Evidence Based Practice
Oral Care in palliative patient.
The oral health is very important for every patient. Patient with cancer treatments, palliative patients, head and neck cancer patient and elderly patients are high risk for oral complications. The oral cavity is the first area of discomfort and loss of function when patient received chemotherapy and radiation therapy especially head and neck cancer patient. Frail Elderly patient who can’t maintain their oral hygiene are the high risk for the oral health problem. Poor oral hygiene could effect patient’ wellbeing, nutrition and quality of life. Every health institution implements protocols for oral care and nurses are doing very important role in rendering this care for the patients. Oral care and education are given to patents and family not only during hospital but also when patient discharge and outpatient setting.
Common oral complications in palliative patients
Complication associated with chemotherapy
Chemo medications damaged the not only cancer cell but also the normal cell. These drugs can caused oral complication including oral mucositis, pain, infection, hamorrahage, xerostomia ( wong, 2014). The oral infection caused by Chemotherapy is 20 -50% of total infection (Wong, 2014). Fungal infection in oral cavity also can occur several forms such as erythmerous candidiasis and pseudomembranous candidiasis (Wong, 2015). Intra oral bleeding also associated with chemotherapy.
Complication associated with radiotherapy
The complication from head and neck radiotherapy are categorized into acute and chronic types. The acute effect will develop early period of treatment and 2-3 week after compleciton of the treatment and the chronic effect will develop weeks to years. Herrstted (2000) mentioned that 90-100% of patient with head and neck radiation therapy will always develop oral complications of xerostomia, mucositis, dysphagia and odynophagia. Nurses play a vital role in providing oral care for patient with head and neck cancer.
Complication associated with oral cancer
Providing evidence based oral care
Oral hygiene is very important for patient with cancer. Lack of adherence to oral hygiene could cause serious complication such as sepsis, cachexia and delayed of treatment and effect patient’s wellbeing (Miller ; Kearney, 2001). The incident of oral complication in patient without head and neck cancer can be reduced by providing an aggressive oral care before treatment (Miller ; Kearney, 2001). Primary prevention measure such as well-balanced diet, adequate oral care, early detection of oral complication are very important in pre-treatment intervention.
Hunt (1987) mentioned that barrier to appropriate oral care by the nurses are lack of knowledge, understanding, belief, inability to convey knowledge from theory to practice and not willingness to change practice. On the other hand, inability to implement best oral care guideline, protocol, nurses negative attitude toward oral hygiene are the main reason for inadequate oral care (Miller ; Kearney, 2001).
The recommendation of best oral care delivery is oral care assessment, equipment required to provide oral hygiene, frequency of oral care, oral care products and saliva substitutes and stimulants (Miller ; Kearney, 2001).
Oral hygiene products
Parde, et. al (2001) found that head and neck radiation therapy side effect of xerostomia was improved when patient used biotene mouth wash, toothpaste, chewing gum and oral balance gel. After two month of treatment, 15 patients 54% reported an improvement in oral dryness, 10 patients (36%) got major improvement and ability to eat normally, 61% of patient reported improvement in oral discomfort and 43% had improvement in symptoms. Therefore, the result of study suggested that biotene improve symptom of radiation induced xerostomia.
HAP Lanolin has anti-inflammatory, antimicrobial and moisturizing properties. HAP Lanolin was applied for chemo patients when patient started chemotherapy. After two week of treatment, 60% of patient still developed mucositis, pain, limitation of mouth opening even applied lanolin (Santos, et al. (2013). However, the dryness of lip and dehydration due to chemo side effect was significantly reduced therefor using Linolin can prevent lip erosion and ulcers (Santos, et al. (2013).
0.2% Chlorhexidine mouth wash ; 1% povidone-iodine mouthwash
Chlorhexidine is antifungal and has antiplaque properties. Bhavanishankar, Bagi,; Madhale (2016) mentioned in their study that experimental and control group patients were advised to rise their mouth with 15 ml of 1% povidone-iodine and Chlorhexidine mouthwash respectively for 30 min and 15 min before radiation therapy, after 15 min and 4 hr after radiation therapy. The result show that both mouthwashes help to reduce, and control radiation induce mucositis but 0.2% chlorhexidine is more efficient.