Oral Mucositis and Infections
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Questions and Answers

What does the development of pus in or around a cold sore lesion typically indicate?

  • The lesion is reacting positively to drying agents.
  • A secondary bacterial infection may be present, requiring medical attention. (correct)
  • The lesion is becoming less contagious.
  • The lesion is healing normally and the pus is a byproduct of the healing process.

Why should caution be exercised when administering 2% viscous lidocaine for oral inflammation?

  • It can anesthetize the entire mouth and throat, potentially leading to accidental burns or injuries. (correct)
  • It may cause hypertension in patients with pre-existing heart conditions.
  • It interacts negatively with common antibiotics.
  • It can cause localized allergic reactions in the oral cavity.

For which patient group is Palifermin (Kepivance) specifically approved?

  • Patients with canker sores.
  • Leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation. (correct)
  • Patients with thrush.
  • Patients with cold sores.

Why is candidiasis often referred to as the 'disease of the diseased'?

<p>It predominantly appears in debilitated patients. (A)</p> Signup and view all the answers

A patient undergoing chemotherapy develops severe mucositis. Which medication is most appropriate to prevent further complications?

<p>Palifermin (Kepivance) (B)</p> Signup and view all the answers

Following the rupture of fluid-filled vesicles in a cold sore, what subsequent development indicates the lesion is progressing through its typical healing stages?

<p>Development of a crust as the vesicles coalesce. (B)</p> Signup and view all the answers

A patient complains of significant oral pain due to inflammation of the mucous membranes. Besides prescribing 2% viscous lidocaine, what crucial information should be conveyed to prevent potential harm?

<p>Ensure the patient understands that the drug anesthetizes the entire mouth and throat, so caution is needed to prevent accidental burns. (C)</p> Signup and view all the answers

A patient presents with signs of Aspergillosis. What is the most likely source of this infection?

<p>Exposure to environments with decaying vegetation, such as dead leaves or compost piles. (A)</p> Signup and view all the answers

Which of the following infections, while similar in occurrence to candidiasis among debilitated patients, is less prevalent?

<p>Trichomoniasis (D)</p> Signup and view all the answers

A patient develops a zoonotic infection after consuming contaminated food. Which of the following diseases is most likely the cause?

<p>Brucellosis (C)</p> Signup and view all the answers

What is the primary etiological factor in the development of most tooth, gum, and periodontal diseases?

<p>Dental plaque (A)</p> Signup and view all the answers

A patient is prescribed viscous lidocaine (Xylocaine) for mucositis. Which instruction is most crucial for the nurse to emphasize to prevent potential complications?

<p>Refrain from eating or drinking for 30 minutes post-administration. (B)</p> Signup and view all the answers

A patient using topical amlexanox paste 5% (Zilactin) for oral lesions states, 'I will apply this medicine before meals.' Which nursing intervention is most appropriate in response to this statement?

<p>Reiterate the correct application time, emphasizing application after meals. (C)</p> Signup and view all the answers

A patient using carbamide peroxide (Gly-Oxide) for canker sores reports tissue irritation and a black hairy tongue. Besides discontinuing the medication, what should the nurse recommend to soothe the pain?

<p>Warm saline rinses (D)</p> Signup and view all the answers

What is the initial source from which dental plaque is primarily derived?

<p>Saliva (B)</p> Signup and view all the answers

A patient presents with symptoms suggestive of brucellosis but denies consuming unpasteurized dairy products. Which alternative route of transmission should the nurse explore?

<p>Occupational exposure involving direct contact with livestock (B)</p> Signup and view all the answers

A patient using a corticosteroid inhaler is at risk for which adverse effect?

<p>Candidiasis (A)</p> Signup and view all the answers

White, milk curd-appearing plaques attached to the oral mucosa are characteristic of which condition?

<p>Thrush (D)</p> Signup and view all the answers

Which of the following is the primary pharmacologic treatment for Candida albicans infections?

<p>Antifungal agents (C)</p> Signup and view all the answers

Saliva substitutes are most likely prescribed to manage which of the following conditions?

<p>Xerostomia (D)</p> Signup and view all the answers

Which instruction is most important for the nurse to include when educating a patient about managing cold sores?

<p>Avoid sharing personal items to prevent transmission. (D)</p> Signup and view all the answers

A patient reports using an over-the-counter mouthwash several times a day and is now experiencing increased oral irritation. Which ingredient in the mouthwash is MOST likely responsible for this adverse effect?

