dental care did not really start until about World War II so maybe your little person has not done a lot of oral care in the past.