Calayan Education Foundation I

Calayan Education Foundation Inc

Case Study
Ulcerative Stomatitis

Submitted to:
Mrs. Wilma OretoRivadenera

Submitted by:
Klent Nikko G. Melencion

Stomatitis, a general term for an inflamed and sore mouth, can disrupt a person’s ability to eat, talk, and sleep. Stomatitis can occur anywhere in the mouth, including the inside of the cheeks, gums, tongue, lips, and palate.

Types of stomatitis include:
* Canker sore: A canker sore, also known as an aphthous ulcer, is a single pale or yellow ulcer with a red outer ring or a cluster of such ulcers in the mouth, usually on the cheeks, tongue, or inside the lip.
* Cold sores: Also called fever blisters, cold sores are fluid-filled sores that occur on or around the lips. They rarely form on the gums or the roof of the mouth. Cold sores later crust over with a scab and are usually associated with tingling, tenderness, or burning before the actual sores appear.
* Mouth irritation. The irritation can be caused by:
o Biting your cheek, tongue, or lip.
o Wearing braces or another type of dental apparatus, or having a sharp, broken tooth.
o Chewing tobacco.
o Burning one’s mouth from hot food or drinks.
o Having gum disease (gingivitis) or other type of mouth infection.
o Having hypersensitivity to certain things, such as foods or medicines.
o Having certain autoimmune diseases affecting the mucosal lining of the mouth, such as lupus, Crohn’s disease, or Behcet’s disease.
o Taking certain drugs such as chemotherapy, antibiotics, medications used forrheumatoid arthritis, or epilepsy medications.
o Receiving radiation as part of cancer treatment.
Causes of Stomatitis
Canker sores: There’s no single reason behind canker sores. Some possible reasons are:
* Mental and physical stress
* Accidental injury due to severe brushing, biting cheek, etc.
* From food allergy
* Deficiency of vitamin B 12,iron, folate, zinc
* Eating too much spicy and citrus foods, chewing tobacco
Cold sores: As said before, since Herpex Simplex Virus-1 type typically causes this infection, they are contagious in nature. The virus can spread through physical contact and sharing personal things with the infected person.
Case Profile
General Data ( Name, Sex, Birthdate, Address, Citizen, Date Admitted, Date Discharge, Chief Complaint)

Name: Patient X
Age: 2 years old Sex: Male Birthdate: October 3, 2012
Status: Child
Religion: Roman Catholic
Address: Calmar Homes, Kan. Mayao, Lucena City
Chief Complaint: Fever and Vomiting
Date of Admission: 07/13/14
Admitting Physician: Dra. San Pablo
Diagnosis: Ulcerative Stomatitis
Physical Assessment
Vital signs are reviewed for fever. The patient’s general appearance is noted for lethargy, discomfort, or other signs of significant systemic illness.
The mouth is inspected for the location and nature of any lesions.
The skin and other mucosal surfaces (including the genitals) are inspected for any lesions, rash, petechiae, or desquamation. Any bullous lesions are rubbed for Nikolsky’s sign (peeling of epithelium with lateral pressure).
A. General Assessment
Actual Vital Signs Normal Values Interpretation RR-32 bpm 20-30 bpm Normal PR-120 80-130 bpm Normal T-36.9 36.5-37.5 Normal
B. Assessment of the Head
* Head is round shape. Hair is long, thick and coarse, straight and evenlydistrubeted
* Scalp is smooth and white in color,
C. Assessment of the Eyes
* Her eyes are symmetrical, black in color, almond shape.
* Eyelashes are equally distributed and skin around the eyes is intact
* The eyes involuntarily blink
D. Assessment of the Ears
* Ears are clean, no ear wax was noted and approximately of the same size and shape
E. Assessment of the Nose
* With narrow nose bridge, there were discharges noted upon inspection
* No swelling of the mucous membrane
F. Assessment of the Mouth
* Oral mucosa and gingival are pink in color moist and positive to lesions inflammation noted.
* Tongue is pinkish
Lips are symmetrical, appears pale without bits noted upon observation
G. Assessment of the Neck
* Lymph nodes noted
* Neck has strength that allows movement back and forth, left and right. Patient is able to freely move her neck
H. Assessment of the Lungs and Thoracic Region
* No reports of pain during the inhalation and exhalation
* Absence of adventitious sound upon auscultation
* Respiratory rate 25 breathes per minute from the normal range of 20-30 breaths per minute.
I. Assessment of the Heart
* Patient heart beat is normal
J. Assessment of the Abdomen
* No Presence of rashes and lashes
Laboratory Result
07/13/2014 Result Normal Values Interpretation Hemoglobin 140 M-140-180 g/L Normal Hematocrit 0.38 0.40-0.54 Slightly decreased hematocrit values due to extra fluid in the blood RBC 4.2 4.5-5.8 10^12/ Normal CBC 7.2 5.0-10.0 10^ g/L Normal Platelet 226 150-500 10^ g/L Normal MCV 90 80-94 fl Normal MCH 30 31-36 g/dl Normal MCHC 33 5-15 10^3 Normal Blood Group R Type/RH Normal Segmenters 0.39 0.50-0.56 Slightly decreased and presence of bacteria in the blood Lymphocytes 0.61 0.20-0.40 Decrease level of Lymphocyte indicates a respond for infection
Normal Anatomy

