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COLEGIO DE SAN JUAN DE LETRAN-CALAMBA

SCHOOL OF NURSING
CALAMBA CITY, LAGUNA
A. Background of the Study

Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may
involve in the cheeks, gums, tongues, lips, throat, roof or floor of the mouth. It’s a common infection that
may occur alone or as part of systemic disease.

The inflammation can caused by condition in the mouth itself, such as poor oral hygiene, poorly
fitted dentures or from mouth bums from hot food or drinks or by conditions that affect the entire body
such as medications, allergic reactions radiation therapy or infection.

The two main types of stomatitis are Acute herpetic stomatitisand Aphthous stomatitis. Acute
herpetic stomatitis is self limiting but may severe and fatal for neonates. There are other several types of
stomatitis. Gingivostomatitis involves the inflammation of the gingiva. Angular stomatitis involves the
irritation and fissuring in the corners of the lips, for children, it is frequently caused by repeated lip-licking.
This is a sign of iron deficiency anemia or Vitamin B deficiencies for adult. Periodorititis and Vincent’s
angina are also types of stomatitis.

Acute herpetic stomatitis result from the herpes simplex virus It’s common in children ages 1 to 3.
The cause of aphthous stomatitis is unknown, but predisposing factors include stress, fatigue, anxiety,
febrile states, trauma, and solar overexposure. This type is common in girls and female adolescents.
Acute herpetic stomatitis begins suddenly with mouth pain, malaise, lethargy, anorexia, irritability,
and fever, which may persist for 1 to 2 weeks. Gums are swollen and bleed easily, and the mucous
membrane is extremely tender.
Papulovesicular ulcers appear in the mouth and throat and eventually become punched-out lesions
with reddened areolae. Submaxillary lymphadenitis is common. Pain usually disappears 2 to 4 days before
healing of ulcers is complete. If the child with stomatitis sucks his thumb, these lesions spread to the hand.

B. Rationale for Choosing the Case

The researchers decided to choose this case because they wanted to help the person behind this study. This
particular individual caught the researcher’s attention which encouraged them to provide relie. The researchers also
chose this case because of its rarity, thus taking the opportunity to discuss the disease and prove its content on why
they have chosen this case despite all the available cases present in their attended area.
C. Significance of the Study

This study will serve as a guide that will offer information for the nursing profession in conducting proper
management and care for Stomatitis. It can be useful for it will increase people’s awareness, increasing their knowledge
to help them prevent from acquiring the disease. It will be beneficial especially for the individuals who have the disease
to help prevent, control, manage, or cure the disease. This work will involve environmental aspects and life style issues
regarding the disease.

D. Scope and Limitations of the Study

This study is confidential, and may only be used by the authors who created it and their educator. It may not be
redistributed without the authority of the said persons. This study focuses on giving relief for the particular person
behind the study. Its authors focused their attention on the diagnostic tests, medications, nursing care plan and the
background of the said disease.

PATIENT’S PROFILE
NAME: Manuel Colorina
AGE: 1 year and 4 months old
SEX: Male
BIRTHDAY: August 8, 2008
ADDRESS: Brgy. Dila, Bay, Laguna
CIVIL STATUS: Toddler
RELIGION: Roman Catholic
DATE OF ADMISSION: December 8, 2009
DIAGNOSIS: Stomatitis Oral Thrush r/o TF

CHIEF COMPLAINT:
Fever of 39.3 degree Celsius

PAST HEALTH HISTORY

○ 1 year old- Patient was Hospitalized due to Bacterial Infection


○ Common coughs and cold
○ The patient has asthma, his pediatrician has given him a maintenance medicine.

PRESENT HEALTH HISTORY

4 days PTA - The patient acquire mouth sores


1 day PTA - The patient has fever
FEW hours PTA - Patient’s fever is 39.3 degree Celsius
PHYSICAL ASSESSMENT
BODY ASSESSMENT
PART
Nose • Clogged nose
Mouth • With sores
Tongue • Whitish
Uvula • With sores, minimal
than before
Skin • With rashes

GORDON’S FUNCTIONAL HEALTH PATTERNS


PRIOR TO HOSPITALIZATION DURING THE HOSPITALIZATION
NUTRITIONAL-METABOLIC The patient usually drinks 10-11 The patient hardly finish a
PATTERN 6 ounces bottle of milk a day. He likes bottle of milk. He usually drinks up to
to eat rice with mashed sayote and 2 ounces but still vomits it. He eats
squash. rice but not as plenty as before, he
just eat about 3 to 5 spoon of rice.
ELIMINATION PATTERN The patient usually use up to 6 The patient usually use up to
diapers per day full of urine. The kind 2 diapers full of urine. He cannot
of urine he has is yellowish. He defecate. The patient defacate a liitle
defecates twice or thrice a day. The amount a day ago and still haven’t
stool is a soft and greenish-yellowish defecate now.
in color. The patient is usually sweaty
because of his hyperactivity in
playing.
ACTIVITY-EXERCISE PATTERN The patient is active and The patient just lie in his bed
always play around with playmates or or sitdown. He wants to play but is
none. He spends his day playing. weak. He is irritable and tends to cry
whenever he see people in blue
uniform.
SLEEP-REST PATTERN The patient sleeps at least 1 to 2 The patient wakes up in the
hours in the morning and afternoon middle of the night when nurses enter
and sleeps regularly for 10 hours at their room and starts to cry. He
night. The patient only wakes up in cannot sleep continuously and is
the middle of the night to ask for milk easily disturbed.
and then goea back to sleep easily
after.
LABORATORY AND DIAGNOSTIC EXAMINATION

