Oral Care for an Unconscious Patient (Nursing)

by Samantha Rhea, MSN, RN

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    00:00 Let's take a look at providing oral care to a debilitated or comatose client. So when we talk about this particular client, this client can't typically do activities of daily living like oral care for themselves, so we have to assist them. So let's take a look at some equipment we need; a towel or washcloth, an emesis basin, some mouthwash. Now, here's one thing to look at is a mouth moisturizer. This is really important because a lot of the times the patient's oral cavity can get dehydrated. You're also going to need a Yankauer for suctioning as well as your suctioning equipment. A penlight for visualization, a toothbrush, toothpaste, and also some water. Now before we get started, don't forget your hand hygiene and to put on your gloves. Now we want to explain the procedure to the client and provide our privacy.

    01:00 Always a good idea to raise the bed to an appropriate height for you and your client. Now this is a great time to take that penlight and assess the oropharyngeal cavity using the penlight. Now, this is really important because we need to take a look especially in the bedridden or comatose client and look at what we're dealing with in their oral cavity. There could be excess mucus, there could be ulcers in there, so we need to be conscious about this when we provide care. Now we want to make sure the suction equipment is on and functioning properly. Perform our hand hygiene again before we come in contact with our patient and put on our gloves. Now because we're providing oral care especially in a debilitated or comatose client, swallowing could be affected so we want to put them in a high Fowler's position. Place a towel over the client's chest so we can make sure we keep their gown clean and we want to use a Yankauer to suction out any excess secretions. Now again, if you remember, a debilitated or comatose client a lot of the times cognitively they are not able to take care of their secretions themselves so that's why suctioning is key. We can assess this again after we do our suctioning and then use our toothbrush and suction device to brush their teeth, their gums, and their tongue thoroughly. Now, we're going to use suction here because, of course, when you brush your teeth lots of excess secretions may occur so we want to make sure the patient doesn't aspirate and use a Yankauer. Now this is a great time to apply mouth moisturizer using a swab stick. Now this is particularly important because a lot of the times hydration and making sure the oral cavity is moist is really important in this client. Now after we've cleaned the patient's mouth and applied mouth moisturizer, we can reassess this cavity for cleanliness. Return the bed to the lowest position for safety and make sure your client is comfortable. Now we want to dispose of any trash, remove our gloves, and also perform our hand hygiene. And of course document our procedure. Let's take a look at providing oral care for the comatose or the debilitated client.

    03:16 Now the key differences here or many times when we provide oral care, we need to make sure that we're suctioning secretions because a lot of the time the patients isn't cognitively able to do that themselves. Also, moisturizing the patient's mouth is really key because again making sure those mucous membranes are moist are going to help with the patient's comfort and also reduce infection. So now let's go ahead and get started. So I've got my patient here in a high Fowler's position or 90 degrees. So especially if they can tolerate it and it's not contraindicated, we want to make sure the patient's head of the bed is up high. Next, I want to make sure I drape the patient so no excess water or toothpaste or anything gets on the patient's gown. So now that I'm here with the client, I also want to talk you through the equipment. Always a good idea to have an emesis basin which really this is just going to help if the patient can spit up for example or any extra catch for when we're brushing the patient's teeth. Also a great idea to have a cup for like mouthwash. Diluted mouthwash with a little bit of water is ideal. Sometimes mouthwash can be a little harsh so it's great idea to dilute that with some tap water. Next, we've got our toothbrush and toothpaste. The other key thing to note, we have our Yankauer or some people may say "yang kower" as well. So this is our oral suctioning device and this is key with a comatose or debilitated patient.

    04:45 Next, I've also got a mouth swab as well. These are really great to add mouth moisturizer and swab in the patient's mouth. So we also have our mouth swabs. Now there's going to be some variations on this so just check your agency. And don't forget your penlight as well.