<p>Alcohol (C)</p> Signup and view all the answers

A patient receiving chemotherapy is experiencing severe mucositis. Which intervention is most appropriate to recommend for pain management?

<p>Viscous lidocaine rinse (A)</p> Signup and view all the answers

A patient with a history of heavy smoking and alcohol use presents with a persistent, non-healing ulcer on the floor of their mouth. Which of the following actions is MOST important for the healthcare provider?

<p>Refer the patient for a biopsy. (C)</p> Signup and view all the answers

A patient undergoing chemotherapy develops mucositis. Which intervention should be prioritized before applying topical carbamide peroxide?

<p>Performing saline rinses. (B)</p> Signup and view all the answers

A chemotherapy patient reports a pain level of '8' due to severe mucositis. Which nursing problem takes priority?

<p>Pain. (C)</p> Signup and view all the answers

A nurse is educating a patient starting chemotherapy. Which dietary instruction is most appropriate for preventing complications associated with oral mucositis?

<p>Avoid acidic and spicy foods. (A)</p> Signup and view all the answers

A patient with mucositis is prescribed nystatin liquid. What instruction regarding its administration is most important for the nurse to emphasize?

<p>Swish the medication in the oral cavity for approximately 1 minute before swallowing. (A)</p> Signup and view all the answers

A patient with oral mucositis is prescribed a topical pain medication. What direction should the nurse give to the patient regarding its use?

<p>Cleanse the oral cavity before applying the topical agent. (B)</p> Signup and view all the answers

Why are OTC mouthwashes generally discouraged in patients undergoing chemotherapy?

<p>They often contain alcohol, which can further irritate the oral mucosa. (C)</p> Signup and view all the answers

Which strategy is most useful for determining the effectiveness of interventions aimed at managing the pain associated with oral mucositis?

<p>Assessing the patient's mucous membrane pain level using a pain scale. (D)</p> Signup and view all the answers

A patient with mucositis is using Milk of Magnesia as part of their treatment plan. What is the primary purpose of this intervention?

<p>To decrease pain by coating the mucous membranes. (D)</p> Signup and view all the answers

A client has a cold sore. Which instructions are appropriate for the nurse to provide regarding care? (Select all that apply)

<p>Note signs of infection, including the presence of pus. Contact the health care provider if this occurs. (A), Keep the cold sore moist to prevent cracking. (B), Oral analgesics may help alleviate pain. (D), Keep the cold sore clean with mild soap. (E)</p> Signup and view all the answers

Which assessment findings are most pertinent when evaluating a client's oral health? (Select all that apply.)

<p>Amount of saliva present (A), Dental history, visit frequency (C), Medication history (D), Presence of halitosis (E)</p> Signup and view all the answers

Which treatment options may promote comfort for a client experiencing severe mucositis following a bone marrow transplant? (Select all that apply.)

<p>Milk of Magnesia mouth rinses (A), 2% viscous lidocaine (Xylocaine) before meals (E)</p> Signup and view all the answers

What are the adverse effects of xerostomia? (Select all that apply.)

<p>Increase in dental caries (B), Difficulty chewing and swallowing food (C), Reduced taste and appetite (D), Difficulty with speech (E)</p> Signup and view all the answers

A nurse is caring for several clients. Which client is at highest risk for developing oral cancer?

<p>A 40-year-old male with a history of excessive alcohol consumption and tobacco use. (A)</p> Signup and view all the answers

A client reports experiencing frequent heartburn. Which statement by the client indicates a need for further teaching regarding the management of gastroesophageal reflux disease (GERD)?

<p>&quot;I drink coffee after dinner to help with digestion.&quot; (A)</p> Signup and view all the answers

A patient is diagnosed with stomatitis related to chemotherapy. Which intervention is most appropriate for the nurse to include in the plan of care?

<p>Administer a topical anesthetic before meals. (A)</p> Signup and view all the answers

A nurse is educating a client about reducing the risk of developing oral health problems. Which recommendations should the nurse include? (Select all that apply)

<p>Brushing teeth at least twice a day with fluoride toothpaste. (A), Avoiding tobacco products in any form. (B), Having regular dental check-ups and cleanings. (E)</p> Signup and view all the answers

Flashcards

Corticosteroid Inhaler: Candidiasis

An adverse effect of corticosteroid inhalers where a fungal infection develops in the mouth.

