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Calayan Education Foundation Inc

Case Study
Ulcerative Stomatitis



Submitted to:
Mrs. Wilma Oreto Rivadenera

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: Theres 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
Nananakit ang
mga kasukasuan
ko at ang aking
mga kalamnan at
nakakaranas ako
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,
dont 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



Jagged teeth, cheek biting, and
mouth breathing
Sensitivity to mouthwashes
Inflammation of the mucous
membranes of the mouth
mucositis
Recurrent aphthous ulcers
or canker sores
Ulcerative Stomatitis