Indian Journal of Palliative Care
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  In this Article
 »  Abstract
 »  Introduction
 »  Mouth care
 »  Naso-gastric tubes
 »  How to use and c...
 »  Tracheostomy Care

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NURSING PRACTISES
Year : 2006  |  Volume : 12  |  Issue : 2  |  Page : 77-80

Home care nursing advice for patients with head and neck cancer in India


Palliative Care Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu, India

Correspondence Address:
Shakila Murali
Palliative Care Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.30250

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 » Abstract 

Please feel free to print and use this article to support patients and their families. You may wish to translate or alter this depending on your local needs. If you are only using one section, remember to include the introduction. The advice contained in this article is aimed to support patients who have limited access to hospital care and equipment.


Keywords: Head and neck cancer, home care, mouth care, naso-gastric tube, nursing, palliative, tracheostomy


How to cite this article:
Rosemund S, Murali S, Leng M. Home care nursing advice for patients with head and neck cancer in India. Indian J Palliat Care 2006;12:77-80

How to cite this URL:
Rosemund S, Murali S, Leng M. Home care nursing advice for patients with head and neck cancer in India. Indian J Palliat Care [serial online] 2006 [cited 2020 Aug 4];12:77-80. Available from: http://www.jpalliativecare.com/text.asp?2006/12/2/77/30250



 » Introduction Top


This article is written to help you and your family know how to care for some common problems that are faced by people with your illness. These problems can cause much distress. They can make simple things like communicating very difficult. While we may not be able to take away all the difficulties there is much that can be done to ease the problems. The article describes how to do mouth care, look after a tracheostomy and use a naso-gastric tube. It is general advice and could be supported by discussion with your doctor or nurse.

Preparing saline solution

Sometimes these problems can make it difficult to eat and drink. The advice in this leaflet should help but often a person who is ill does need or want the usual amount of food. It is best to avoid forcing down a large meal, but rather to have small tasty amounts of food and plenty of fluids.

The following solutions will be needed and can be prepared at home.

Take 500 mls of drinking water and add one teaspoon of salt.

Boil, cool and keep covered till needed.

Take 500 mls of boiled water and add a quarter teaspoon of soda bicarb. (Soda bicarb is the same as idly/appam soda.)


 » Mouth care Top


Preparing soda bicarb solution

What is mouth care and why is it needed?

A clean, fresh, comfortable mouth is very important for patients. It helps with comfort, communication and feeding. Many people with head and neck cancer have problems with their mouth. This can be related to the disease itself, to the treatments or other problems. Many patients will need help with their mouth care.

Main problems

Dry mouth (this may affect up to half of all patients and can be very troublesome)

Sore mouth

Infection

Assessment

The mouth (including the lips, gums, tongue, teeth and palate) should be carefully examined every day to look for any problems.

Things to look for

Cracked lips, sores at the corner of the mouth, dry or coated tongue, white curd-like patches on the surface of the tongue or around the gums and palate, ulcers in the mouth, redness and dryness thoughout the mouth and bleeding.

Things to ask about

Pain in the mouth; including when trying to swallow. Difficulty chewing or speaking due to dryness.

Management

  • Assist the patient in brushing and cleaning the mouth, tongue and teeth.
  • If brushing is difficult then a small gauze or clean cloth can be used.
  • For a coated tongue a soft baby's toothbrush or clean cotton cloth can be used. Also helpful is using a solution of soda bicarb to assist cleaning.
  • Rinse the mouth before and after food using warm water or saline solution.
  • If the mouth is dry, saliva production may be stimulated by sucking a piece of pineapple or sipping fresh lime juice. Be careful with this if there are ulcers or pain.
  • Regularly apply a simple vegetable oil, such as coconut, to the lips. A few drops can also be smeared on the tongue. Often it is best to ask the patient to do this himself.
  • Frequent sipping of water can also be helpful so ensure a cup is nearby.


Troubleshooting

  • If the dry mouth is severe consult with your doctor who may be able to adjust any drugs to help.
  • If there are white curd-like patches, especially with pain on swallowing, there is likely to be a fungal infection and the doctor will prescribe some specific treatment.
  • If pain persists you will need general painkillers which your doctor can prescribe.
  • If there is an unpleasant smell there may be bacterial infection and your doctor may give antibiotics as tablets or metronidazole solution.



 » Naso-gastric tubes Top


What is a naso-gastric tube?

A naso-gastric tube is a plastic tube passed through the nose into the stomach and left in place. A piece of sticking plaster is usually used to keep the tube attached to the nose. It may be in place for a short time or even for many weeks. It is mainly used to pass food, fluids and drugs directly to the stomach when there is difficulty eating by mouth. It needs to be kept clean and free of blockage.