Thrush

A fungal infection characterized by white, milk curd-like plaques on the oral mucosa.

Candida albicans Risk Factors

Medications that suppress the immune system or cause dry mouth can cause this infection.

Antifungal Agents

Medications used to treat fungal infections.

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Xerostomia

Lack of saliva leading to dry mouth.

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Saliva Substitutes

Products that replace or mimic the function of saliva to alleviate dry mouth.

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Cold Sores

Most commonly found at the junction of the mucous membrane and the skin of the lips or nostrils.

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Mucositis

Painful inflammation of the mucous membranes of the mouth.

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Saline Rinses

Soothing and used before topical application of carbamide peroxide.

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Mucositis Pain Priority

Mucous membrane is painful.

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Mucositis: Avoid These Foods

Irritate mucous membranes

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Mucositis: Milk of Magnesia

Coat mucous membranes.

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Mucositis: Nystatin liquid

Taken orally to kill fungal infections.

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Topical Mucositis Meds

Contact with mucous membranes to be effective.

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OTC Mouthwashes

Not recommended for mucositis treatment.

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Mucositis: Oral Cavity

Clean the oral cavity

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Brucellosis

A zoonotic infection transmitted from animals to humans via infected food, direct contact, or aerosols.

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Plaque

The primary cause of tooth, gum, and periodontal disease.

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Plaque Definition

Whitish-yellow substance on teeth that traps bacteria and food particles.

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Viscous Lidocaine Instruction

Do not eat or drink for 30 minutes after using due to risk of aspiration because of the gag reflex absence.

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Amlexanox Paste 5% Application

Apply after meals to control discomfort, promote healing, and target each lesion.

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Amlexanox Paste 5% Actions

Controls discomfort, is applied to each lesion, and promotes healing.

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Optimal Timing for Amlexanox Paste

Amlexanox paste 5% (Zilactin) should be applied after meals.

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Cold Sore Contagion

Cold sore fluid contains live virus, spread by direct contact. Pus indicates a secondary bacterial infection needing medical attention.

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Oral Inflammation Anesthetic

2% viscous lidocaine is a topical anesthetic used for oral inflammation pain.

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Mucositis Prevention

Palifermin prevents/reduces mucositis in chemo/radiation patients before bone marrow transplant.

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Candidiasis

Candidiasis is a fungal infection common in debilitated patients, often called the 'disease of the diseased'.

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Cold sore development

Small, red papules that develop into fluid-filled blisters. Over 10-14 days, the vesicles burst and coalesce into larger lesions.

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Candidiasis cause

A fungal infection caused by C.albicans, the most common organism associated with oral infections

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Palifermin

A recombinant human keratinocyte growth factor.

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2% viscous lidocaine

A topical anesthetic for pain associated with oral inflammation.

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Cold Sore Care: Moisture

Keeping it moist prevents cracking and secondary bacterial infection.

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Cold Sore Infection Signs

Note pus, redness, swelling, and pain. Contact the healthcare provider if observed.

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Cold Sore Pain Relief

Analgesics (like ibuprofen or acetaminophen) can reduce pain.

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Oral Health Assessment: Key History

Current medications and dental visit frequency.

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Halitosis Importance

May indicate poor hygiene or infection. It is a key factor for oral health.

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Saliva Amount Significance

Less saliva increases risk of damage and infection.

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Viscous Lidocaine (2%) Use

It can numb the mouth to facilitate eating with mucositis.

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Milk of Magnesia Mouth Rinses

It coats the mucous membranes provides relief.

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Study Notes

  • Medications like immunosuppressants, corticosteroids, cytotoxics, and broad spectrum antibiotics can lead to candidiasis by suppressing the immune system.
  • Proper oral hygiene during inhalation dosage regimens can help prevent candidiasis.
  • Mucositis, plaque, and xerostomia aren't typically linked to steroid inhaler usage.

Oral Mucosa Issues and Treatments

  • Thrush presents as white, milk curd-like plaques attached to the oral mucosa.
  • Canker sores are ulcers 0.5 to 2 cm in diameter that appear on surfaces not attached to bone.
  • Cold sores, or fever blisters, usually form at the junction of mucous membranes and skin around the lips or nostrils.
  • Mucositis is a broad term for painful inflammation of the oral mucous membranes.

