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.
02:50
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.
03:21
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.
04:49
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.
05:06
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.
07:03
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.
07:48
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.
07:58
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.