Mouth & Dental Care and Maintaining Oral Care

Written by Amanda R. McDaniel, MS, BSN, RN
Amanda is a BSN/RN with a MS in Physiology and a BA in English. She worked as a medical writer in the pharmaceutical industry for 11 years before pursuing a career in nursing. She now works as a nurse on a NeuroTelemetry unit and continues to write and edit on a freelance basis. Amanda’s LinkedIn

Oral hygiene is about more than good breath. For patients, it can increase their sense of well-being and normalcy, as well as help ensure that they can easily consume food.

Providing Oral Care

  1. Gather your supplies.
    • Gloves
    • Emesis basin
    • Towels
    • Toothbrush with soft bristles or mouth cleaning swab/sponge
    • Toothpaste
    • Dental floss
    • Alcohol-free antiseptic mouth wash
    • Water glass with water and a straw (check that the patient is allowed straws)
  2. Introduce yourself to the patient, perform hand hygiene, and put on gloves. Close the door or draw the curtain to ensure patient privacy.
  3. Ask the patient what they feel comfortable doing and what they would like assistance with.
  4. Raise the bed to a height that is comfortable for you to work with, at least 45 degrees. Place a towel over the patient’s chest. Lay a towel on the bedside table and position the table over the patient’s lap. Place your supplies on the table so they are in easy reach.
  5. Apply toothpaste to the toothbrush. Moisten the toothbrush with a small amount of water from the glass. If a toothbrush is unable to be used, moisten a mouth cleaning swab with water or antiseptic mouth wash, depending on the brand of swab used.
  6. If the patient is able, allow them to brush their own teeth. Observe them as they do and offer suggestions if you see that they are neglecting areas (ex: äóìBe sure to get the backs of your teeth.äó).
  7. If the patient is unable to brush their own teeth, ask them to open their mouth. Place the toothbrush at a 45-degree angle to the gum line. Using an up-and-down motion, brush the outer and inner surfaces of all teeth, making sure to include the gum line. Brush the bite surfaces of the teeth with a back-and-forth motion. Lastly, brush the surface of the tongue. Be gentle! An accidental jab with the toothbrush can upset the patient and make them refuse further oral care.
  8. Have the patient rinse their mouth with water and spit into the emesis basin.
  9. The patient should then swish with the alcohol-free antiseptic mouth wash for at least 30 seconds.
  10. Allow the patient to floss their teeth, or do it for them (unless contraindicated). The floss should be gently moved up and down between the teeth. Make sure that none are missed.
  11. Allow the patient to rinse their mouth with water again and spit into the emesis basin.
  12. Help the patient dry their face. Remove the towel from the patient’s chest and clean off the bedside table. Help the patient back to a comfortable position.
  13. Remove gloves and perform hand hygiene.
  14. Record the hygiene procedure per institutional or unit policy. Report any patient complaints of pain or tenderness, or any signs of oral infections such as new odors, lesions, redness or swelling of the gums to the nurse per institutional or unit policy.

Amanda R. McDaniel, MS, BSN, RN

References

Hygiene. (2014). In A. G. Perry, P. A. Potter, and W. R. Ostendorf (Eds), Clinical nursing skills & techniques (8th ed., pp. 405-410). St. Louis, MO: Mosby Elsevier.

More Resources

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Stool specimens are collected to test for a variety of disorders from colon cancer to parasites. While it is not the most pleasant job, it is important that the collection is done correctly for accurate results.

Feeding the Patient

Not all patients will need help feeding themselves. Some patients will only need assistance opening cartons or cutting their food. To promote independence, always let the patient do as much as he or she can before assisting. It is vitally important that the nurse’s aide verifies that the patient receives the correct meal tray. Patients may have special diets that play a critical role in their health (i.e., pureed diet, gluten-free diet, food allergies, etc.). Feeding the wrong food to the wrong patient could result in serious complications.

Dressing and Undressing a Patient

Patients who have suffered a stroke or have weakness or injury to one side of their body may struggle with dressing and undressing. In order to help these patients regain their strength and independence, it is important that the nurse’s aide only assist them as needed. The nurse’s aide may need to teach patients how to dress and undress safely with their limitations.

Measuring the Apical Pulse

The apical pulse rate is the most accurate non-invasive measurement of heart rate because it is measured directly over the apex of the heart. Apical pulse is preferred in cases when the radial pulse is difficult to palpate, when the pulse is irregular, greater than 100 beats per minute, or less than 60 beats per minute when measured by other means (electronic, radial, etc.).

person wearing orange and white silicone band

Applying Restraints

Restraints have very strict guidelines for use due to the number of complications that can result. Use of restraints is associated with increased physical and psychosocial health issues. Restraints are only considered necessary when restraint-free alternatives have failed and the patient or others are at risk of harm without the restraints. It is illegal to use restraints for the staff’s convenience or to punish the patient.

Removing Personal Protective Equipment

It is important to follow the correct procedure while removing personal protective equipment to avoid contaminating your skin or clothing. The most common source of contamination in this process stems from improper removal of gloves. Gloves are often the most soiled piece of equipment. To avoid contaminating your skin or the other equipment worn, gloves should always be removed first. Then remove the goggles, gown, and mask, in that order.