NOSE CARE

The nose is inspected using a _________________ and ___________________________ To remove secretions from the nose, the midwife can instruct the client to gently blow the nose. If the client can use a saline moistened washcloth or cotton tipped applicator or use gentle suction.

ORAL CARE
1. A good oral hygiene and healthy mouth is manifested by: a. __________________________________________ b. __________________________________________ c. __________________________________________ d. No complaint of oral discomfort and verbalization of feeling of oral cleanliness 2. Parts of Teeth: a. ______________ - exposed part which is outside the gum b. ______________ - hard substance covering the gown c. ______________ - ivory-colored located below the enamel d. ______________ - part embedded in the jaw e. ______________ - bony tissue covering the root f. ______________ - innermost part containing nerves and blood vessels 3. Deciduous Teeth a. Teeth begin to appear at 5 months of age. By two years old, children usually have all their 20 deciduous teeth b. 20 deciduous teeth are: 2 upper central incisors 5-8 months 2 lower central incisors 5-8 months 2 upper lateral incisors 7-12 months 2 lower lateral incisors 7-9 months 2 upper cuspids 16-20 months 2 lower cuspids 14-18 months 2 upper first molars 12-16 months 2 lower first molars 16-24 months 2 upper second molars 20-30 months 2 lower second molars-20-30 months c. Children begin losing their deciduous teeth at 6 years old and this is gradually replaced by the 32 permanent teeth. By 25 years old, all 32 permanent teeth have already erupted in most people. 4. Permanent Teeth a. The 32 Permanent teeth 4 upper and lower central incisors 7-8 years 4 upper and lower lateral incisors 7-10 years 4 upper and lower cuspids 9-14 months 4 upper and lower first bicuspids 9-13 months 4 upper and lower second biscuspids 10-14 months 4 first molars 5-8 years 4 second molars 10-14 years

4 third molars/wisdom tooth 7-24 years b. Most people have lost their teeth at age ___ because of gum disease (________________) c. Risk factors for periodontal disease: The incidence of periodontal disease increase during pregnancy because of the effect of hormones. Persons who cannot perform oral hygiene: ______________, ______________, _________________, ____________________, __________________, and ____________________. Persons with NGT (_____________________) and receiving oxygen especially if they breathe through their mouth because they likely develop dry oral mucous membrane. Persons who just undergone oral or jaw surgery because of the risk of ___________________. Persons with inadequate nutrition, excessive intake of refined sugars and salty foods, family history of periodontal disease. Aged because of decrease saliva that causes dry mouth and thinning of oral mucous membrane. Persons who always have dry mucous membrane which may be caused by: _____________________, ____________________, _______________________, ____________________, ________________________, and _____________________ when used excessively (thorazine and diazepam) and some drugs used to treat cancers. 5. Common Health Problems a. __________________ - bad breath b. __________________ - inflammation of the tongue c. __________________ - inflammation of gums d. __________________ - cracking of the lips e. __________________ - teeth cavities with darkened areas f. __________________ - invisible soft film consisting of bacteria, molecules of saliva and remnants of epithelial cells and leukocytes that adhere to the surface of teeth. g. __________________ - periodontal disease h. __________________ - a visible hard deposit of plaque and dead bacteria that forms of the gum lines i. __________________ - inflammation of the oral mucosa j. __________________ - inflammation of the parotid gland k. __________________ - accumulation of foul matter consisting of food, microorganisms and epithelial elements on the teeth and gums Mouth Care a. Instruct client to prevent tooth decay by: Having dental check up every ___ months Brush teeth frequently after meals and at bedtime (4x a day) using sulcular technique. Brushing has the following beneficial effects: 1. Helps prevent tooth decay by removing dental plaque, sordes and food particles that can harbor and incubate bacteria 2. Massages the gum thereby stimulates blood circulation 3. Relieves discomfort caused by unpleasant odor and taste Floss teeth daily to remove food particles trapped between teeth that can cause gum inflammation and infection Have adequate intake of calcium, phosphorous, vitamin A, C, D and fluids. Avoid sweet foods and drinks between meals Eat coarse, fibrous foods such as fresh fruits and raw vegetables.

Take fluoride supplement daily until age 14 or 16 unless drinking water is fluoridated. Have dental checkup every 6 months. Childs first dental visit occurs at 2 to 3 years old when all the deciduous teeth have erupted. When cleaning dentrifice, use commercial toothpaste of use two parts table salt mixed with one part baking soda. Rinse mouth with normal saline, sodium bicarbonate or commercial mouth rinse to remove bacteria. b. Special mouth care to persons with excessive mouth dryness and unconscious. Perform ____________________ and wear disposable gloves when providing mouth care to patients and when cleaning artificial dentures to protect yourself against infections such as AIDS. Determine if client has gag reflex by placing tongue blade or suction tip on back of tongue. Clients without gag reflex are at risk of aspiration. Suction equipment should be used. Inspect lips, teeth, gums, buccal mucosa, palate and tongue using tongue depressor and penlight if necessary. Ask if areas of tenderness exist. This assessment will help to determine what kind of oral care the cline needs. Identify presence of oral problems such as: 1. Dental carries 2. Gingivitis 3. Periodontitis 4. Cracked lips 5. Halitosis 6. Dry, cracked, coated tongue Remove gloves and perform hand hygiene. Prepare equipments at bedside - Soft-bristled tooth brush - Nonabrasive fluoride toothpaste or dentrifice - Dental floss - Water glass with cool water - Normal saline for mouth wash - Emesis basin - Tongue blade - Face towel - Paper towels - Disposable gloves Explain procedure if client is conscious and coherent. Raise bed to comfortable working position. Move client close to side of bed. Place client in sidelying position with the head of the bed lowered. Then raise side rail. This helps to prevent muscle strain on the part of the midwife. Place a towel and curved basin under the chin and lower cheek to receive fluid from the mouth. ___________________ position minimizes the risk of aspiration. Use disposable gloves. Wait until client is relaxed with mouth open before separating upper and lower teeth gently with padded tongue blade between back molars. If client is not relaxed, he or she may bite any object placed in mouth. Have ____________ equipment ready for use if client has no gag reflex. Rinse the mouth by drawing ____ ml of water or ______________ into the rubber tipped blul-syringe and injecting it gently into each side of the mouth. Use gauze square dipped in ______________________ diluted in water (1:1 to clean the oral mucosa).

Clean the mouth in this order using separate applicators: - _________ - _________ - _________ Suction secretions as they accumulate as necessary. Rinse the mouth again. Remove the towel and basin. Apply _______________ or _____________ on the lips to lubricate lips and prevent _____________. Place patient in comfortable position. Provide dental care at least every ___ hours.

Prepared by:

Maria Victoria S. Lorenzana-Andaya, RN, MAN Instructor