Domain 11. Safety-protection
Class 2. Physical injury
Diagnostic Code: 00261
Nanda label: Risk for dry mouth
Diagnostic focus: Dry mouth
Nursing Diagnosis Risk for Dry Mouth
Introduction
Dry mouth, or xerostomia, is a common symptom caused by decreased salivary flow. It can be caused by many factors such as medication use, radiation therapy, aging, and disease such as diabetes. Although it is not a serious health threat, dry mouth can cause difficulty in speaking and eating, as well as an increased risk for tooth decay. Therefore, it is important for nurses and health care professionals to understand the causes and risk factors of dry mouth and how to provide interventions to decrease its negative effects.
NANDA Nursing Diagnosis Definition
The NANDA definition of Risk for Dry Mouth includes the following statement: “At risk for decreased secretion of saliva that may lead to oral discomfort”.
Risk Factors
There are many risk factors for developing dry mouth. These include medications such as anticholinergics, antidepressants, and antihistamines, radiation therapy, aging, neurological diseases such as Alzheimer’s, diabetes, chemoradiation, autoimmune diseases such as Sjogren’s syndrome, alcoholism, nervous system disorders such as Parkinson’s, chronic stress, dehydration, and smoking.
At Risk Population
Individuals who are more likely to suffer from dry mouth include those who are elderly, have chronic illnesses such as diabetes and cancer, or have conditions that disrupt the normal functioning of the salivary glands such as Sjogren’s syndrome. Additionally, people who experience chronic stress, engage in excessive alcohol consumption, or smoke cigarettes are at a higher risk for dry mouth.
Associated Conditions
Dry mouth can contribute to other conditions such as cavities, tooth decay, inflammation of the gums, and sore throat. Additionally, individuals who suffer from dry mouth are at an increased risk for dysphagia, a condition characterized by difficulty in swallowing.
Suggestions for Use
Health care professionals should assess patients for signs and symptoms of dry mouth and counsel them on appropriate ways to reduce its effects. Some suggestions may include avoiding sugary beverages and foods, limiting caffeine consumption, drinking plenty of water throughout the day, using saliva substitutes or artificial saliva, using breath mints or gum to stimulate saliva production, and avoiding tobacco products.
Suggested Alternative NANDA Nursing Diagnosis
In addition to Risk for Dry Mouth, alternate nursing diagnosis considerations include Impaired Oral Mucous Membrane Integrity (promoting healing), Dysfunctional Salivary Secretion (stabilizing), Acute Pain (relieving), Unilateral/Bilateral Facial Paralysis (alleviating), and Deficient Knowledge (teaching).
Usage Tips
When considering Risk for Dry Mouth in a patient, it’s important to assess signs and symptoms and consider potential causes. From there, the nurse can then provide appropriate interventions to help mitigate the side effects of dry mouth.
NOC Outcomes
Some relevant NOC outcomes for addressing dry mouth include Comfort Level, Oral Health Hygiene, Oral Hygiene Effectiveness, Saliva Control, Leakage Control, and Swallowing Efficiency.
Evaluation Objectives and Criteria
To evaluate the patient’s progress with regard to Risk for Dry Mouth, the nurse should assess oral hygiene, comfort level, saliva control, leakage control, and swallowing efficiency. The nurse should compare the patient’s results before and after interventions are introduced, and measure the patient’s success in achieving the desired outcomes.
NIC Interventions
Relevant NIC interventions that can be used to address dry mouth include Dental Hygiene Assistance, Oral Care, Fluid Maintenance, Nutrition Management, Enteral Feeding, Communication Enhancement, Swallowing Enhancement, and Restorative Care.
Nursing Activities
When offering interventions for dry mouth, nurses must evaluate the patient’s oral health and oral hygiene practices, and adjust their treatments accordingly. Additionally, nurses should provide instruction on proper diet and hydration, and suggest psychological interventions such as counseling and supports groups for stress relief. Nurses must also ensure that the patient is taking the appropriate medications for dry mouth and that they understand the risks and side effects associated with these medications.
Conclusion
Risk for Dry Mouth is a common symptom that can cause severe discomfort, difficulty in speaking and eating, and an increased risk for tooth decay. By understanding the risk factors, associated conditions, and nursing interventions, nurses and health care professionals can better assess and treat dry mouth.
FAQs
1. What is dry mouth?
Dry mouth, or xerostomia, is a common symptom caused by decreased salivary flow. It can be caused by many factors such as medications, radiation therapy, aging, and disease.
2. What are the risks of dry mouth?
Dry mouth can cause difficulty in speaking and eating, as well as an increased risk for tooth decay, cavities, tooth decay, inflammation of the gums, and sore throat. Additionally, individuals who suffer from dry mouth are at an increased risk for dysphagia, a condition characterized by difficulty in swallowing.
3. What are the treatments for dry mouth?
Some recommended treatments for dry mouth include avoiding sugary beverages and foods, limiting caffeine consumption, drinking plenty of water throughout the day, using saliva substitutes or artificial saliva, using breath mints or gum to stimulate saliva production, and avoiding tobacco products.
4. What types of nursing interventions can be used to treat dry mouth?
Relevant NIC interventions used to address dry mouth include Dental Hygiene Assistance, Oral Care, Fluid Maintenance, Nutrition Management, Enteral Feeding, Communication Enhancement, Swallowing Enhancement, and Restorative Care.
5. What should I know about dry mouth symptoms?
Signs and symptoms of dry mouth include discomfort or burning sensation in the mouth, thick or stringy saliva, frequent thirst, dry or cracked lips, bad breath, and a dry feeling at the back of throat.