Candida Albicans and Antifungal Therapy

  • Candida albicans is a common oral infection, especially in debilitated patients.
  • Conditions depressing the immune system or causing xerostomia increase the risk.
  • Antifungal agents (e.g., nystatin) are the primary treatment for C. albicans.
  • Steroids, topical anesthetics, and anti-inflammatory agents aren't used to treat C. albicans.

Xerostomia and Saliva Substitutes

  • Xerostomia, or dry mouth, stems from non-oral causes.
  • Treatment includes discontinuing medications causing dry membranes or using artificial saliva products.
  • Dentifrices treat caries, while mouthwash addresses halitosis alongside dentifrices.

Cold Sore Management

  • Cold sore lesions start as small red papules, then become fluid-filled blisters of 1-3 mm. As vesicles burst a crust develops.
  • The fluid in these vesicles harbors live virus, making direct contact contagious.
  • Pus in vesicles or under the cold sore crust indicates a secondary bacterial infection.
  • Drying agents are not suitable for cold sores, which are contagious, not tied to personal hygiene.

Oral Mucous Membrane Inflammation and Local Anesthetics

  • Viscous lidocaine 2% is a topical anesthetic for oral inflammation-related pain.
  • Caution is needed to avoid burns due to the drug anesthetizing the mouth and throat.
  • Chlorhexidine, nystatin, and hydrogen peroxide are not local anesthetics.

Mucositis Prevention and Treatment

  • Palifermin is a recombinant keratinocyte growth factor used to prevent and treat mucositis in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation.
  • Amlexanox paste is used for canker sores, docosanol for cold sores, and nystatin for thrush.

Candidiasis

  • Candidiasis, caused by C. albicans, is often called the "disease of the diseased" because it appears in debilitated patients.
  • Aspergillosis is caused by Aspergillus, found on decaying vegetation.
  • Trichomoniasis is a sexually transmitted parasitic disease.
  • Brucellosis is a zoonotic infection from animals to humans via contaminated food, direct contact, or aerosol inhalation.

Plaque

  • Plaque, linked to tooth, gum, and periodontal disease, originates from saliva that is a sticky substance forming on teeth trapping bacteria.
  • If not removed, plaque thickens, and bacteria multiply.
  • Sugar leads to oral health issues when poor hygiene allows it to collect.
  • Halitosis indicates poor oral hygiene but doesn't cause dental disease.
  • Smoking contributes to periodontal disease through vasoconstriction, not dental disease itself.

Viscous Lidocaine Use

  • When using viscous lidocaine (Xylocaine) for mucositis it is most important to counsel patients to avoid eating or drinking for 30 minutes after administration due to risk of aspiration from diminished gag reflex.

Amlexanox Paste 5% (Zilactin) Use

  • When applying amlexanox paste 5% (Zilactin), it is best to apply after meals.
  • Comfort is controlled with this medication; it is applied to each lesion and promotes healing.

Canker Sore Treatment

  • Saline rinses may soothe tissue irritation from carbamide peroxide (Gly-Oxide) used for multiple canker sores, and can be used before topical application.
  • Milk of Magnesia, viscous lidocaine 2%, and Salivart are not used to soothe this side effect.

Severe Mucositis and Nursing Priorities

  • When assisting with the care of a patient on chemotherapy reporting severe mucositis, a pain level of "8" indicates pain is the priority nursing concern.
  • Addressing pain and comfort is paramount.

Oral Mucositis Prevention

  • To manage oral mucositis from chemotherapy, avoid acidic/spicy foods, use Milk of Magnesia to coat mucous membranes, use Nystatin liquid to combat fungal infections and cleanse the mouth before applying topical agents.

Cold Sores in Children

  • Instruct children to keep cold sores clean with mild soap, keep them moist to prevent cracking, monitor for infection signs and consider pain relief options.

Oral Health Assessment

  • Oral health assessment should include medication history, dental visit frequency, presence of halitosis, and amount of saliva present.

Mucositis Treatment

  • Options that may promote comfort for patients with severe mucositis that developed while undergoing bone marrow transplantation are, 2% viscous lidocaine (Xylocaine) before meals and Milk of Magnesia mouth rinses.

Xerostomia

  • The adverse effects of xerostomia are reduced taste and appetite, difficulty chewing and swallowing food, increase in dental caries, and difficulty with speech.

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Description

Questions cover complications like pus development in cold sores and risks of medications like viscous lidocaine. They address specific treatments for mucositis, especially in chemotherapy patients, and opportunistic infections, such as candidiasis and aspergillosis. Also covers healing stages of cold sores.

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