# Situation: A 49-year-old woman is receiving chemotherapy and radiation to the head and neck for oral cancer. She wears an upper denture. Her oral mucosa is red and painful with several small ulcers. Which mouth care should the nurse teach?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630466  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 49-year-old woman is receiving chemotherapy and radiation to the head and neck for oral cancer. She wears an upper denture.

Her oral mucosa is red and painful with several small ulcers. Which mouth care should the nurse teach?

## 보기

1. Brush with a firm toothbrush to clear food debris
2. Rinse after meals with an alcohol-based mouthwash
3. Rinse often with a salt or baking soda solution **✔ 정답**
4. Moisten the mouth with lemon-glycerin swabs often

**정답: 3**

## 해설

Oral mucositis (stomatitis) is the most common acute oral complication of head and neck radiation. Frequent bland rinses with saline or sodium bicarbonate, a soft toothbrush, and topical anesthetics before meals keep the mouth clean with less pain. Alcohol-based mouthwash, rough brushing, and acidic or drying products injure the mucosa further.

## 심화 해설

Recognizing oral mucositis
Chemotherapy and radiation to the head and neck injure the rapidly dividing cells of the oral lining. The result is oral mucositis (stomatitis): red, painful mucosa with ulcers, the most common acute oral complication of head and neck radiation. Frequent bland rinses with saline or sodium bicarbonate solution keep the mouth clean and soothe the mucosa with less pain. These rinses remove debris and bacteria without drying or burning the tissue.

Principles of mouth care in mucositis
Mouth care aims to keep the mucosa clean, moist, and intact while avoiding further injury. Key measures include: rinsing often, for example after meals and at bedtime, with a salt or baking soda solution; brushing gently with a soft toothbrush or foam swab; removing and cleaning the denture, and leaving it out when the mouth is very sore; using topical anesthetics before meals if prescribed; choosing soft, bland, moist foods; and avoiding alcohol, tobacco, and spicy or acidic foods. The nurse also inspects the mouth daily for infection such as candidiasis.

| Option | Effect on inflamed mucosa | Verdict |
| --- | --- | --- |
| Firm toothbrush | Traumatizes ulcers and causes bleeding | Avoid; use a soft brush |
| Alcohol-based mouthwash | Dries and burns the mucosa | Avoid |
| Salt or baking soda rinses | Clean and soothe without irritation | Correct |
| Lemon-glycerin swabs | Acidic and drying; irritate ulcers | Avoid |

Why the distractors cause harm
A firm toothbrush injures inflamed tissue and can open new ulcers. Alcohol in commercial mouthwashes dehydrates the mucosa and causes stinging pain. Lemon-glycerin swabs seem moistening, but lemon is acidic and glycerin draws water from tissue, so they dry and irritate the mouth. Each of these increases pain and the risk of infection.

Watch out! Products marketed for freshness or moisture are not always safe in mucositis. Check whether they contain alcohol, acid, or drying agents.

Exam takeaway
Key point! For oral mucositis, teach frequent bland saline or sodium bicarbonate rinses and a soft toothbrush; avoid alcohol mouthwash, firm brushing, and lemon-glycerin swabs.

## 임상 시나리오

Mouth Care in MucositisHead and neck radiation and chemotherapy
Red, painful mucosa with small ulcers is oral mucositis, common with head and neck radiation and chemotherapy.

Teach frequent saline or baking soda rinses, a soft toothbrush, denture removal and cleaning, and soft bland foods; topical anesthetics before meals if prescribed.

Inspect the mouth daily for infection such as white plaques of candidiasis.

CautionAvoid alcohol-based mouthwash, firm brushes, and lemon-glycerin swabs; they dry and injure the mucosa.

## 핵심 개념

- **Oral mucositis** — Inflammation and ulceration of the mouth lining caused by chemotherapy or radiation.
- **Stomatitis** — Inflammation of the mucous membranes of the mouth.
- **Sodium bicarbonate rinse** — A mild baking soda solution used to clean the mouth and neutralize acids.
- **Lemon-glycerin swab** — An acidic, drying mouth swab that irritates inflamed oral mucosa.

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