This nursing care plan is for patients who have impaired oral mucous membranes. According to Nanda the definition for impaired oral mucous membranes is the state in which an individual experiences or is at risk for experiencing disruptions in the oral cavity.
Patients must have or be at risk for disrupted oral mucous membranes to qualify for this nursing diagnosis. In addition, the patient may or may not present with a coated tongue, xerostomia, stomatitis, leukoplakia, edema, gingivitis, purulent drainage, or taste changes.
Patients can develop impaired oral mucous membranes for a number of reason such as drying effect (affects of NPO for 24 hours or more, prolonged use of steroids, immunosuppressants, or anti-neoplastic drugs), mechanical irritation, malnutrition, trauma, mouth breathing, inadequate oral hyigene, or decreased salivation.
Below is a nursing care plan with diagnosis and nursing interventions/goals for patients with impaired oral mucous membranes.
What are nursing care plans? How do you develop a nursing care plan? What nursing care plan book do you recommend helping you develop a nursing care plan?
This care plan is listed to give an example of how a Nurse (LPN or RN) may plan to treat a patient with those conditions.
Important Disclosure: Please keep in mind that these care plans are listed for Example/Educational purposes only, and some of these treatments may change over time. Do not treat a patient based on this care plan.
Care Plans are often developed in different formats. The formatting isn’t always important, and care plan formatting may vary among different nursing schools or medical jobs. Some hospitals may have the information displayed in digital format, or use pre-made templates. The most important part of the care plan is the content, as that is the foundation on which you will base your care.
Nursing Care Plan for Impaired Oral Mucous Membranes
If you want to view a video tutorial on how to construct a care plan in nursing school, please view the video below. Otherwise, scroll down to view this completed care plan.
Scenario
A 65 year old female is admitted to your medical surgical floor for COPD exacerbation. The patient is started on IV Solu-Medrol. The patient has been taking Prednisone prior to the hospitalization and has been experiencing extreme dry mouth. You note on assessment the patients mucous membranes are dry and the tongue is red with some leukoplakia noted. The patient states her mouth is “extremely tender” and it makes it hard to eat.
Nursing Diagnosis
Impaired oral mucous membrane related to drying effect of prolonged use of steroids as evidence by patient has dry mucous membranes, red tongue with some leukoplakia and reports taking Prednisone.
Subjective Data
The patient states her mouth is “extremely tender” and it makes it hard to eat.
Objective Data
A 65 year old female is admitted to your medical surgical floor for COPD exacerbation. The patient is started on IV Solu-Medrol. The patient has been taking Prednisone prior to the hospitalization and has been experiencing extreme dry mouth. You note on assessment the patients mucous membranes are dry and the tongue is red with some leukoplakia noted.
Nursing Outcomes
-The patient will report less discomfort in her mouth while eating or drinking within in 24 hours.
-The patient’s mucous membranes will appear moist and pink with 48 hours.
-The patient’s mucous membranes will be free from harmful plaque to prevent secondary infection throughout hospital stay.
-The patient will demonstrate proper oral hygiene by discharge.
-The patient will verbalize 3 ways on how to relieve dry mouth by discharge.
Nursing Interventions
-The nurse will assess the patients mouth discomfort every shift until patient reports less discomfort in her mouth.
-The nurse will educate the patient about avoiding, mouthwashes with high alcohol content, lemon swabs or prolonged use of hydrogen peroxide.
-The nurse will encourage the patient to rinse mouth with saline solution every 2 hours.
-The nurse will encourage the patient to suck on sugar-free candies every 2-3 hours to help with dry mouth.
-The nurse will educate the patient on how to provide proper mouth care.
-The nurse will assess the patient mucous membranes every shift for integrity.
-The nurse will educate the patient on 3 ways on how to relieve dry mouth by discharge.