Stomatitis Sample Nursing Care Plan.

Stomatitis Nursing Care Plan

Definition

• Stomatitis: inflammation of the oral mucosa, which may be due to infection (viral, bacterial, fungal), chemical/thermal injury, medications (e.g., chemotherapy), autoimmune conditions, or nutritional deficiencies.

Common Signs & Symptoms

• Oral pain and tenderness

• Redness, swelling, ulcers or erosions, white patches

• Difficulty eating, drinking, speaking

• Excessive salivation or dry mouth

• Halitosis

• Fever and malaise if infectious

Nursing Diagnoses (examples)

1. Acute Pain related to inflammation and ulceration of oral mucosa

2. Impaired Oral Mucous Membrane Integrity related to infection, chemotherapy, or trauma

3. Imbalanced Nutrition: Less Than Body Requirements related to difficulty chewing/swallowing and pain

4. Risk for Infection related to breakdown of mucosal barriers and immunosuppression

5. Impaired Communication related to oral pain and speech difficulties

Assessment

• History: onset, duration, possible triggers (recent chemo, radiation, new medications, recent illness), oral hygiene practices, tobacco/alcohol use, nutritional status

• Physical: inspect oral cavity for lesions, color, exudate, size, location; assess lips, tongue, gingiva, buccal mucosa, palate

• Pain assessment: location, intensity (0–10), quality, aggravating/relieving factors

• Vital signs: fever may indicate systemic infection

• Hydration and nutritional intake: weight changes, ability to swallow, appetite

• Laboratory/culture results if ordered (HSV culture, fungal KOH, CBC)

• Medication review: immunosuppressants, antibiotics, chemo agents, bisphosphonates, ACE inhibitors

Nursing Interventions with Rationales

1. Pain management

   • Administer prescribed analgesics (acetaminophen, NSAIDs, topical anesthetics like viscous lidocaine as ordered). Rationale: Reduces pain to facilitate eating and oral care.

   • Offer topical protective agents (gel-forming rinses, protective pastes) per orders. Rationale: Coats lesions, reduces irritation and pain.

2. Oral hygiene and local care

   • Encourage gentle oral care: soft-bristled toothbrush or foam swabs after meals and at bedtime; avoid alcohol-containing mouthwashes. Rationale: Removes debris and organisms while minimizing trauma.

   • Perform saline or sodium bicarbonate mouth rinses (0.9% saline or baking soda solution) several times daily. Rationale: Promotes cleansing, soothes mucosa, and maintains pH balance.

   • Apply prescribed antifungal (nystatin), antiviral (acyclovir), or topical steroid agents as ordered for specific etiologies. Rationale: Treats underlying infectious or inflammatory causes.

3. Nutrition and hydration support

   • Offer small, frequent, soft, bland, cool or room-temperature foods; avoid acidic, spicy, hot, or rough-textured foods. Rationale: Minimizes mucosal irritation and improves intake.

   • Encourage high-calorie, high-protein oral supplements; consider thickened liquids if swallowing difficulty present. Rationale: Prevents malnutrition and supports healing.

   • Monitor intake and output; assess for dehydration and weight loss. Rationale: Detects need for additional interventions like IV fluids or enteral nutrition.

4. Infection control and prevention

   • Practice strict hand hygiene before and after oral care; use gloves for mouth care in immunocompromised patients. Rationale: Prevents cross-contamination and secondary infection.

   • Isolate if droplet precautions are indicated for contagious viral causes per facility policy. Rationale: Reduces transmission risk to others.

5. Education and psychosocial support

   • Teach patient/caregiver proper oral hygiene techniques, signs of worsening infection, and when to seek care (increasing pain, fever, inability to eat/drink). Rationale: Empowers self-care and early recognition of complications.

   • Provide instruction on medication administration (e.g., how to swish and swallow or swish and spit for nystatin) and adherence. Rationale: Ensures effective topical therapy.

   • Address emotional distress related to pain and altered nutrition; offer support and referrals (nutritionist, social work). Rationale: Improves coping and adherence to care plan.

6. Collaboration and referrals

   • Collaborate with prescribing provider for topical/systemic antimicrobials, analgesics, or corticosteroids as indicated.

   • Refer to dietitian for tailored nutritional plan.

   • Consult speech-language pathology if swallowing or speech is significantly impaired.

   • Consider dental referral for persistent lesions or suspected dental sources.

Evaluation Criteria (Expected Outcomes)

• Pain decreased to a tolerable level