 » How to use and care for a naso-gastric tube Top


Articles needed

Dry towel, 20 ml syringe, glass of water, glass of liquid food.

Preparation of liquid food

Simple home foods can be used depending on the patient's choice and what is available. This can include foods such as porridge, rice gruel, soup, juice, milk or curd. More solid foods such as idly, fish, vegetables, dals or meat can be used if cooked well and ground finely. The usual food cooked for the family can also be used. Any food to be given should be ground finely with a mixer or mashed with a large spoon. Liquid is added to make a thin consistency and then filtered through a strainer such as that used for tea. Patients who cannot swallow can still taste a tiny amount which can give pleasure.

Procedure

  • Place the patient in a sitting position. If unable to sit, place 2-3 pillows under the head and shoulders.
  • Wash hands well with soap and water.
  • Place a dry towel around the neck to catch any spills.
  • Fix the syringe to the end of the naso-gastric tube.
  • Gently pull back and make sure it fills with stomach contents. This checks the tube is still in the correct place in the stomach.
  • Take off the syringe and remove the central piston or inner tube from the syringe.
  • Re-fix this outer part of the syringe to the end of the tube.
  • Pinch the tube to prevent air going down the tube.
  • Hold the end of the tube about 12 inches above the patient's head.
  • Slowly pour the prepared liquid food, fluid or drugs into the outer syringe. It should flow slowly and steadily. Do not force fluids to go through.
  • Take care not to let air enter as this will cause wind and discomfort for the patient.
  • Flush the tube at the end of the feed by pouring enough drinking water to clear the tube. Around half a small cup. (50 ml)
  • Give small amounts of feed regularly. Usually a small cup or 150 mls is enough.
  • Remember to add salt to the feeds. Most patients require around 2 teaspoons of salt per day.
  • Once every 3-4 days repeat this procedure using only warm saline solution to clean thoroughly and prevent coating of the tube which may lead to blocking.
  • Occasionally change the sticking plaster that keeps the tube attached to the nose. This is not needed every time.


Troubleshooting

  • If the fluid is not flowing well, then first check it is still in place by looking for stomach contents when you pull back on the syringe. You may also notice that the tube has slipped out and appears much longer.
  • If the tube is in the correct place it may be becoming blocked so increase the number of times you flush and clean it with warm saline. Using soda bicarb solution to flush may be more effective.
  • If the tube has come out of the stomach or is completely blocked you will need to seek advice from your doctor or nurse.



 » Tracheostomy Care Top


What is tracheostomy care and why is tracheostomy care needed?

A tracheostomy is an opening made in the front of the wind pipe. A tube is then inserted into the opening to help with breathing. There will be a metal outer tube which stays permanently in place and a metal inner tube regularly removed for cleaning.

Tracheostomy care includes changing and cleaning the inner tube, cleaning around the site and changing dressings. It should be carried out daily or more often if needed and will take around twenty minutes. The inner tube should always be in place except when cleaning.

How ?

Articles needed

Clean cotton cloth pieces (cotton balls and gauze may be used if available), two small cups, saline solution, sodium bi-carbonate solution, paper cover to dispose the waste.

Procedure

  • Position the patient in a sitting position. If unable to sit place 2-3 pillows under the head and shoulders.
  • Wash hands well with soap and water.
  • Remove the cloth or gauze from around the tracheostomy.
  • Gently remove the inner tube and place in a cup with sodium bi-carbonate solution.
  • Clean the tube by passing a cloth or gauze piece through the tube and then remove.
  • Rinse the tube thoroughly with water, allowing the water to run freely through the tube.
  • Boil the inner tube in water for ten minutes then allow to cool and dry.
  • Clean around the tracheostomy area and outer tube with saline solution.
  • Place a saline soaked cloth or gauze around the outer tube leaving the opening clear.
  • Replace the inner tube by holding the outside edge and gently inserting back into the outer tube.
  • Place another saline soaked gauze over the opening. Covering the opening avoids dusts or insects getting into the tube and also helps moisten the air breathed by the patient. Cotton cloth can be used only if it is of a very fine mesh as air needs to pass through.
  • Provide some rag pieces and encourage the patient to cough out any secretions through the tracheostomy tube.


Troubleshooting

  • If the inner tube is becoming blocked by mucus or blood you may increase the cleaning up to three or four times a day.
  • If the tube becomes totally blocked or there are breathing difficulties, then try removing the inner tube to let the air pass through. If it remains blocked consult a doctor or nurse.
  • If you are not able to reinsert the inner tube then cover the area with a wet gauze and consult a doctor or nurse.
  • If the patient is having fever and increased sticky secretions then consult your doctor.





 

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Online since 1st October '05
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