One of the strongest muscles in the body is the tongue, the organ that gives you the sense of taste. In addition, the tongue is imperative for speech as well as chewing food.
A tongue is covered with innumerable taste buds, clusters of cells that link to nerves connected to the brain. As a result, the tongue is able to distinguish four tastes: sweet, bitter, salty and sour.
There is purportedly a fifth taste, known as umami. This taste supposedly manifests itself when the food is mixed with MSG or monosodium glutamate.
In any case, all areas of the tongue are able to sense the four common tastes. Contrary to popular belief, a tongue does not have a clear-cut “taste map.”
Moist tissue known as mucosa cover the tongue, which has a rough texture due to small lumps known as papillae. Mucosa and tough tissue work to secure the tongue to the mouth.
A tongue is bound to the mouth by way of the frenum and the hyoid bone.
Clincal Management
* Drink more water.
* Rinse with salt water.
* Practice proper dental care.
* Apply a topical anesthetic such as lidocaine or xylocaine to the ulcer (not recommended for children under 6).
* Apply a 1-to-1 mixture of hydrogen peroxide with water or baking soda with water to the ulcers.
* Use a topical corticosteroid preparation such as triamcinolone dental paste (Kenalog in Orabase 0.1%), which protects a sore inside the lip and on the gums.
* Blistex and Campho-Phenique may offer some relief of canker sores and cold sores, especially if applied when the sore first appears.
Prognosis
The prognosis for the resolution of stomatitis is based upon the cause of the problem. Many mouth ulcers are benign and resolve without specific treatment. In the case of herpes stomatitis, complete recovery is expected within ten days without any medical intervention. Oral acyclovir may speed up recovery. Most children are minimally inconvenienced by aphthous stomatitis, because attacks are usually infrequent and only last a few days.
Nursing Care Plan
Assessment Diagnosis Planning Intervention Rationale Evaluation Subjective:
“Nilalagnat ang anak ko” as verbalized by the mother
Objective:
-flushed skin
-fever of 38.9 celcius
-skin pale in color
-irritable
-restless
Hyperthermia related to increased metabolic rate illness After 4 hours of nursing intervention the will demonstrate temp. within normal range and free from chills 1.Monitor pt. temp degree and patterns

2. observe for shaking chills and profuse diaphoresis
3. Encourage proper hygiene
4. Provide Tepid Sponge Baths
5.Monitor signs of deterioration

