J.B. undergoes surgery. His postoperative course is complicated by pneumonia and poor wound healing

Question

After being hospitalized for 6 weeks, he is discharged to a long-term care facility for care while recuperating for external radiation therapy.

He is scheduled to receive 2000 cGy to the head and neck three times
weekly for the next 8 weeks.
As J.B.'s nurse, which adverse effects of external radiation therapy would most concern you?
Radiation to the head and neck produces dry mouth (xerostomia), irritation of the oral mucous
membranes (stomatitis), and diminished sense of taste (dysgeusia).
Outline independent nursing actions that will assist J.B. in managing mucositis and
xerostomia.
Mucositis

Answer 1

• Assess oral mucosa, characteristics of saliva, and ability to swallow daily.
• Perform brushing with a soft toothbrush, and floss gently to prevent bleeding of the gums. If
platelet counts are too low, temporarily omit flossing.
• Rinsing with approximately 30 mL of normal saline on awakening in the morning, after each meal,
and at bedtime will help clean the oral cavity.
• Avoid irritants such as alcohol and commercial mouthwash.
• To manage pain, use oral analgesics and apply topical anesthetics (e.g., viscous lidocaine,
oxethazaine) as needed.
• If infection is documented, administer the appropriate antibiotics.
Xerostomia
• Administer radioprotectors, medications that help protect the salivary glands and mucusproducing tissue, before radiation treatment.
• Administer artificial saliva or saliva substitutes to manage dryness as needed.
• Perform oral care before and after each treatment, after each meal, and at bedtime. A saline
solution of 1 teaspoon of salt in 1 L of water is an effective cleansing agent. One teaspoon of
sodium bicarbonate can be added to the oral care solution to decrease odor, alleviate pain, and
dissolve mucin.
• If tolerated, stimulate salivary flow using chewing gum and mints.
• Keep lips liberally lubricated with lip balm.