    05:01 We're going to use this to assess the patient's oral cavity. So now we've just talked about our equipment, let's go ahead and prepare our patient. So now I've done my hand hygiene and I'm going to put on my gloves. So again, as you know, if the patient can tolerate it make sure the patient's in the highest position as possible. Also remember that even though the patient maybe comatose or debilitated, please make sure you still explain the procedure to the patient. Sometimes as nurses, we're not really quite aware of what the patient can hear and what they can't, but any time and any situation you have a comatose or debilitated patient we want to make sure we're still explaining the procedure, providing therapeutic communication for comfort for your client. Okay, so now that my patient's upright, again I have a drape over here just to catch anything to keep the patient's gown from getting dirty. So now this is a great time to assess their oropharyngeal cavity, and when I do this I just like to take my penlight and make sure I don't see any abnormal lesions or maybe some weird white patches from bacteria back there, but we want to check. So now we can take my penlight. So it's up to you, but some people may remove secretions first and then assess, but I like to take a look what's in there before I put the Yankauer which is our suction tubing down our patient's mouth to remove any excess secretions. Okay, so let's take a minute on this. This is what we call our Yankauer or you may hear the word yang hower, there may be a lot of variations on how this is explained, but this is for oral suctioning only. So this thing's pretty hard plastic and pretty rigid, but really helpful to remove any excess secretions out of the mouth. One key thing, please don't place this all the way back to the patient's throat.

    06:59 It really could gag them. So think about putting this and maybe the pockets of the cheeks in the mouth and the front, this is going to help remove any excess secretions, but please don't gag your patient with this. Okay, so we've assessed the oral cavity, we've removed any excess secretions, now we can help them with oral care. So, there are also alternatives for this. Some facilities have a toothbrush with suction. So make sure you check your agency and see what equipment you have. But for today, I'm using our toothbrush and our suction device. So, anytime that I assess my client, I want to make sure I'm cleaning their teeth, top, bottom, making sure we're checking the hard palate of their mouth and also their tongue.

    07:43 But again, as you can imagine just like it does for us, when we promote toothbrushing, excess secretions can happen so we want to have our Yankauer or our suction device close.

    07:54 As I'm toothbrushing, I'm also going to use my suction device as well. Again to note, just know some facilities have a toothbrush with a suction attached to it so that's really helpful to eliminate the use of both the toothbrush and the Yankauer. So just know that maybe available so you may want to check your facility. Now after this is done, mouth moisturizer is really important because many times with the debilitated or comatose client, they are not able to take anything by mouth. So a swab stick is a really great piece of equipment to use. So a swab stick is going to look like this. It's soft, it's spongy, there is nothing hard on here. So we can use our mouth moisturizer and apply it and then we can go inside the patient's mouth, go on to their cheeks, go on to the top of their mouth and all around to make sure we put the moisturizer in their mouth. And once that's done, we can dispose of the swab stick. Now at this point, we've moisturized their mouth and it's a great time to reassess the patient's oral cavity using our penlight.

    About the Lecture

    The lecture Oral Care for an Unconscious Patient (Nursing) by Samantha Rhea, MSN, RN is from the course Oral Hygiene for Bedridden Patients (Nursing).

    Included Quiz Questions

    1. Place the client in a high Fowler's position to prevent aspiration.
    2. Brush the client's teeth, gums, and tongue while removing excess debris.
    3. Assess the oropharyngeal cavity with a penlight.
    4. Place the client in the lateral position to prevent aspiration.
    5. Use a suction bulb to suction the oropharyngeal cavity.
    1. Keeping the client in high Fowler's position
    2. Using a Yankauer to suction excess secretions
    3. Ensure the suctioning equipment works before the procedure
    4. Instruct the client to cough
    5. Instruct the client to spit out excess secretions
    1. The Yankauer should not suction the back of the pharynx.
    2. The Yankauer is a soft and flexible tube.
    3. The Yankauer's purpose is to suction the larynx.
    4. The Yankauer can stay in the client's mouth continuously.
    1. Mouth moisturizer using a swab stick
    2. Water using a swab stick
    3. Mouth wash using a cup
    4. Lotion using the nurse's finger

    Author of lecture Oral Care for an Unconscious Patient (Nursing)

     Samantha Rhea, MSN, RN

    Samantha Rhea, MSN, RN

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