6.Administered antipyretics as prescribed
1.fever pattern may aids in diagnosing underlying disease
2. Chills often precede during high temp. and to presence of generalized
3. Reduces cross contamination and prevents the spread of infections
4. May help reduce fever and comfortable
5. may reflect inappropriate antibiotic therapy
6. Use to reduce fever by its verbal action hypothalamus. After 4 hours of nursing intervention the patient was able to demonstrate temperature with normal range and free from chills
Assessment Diagnosis Planning Intervention Rationale Evaluation Subjective
“Nananakitangmgakasukasuanko at angakingmgakalamnan at nakakaranasako ng panghihina” as verbalized by the client
Objective:
> Facial Grimace
>Fatigue
>Pain scale of 7/10
>Good Capillary refill
>not in respiratory distress
>BP: 120/90mmHg
Activity intolerance R/T joint pain and muscle pain with fatigue
After 4 hours of nurse patient significant others interaction the patient will be able to:
>The patient will able to demonstrate an increase in activity tolerance
>Demonstrate and perform ADL desired
>Adjust activities
>Promote comfort measures and provide for relief of pain
>Assist the client in performing ADL of choice.
>Plan for progressive increase of activity level/participation in exercise training, as tolerated by client.
>Give the client information that provides evidence of daily/weekly progress to sustain
>Assist client in learning and demonstrating appropriate safety measures
>Encourage client to maintain positive attitude; suggest use of relaxation techniques, such as visualization/ guided imagery, as appropriate
>to prevent overexertion
>to enhance ability participate in activities
>To promote exercise and avoid muscle atrophy
>Both activity tolerance and health status may improve with progressive training
>to sustain motivation
>to prevent injuries
>to enhance sense of well-being.
After 8 hours of nurse patient significant other interaction the patient was able to cope fatigue and increase activity participation and demonstrate activity tolerance.
Treatment Action Contraindication Toxicity Intervention Safe Dose Paracetamol

Classification
Anti-pyretic Decreases fever by (1) hypothalmic effect leading to sweating and vasodilation
(2) inhibits the effects of pyrogens on the hypothalamic heat regulating centers. Renal insufficiency, anemia, liver failures. Clients with cardiac or pulmonary disease are more susceptible to toxicity Contraindicated in patients hypersensitive to drug.

Use cautiously in patients with long term alcohol use because therapeutic doses cause hepatotoxicity in these patients.

Hematologic: hemolytic anemia, neutropenia, leucopenia, pancytopenia.

Hepatic: Jaundice

Metabolic: Hypoglycemia

Skin: rash, urticaria.
Use liquid form for children and patients who have difficulty swallowing.

In children, don’t exceed five doses in 24 hours.

Advise patient that drug is only for short term use and to consult the physician if giving to children for longer than 5 days or adults for longer than 10 days.

Advise patient or caregiver that many over the counter product contain acetaminophen; be aware of this when calculating total daily dose.
Adults and children 500-1000 mg orally every 4-6 hours. Paracetamol

Classification
Anti-pyretic
Isoprinesine
Therapeutic Effect Action Contraindication Toxic/Side effects Intervention Safe Dose Anti-herpes Used as an immune stimulator for AIDS, herpes and cancer.
as a double mode of action that enables a fast and vigorous immune system response at the same time that it prevents viral replication, quickly resulting in the disappearance of clinical symptoms. First trimester of pregnancy, caution advised with any drug. no side effects have been reported with the use of isoprinosine for two to five daysin the limited research available however, unused disoprinosine is converted by the body to uric acid, which may be hazardous to people at risk for gout Viral Infection 500mg tablet
Drug Study
Ibuprofen
Therapeutic effect Action Contraindication Toxic/Side effects Intervention Safe Dose anti-inflammatory, analgesic and antipyretic exhibits anti-inflammatory, analgesic and antipyretic activities. Its analgesic effect is independent of anti-inflammatory activity and has both central and peripheral effects. It potently inhibits the enzyme cyclooxygenase resulting in the blockage of prostaglandin synthesis. It also prevents formation of thromboxane A2 by platelet aggregation. Active peptic ulcer; hypersensitivity. Neonates with congenital heart disease, suspected necrotising enterocolitis and active bleeding (parenteral). Dyspepsia, vomiting, abdominal pain, heartburn, nausea, diarrhoea, epigastric pain, oedema, fluid retention, dizziness, rash, tinnitus. Parenteral: Intraventricular haemorrhage, skin irritation, hypocalcaemia, hypoglycaemia, GI disorders, anaemia, apnoea, respiratory infection, sepsis. Relief of signs and symptoms of rheumatoid arthritis and osteoarthritis
Relief of mild to moderate pain
Treatment of primary dysmenorrhea
Fever reduction
Unlabeled uses: Prophylactic for migraine; abortive treatment for migraine 400mg

Pathophysiology