DATE PROCEDURE NORMS RESULT INTERPRETATION


December 8, 2009 Complete Blood Count
Hgb M=13-18gms%, C=14- 13.4
Hct 26gms% 42.3
WBC M= 40-54 5700
RBC 5000-10000 cumm
Differentiial Count 4.6
Segmenters 4.5-5.5 45
Lymphocytes 55-65 53
Monocytes 25-35 02
3-7
December 9, 2009 Urinalysis
Color Slightly hazy
Reaction 5.0
Specific Gravity 1.030
Sugar Negative
Albumin
WBC
RBC
Spith cell
December 10, 2009 Complete Blood Count
Hct M= 40-54 37
Platelet Count 150,000-450,000 170,000

December 11, 2009 Complete Blood Count


Hgb M=13-18gms%, C=14- 14.2
Hct 26gms% 45.0
WBC M= 40-54 4000
RBC 5000-10000 cumm 5.0
Differentiial Count 4.5-5.5
Segmenters 13
Lymphocytes 55-65 81
Monocytes 25-35 06
3-7
DISEASE OVERVIEW
Stomatitis is an inflammation of the mucous lining of any of the structures in the mouth, which may involve in
the cheeks, gums, tongues, lips, throat, roof or floor of the mouth. It’s a common infection that may occur alone or as
part of systemic disease.

The inflammation can caused by condition in the mouth itself, such as poor oral hygiene, poorly fitted dentures
or from mouth bums from hot food or drinks or by conditions that affect the entire body such as medications, allergic
reactions radiation therapy or infection.

The two main types of stomatitis are Acute herpetic stomatitisand Aphthous stomatitis. Acute herpetic stomatitis
is self limiting but may severe and fatal for neonates. There are other several types of stomatitis. Gingivostomatitis
involves the inflammation of the gingiva. Angular stomatitis involves the irritation and fissuring in the corners of the
lips, for children, it is frequently caused by repeated lip-licking. This is a sign of iron deficiency anemia or Vitamin B
deficiencies for adult. Periodorititis and Vincent’s angina are also types of stomatitis.

Acute herpetic stomatitis result from the herpes simplex virus It’s common in children ages 1 to 3. The cause of
aphthous stomatitis is unknown, but predisposing factors include stress, fatigue, anxiety, febrile states, trauma, and
solar overexposure. This type is common in girls and female adolescents.
Acute herpetic stomatitis begins suddenly with mouth pain, malaise, lethargy, anorexia, irritability, and fever,
which may persist for 1 to 2 weeks. Gums are swollen and bleed easily, and the mucous membrane is extremely
tender.
Papulovesicular ulcers appear in the mouth and throat and eventually become punched-out lesions with
reddened areolae. Submaxillary lymphadenitis is common. Pain usually disappears 2 to 4 days before healing of ulcers
is complete. If the child with stomatitis sucks his thumb, these lesions spread to the hand.
A patient with aphthous stomatitis typically reports burning, tingling, and slight swelling of the mucous
membrane. Single or multiple shallow ulcers with whitish centers and red borders appear and heal at one site and then
reappear at another

Diagnosis is based on the physical examination; in Vincent’s angina, a smear of ulcer exudate allows for
identification of the causative organism.
For acute herpetic stomatitis, treatment is conservative. For local symptoms, supportive measures include warm
salt-water mouth rinses (antiseptic mouthwashes are contraindicated because they are irritating) and a topical
anesthetic to relieve mouth ulcer pain. Topical antihistamines, antacids, or corticosteroids may also be recommended.
Supplementary treatment includes a bland or liquid diet and, in severe cases, I.V. fluids and bed rest.
For aphthous stomatitis, primary treatment is application of a topical anesthetic. Effective long-term treatment
requires alleviation or prevention of precipitating factors.
PATHOPHYSIOLOGY

Mechanical
Factors
– Poor oral
hygiene
– Mouth
burns (hot
food or
drinks)
– Poor eating
ANATOMY AND PHYSIOLOGY
Chemical Factors
– Medications
Mouth-Buccal/Oral Cavity Biological Factors – Allergic
Iron deficiency anemia reaction
1. Lips and Cheeks – Radiation
• made up of skeletal muscles covered by a skin
therapy
• keep food in mouth while chewing
1. Palate – Infection
a. Hard
• Covers bone and provides hard surface against which the tongue forces food
a. Soft
• Ends at uvula
• When food is swallowed, soft palate rises as a reflex to close oropharynx
1. Tongue
• Contains mucus and serous glands, taste buds
• Mixes food and saliva during chewing, forms the food into a mass (bolus)
STOMATITIS
• Initiates swallowing
Signs and
Saliva Symptoms
• Produced
- halitosis by the salivary gland
- soreness
• Moistens of mouth
food to form bolus
- excessive
• Dissolves food salivation
substances that begin chemical breakdown of starches
-mouth bleeding
1. Teeth
• Used to chew (masticate)
• 32 permanent
• embedded at the gingiva
NURSIING CARE PLAN

ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Imbalanced After 8 hours of – Encouraged – To increase Goal partially


“Hindi pa rin siya Nutrition less than nursing family appetite met.
masyado kumakain body requirements intervention, the members to for food After nursing
at konti lang ang related to mouth patient will be do proper intervention the
dinedede niya” as ulcer able to eat or oral hygiene patient’s
verbalized by the drink properly if to the appetite
patient’s mother not, at least have patient increased and
an intake of a – To consumed 6
Objective: quarter of food – Encouraged stimulate ounces of milk.
– (+) mouth served family appetite
ulcer members to
– Disagreed to bring food
eat that seem
appealing

– Applied – To
topical decrease
ointment the
(Rowagel) presence
to mouth of mouth
ulcers sores
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Risk for After 8 hours of – Reviewed – To Goal partially


constipation nursing medications determine if met.
“Hindii pa siya related to poor intervention the there are After nursing
nakakadumi eating habits patient’s mother drugs that intervention
simula pa nung will be able to contributes shown
isang araw, may know the things to understanding on
bahid lang ng she should do to – Instructed constipation what she should
dumi khapon, un manage the mother do in managing
na” as verbalized constipation to have the – To improve constipation
by the patient’s child be fed consistency
mother by food rich of stool and
in fiber facilitate
Objective: passage
– Restlessness through
– Irritability colon
– Disagreed to – Suggested
eat to increase
fluid intake – To promote
including soft stool
fruit juices and
stimulate
bowel
activity
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION RATIONALE EVALUATION

Subjective: Sleep deprivation After 8 hours of – Evaluated – To Goal partially


“Hindi siya gaano related to Nursing drugs that determine met.
makatulog, uncomfortable Intervention, the are whether the After nursing
paputol putol pa sleep patient will be affecting drugs affect intervention, the
tuwing gabi gawa environment able to sleep at sleep the sleeping patient has been
ng mga least 2 hours pattern able to sleep for 5
pumapasok na without hours without
nurse” as interruption – To disturbance.
verbalized by the – Noted determine if
patient’s mother Environmen it affects
tal factors the sleeping
Objective: affecting pattern
– (+) sleep, such
irritability as
– (+) uncomforta
restlessness ble
environmen
t and
excessive – To manage
noise. sleep
disturbance
– Provided
calm, quiet
environmen
t
ASSESSMENT DIAGNOSIS PLANNING INTERVENTION EVALUATION

Subjective: Impaired skin After 8 hours of – Reviewed Goal was partially


“Bigla siya integrity related nursing medication met.
nagkaroon ng to rashes in the intervention the After nursing
mga rashes sa body patient’s rashes – Palpate skin intervention the
katawanniya” as will decrease and lesions rashes has
verbalized bythe will not cause – Inspected decreased and
mother another surrounding itchiness subsides
complications for
Objective: erythema
Conscious and – Noted skin
coherent color,
(+) rashes texture
(+) pruritis – Maintain
(+) itchiness appropriate
moisture
environmen
t

DRUG STUDY
DRUG CLASSIFICA INDICATION CONTRAINDICATIO ACTION SIDE EFFECTS NURSING
NAME TION N CONSIDERA
TION
Brand Analgesics – Fever – skin rashes
Name: and – Headache – other
Tempra antipyretic – Muscular allergic
Syrup aches reactions
Generic – pain
Name:
Paracetam
ol
Dosage:
6mL P.O.
PRN
Frequency
:
q 4 hrs.
T>37.8
Brand Immunostimu – Shor - Inosiplex is – Elevation
Name: lant tens the a potent and of serum
Immunosin course of safe and urine
Generic illness and immunostimu uric acid
Name: reduces lant it values
the enhances which
Dosage: severity of and return to
3.5ml PO symptoms stimulates normal of
Frequency of resp certain the
: infection cellular cessation
TID aspects of of drug
the immune administra
response tion.
Brand Antibiotic – respiratory – hypersensitivit - Penicillin – GI
Name: – GIT y binds to disturbanc
Pediamox – GUT protein es
Generic – Skin receptors, – Allergic
Name: and soft cell wall of reaction
Amoxicillin tissue bacteria is –
trihydrate infection synthesis.
Dosage: Cell division
4ml PO and growth
Frequency are inhibited.
:
TID
Brand Antihistamine - Symptomatic – Hypersensitivit - potent H1 – drowsiness
Name: relief of allergic y receptor – sore throat
Alnix rhinitis , skin – Impaired renal antagonist. – headache
Generic symptoms of function Mild – dry mouth
Name: allergy bronchodilato
Cetirizine r that
hydrocholo protects
ride against
Dosage: histamine
1.3ml HS induced
PO anticholirgeni
Frequency c and
: sedative
OD activity