A.V.

TIME SPECIFIC CONTENT TEACHER STUDENT AIDS EVALUATION

OBJECTIVES ACIVITY
A ACTIVITY
00:00 Chalk
Board
INTRODUCTION OF TOPIC:-
As we are human being we have basic needs those are
food, clothing, and shelter. Yes the 1st one is food. We are
surviving on food only. We are taking it by mouth and fulfilling
our body requirements. We are eating eatable substance but some Introducin
of individuals taking unnecessary food which causing sever illg
effects……. topic by
ANNOUNCEMENT OF TOPIC:- Asking
The ill effects may affect to the any part of the GI tract Question
and the 1st affecting organ is mouth i.e. oral cavity and most
dangerous one is malignancy
What is that? Yes, That is cancer of oral cavity……. Answerin
Announci g
ng
DEFINITION OF ORAL CANCER of topic
Define oral Carcinoma of the oral cavity may occur on the lips or and P What is the
00:01 cancer. anywhere within the mouth which includes tongue, floor of the writing P definition of
mouth, buccal mucosa, hard palate, soft palate, pharyngeal walls on black oral
T
and tonsils. board Cancer?
Listening
Enumerate Etiology & Risk factors What is
the The development of oral cancer is dearly linked to a history of mean by
etiological smoking and alcohol consumption and the risk increases strongly Carcinom
& risk with heavy use. The exact cause of oral cancer is not clear, buta? What are
factors of there are number of predisposing factors which includes: Answer P the etiological
oral cancer. • Constant over-exposure to ultraviolet radiation from the sun, for &P
cancer lips. What is T risk factors of
• Tobacco usage (smoking and chewing), i.e. pipe and cigarette Cirrhosis Listening oral cancer?
smoking, snuff, chewing tobacco. of & Writing
• Chronic alcohol intake (excessive use of alcohol). Liver? notes
 • Chronic irritation (jagged tooth, ill-fitting prosthesis, chemical or
mechanical irritants).
• Ruddy fair complexion leads to lip cancer.
• Syphilis, immunosuppression leads to lip cancer. • Recurrent
herpetic lesions.
• Poor oral hygiene.
• Hot and spicy foods or drinks.
• Malnutrition.
• Cirrhosis of the liver.
• Age over 45 years.
• Family history of oral cancer.

Explain the Pathophyslology How oral

pathophysi cancer occurs?
ology of Due to etiological factors such as chewing tobacco
oral cancer. Answer

It affects the layers of oral mucosa, which form an oral ulcer &
infection Listening
& Writing
What are notes
Development of malignancy arise from squamous cells, which line the layers
the surface oral epithelium, epidermoid, basal cell & otherof
carcinoma arises. oral
cavity.

Formation of majority of tumors on the lateral or ventral

Surface of the tongue & rarely on the dorsal surface.

The tongue has on abundant vascular supply and lymphatic

Drainage channels
 Spread of the cancer to adjacent structure rapidly

Metastasis to the neck occurs at the time of diagnosis, sign

& symptoms occurs.

Clinical Manifestations
What are the
Many oral cancers are asymptomatic in the early stages. The sign and
Discuss the premalignant lesions of the oral cavity are: symptoms of
clinical • Leukoplakia— is potentially precancerous, yellow-white or grey oral cancer?
manifestati white lesions may occur in any region of mouth also called "white Answer
ons of oral patch" or "smoker's patch". Leukoplakia is the result of chronic
cancer. irritation usually from the smoking and Candida infection. What is
• Hyperkeratosis- The patch becomes keratonical (hard and Leukopla- Listening
leathery) is sometimes described as hyperkeratosis. kia? & Writing
• Erythroplasia— is a red, velvety-appearing patch that is often notes
indicative of early squamous cell carcinoma occurs on the mouth
or tongue. These may turn to malignant.

Cancer of the lip usually appears as an indurated, painless ulcer on

the lip. The first sign of carcinoma of tongue is ulcer or area of
thickening. Soreness or pain of the tongue may occur, especially
on eating hot or highly-seasoned foods. Cancer lesions are most
likely to develop in the proximal half of the tongue. T.ater
symptoms of cancer of the tongue include increased salivation,
slurred speech, dysphagia, toothache, and earache.
 Approximately 30% of oral cancer present with an asymptomatic
neck mass. Anyhow, the common clinical manifestation of oral
cancer are as follows:
• Masses in the mouth or neck.
• Otalgia.
• Enlarged lymp nodes (cervical nodes are commonly affected). Answer
• Ths comfort or burning.
• Ulcer on lateral or ventral surface of the tongue or elsewhere. What is
• Dysphagia. Otalgia? Listening
• Visible lesions on lips or elsewhere. & Writing
• Presence of erythroplasia (bright red, velvety leisions). notes What are the
diagnostic
Diagnostic Evaluation:- evaluation of
oral cancer?
• Biopsy of the suspected lesion with cytologic examination. It
may be used to evaluate lymph nodes, leukoplakia or
erythroplasia.
Describe • Ultrasonography is an excellent adjust to evaluate masses that are
the closed to the surface.
diagnostic • Computed tomography (CT) scans may be used to evaluate
evaluation deeper, less definite masses.
of oral • Magnetic resonance imaging (MRI) is most useful in the effort to
cancer. evaluate deep masses of the inconclusive structure.

Treatment

Treatment of oral cancer depends on the location and staging of

the tumor. Early-stage cancer is usually treated by either radiation
or surgery, depend upon the size and accessibility of the tumor.
More invasive cancers may require both modalities and advanced
cancers are treated palliatively. Answer
What is
Chemo-
Therapy? Listening
 Radiation Therapy for Oral Cancer & Writing
Early lesions are highly curable with radiation, if they are confined notes
Explain the to the mucosa, and the use of radiation prevents widespread tissue
medical & destruction. Radiation maybe delivered by external beam or
surgical through the insertion of needle. If both radiation and surgery are
manageme planned, the radiation therapy is usually administered after the
nt of oral surgery because irradiated tissue is more susceptible to infection
cancer. and breakdown. Care of the patient with implanted radioactive
needles in oral tissue includes the following:
• Implant care
- Do not pull on the strings. Any movement could alter the
placement or direction of the radiation or cause the needles to
loosen.
- Check needles-patency several times each day.
- Monitor linens, bed areas, and emesis basin, for needles that may
dislodge.
Ensure that a protective container is present in the room to contain
any needles that might dislodge. Patient care Answer
- Be familiar with gentle oral hygiene q 2h while awake.
- Encourage the patient to avoid hot and cold foods and beverages
as well as smoking. Listening
- If the patient has dentures, encourage their removal at night, for & Writing
comfort. Assess gums for irritations and bleeding whenever notes
dentures are removed.
- Provide viscous Lidocaine (Xylocainc) solution or lozenges as
needed, when oral discomfort interferes with nutrition.
- Provide the patient with an alternate means of communication,
talking around implanted needles is usually difficult or impossible.
- Assist the patient to implement the mouth care regimen
prescribed by the physician.
- The side effects of radiation therapy to the mouth and neck
include mucositis, xerostomia, and dental decay should be
reported and managed accordingly.
Surgical Management
Surgical management of oral cancers range from local excision of
small tumors to expensive surgery for invasive tumors. Some
examples are partial mandibulectomy, hemiglossectomy, resection
of the buccal mucosa and floor of the mouth and radical neck
dissection. etc. Chemotherapy and radiation therapy also may be
used along with surgical measures wherever indicated in palliative
purposes. Because of depression, alcohol or presurgery radiation
treatment patient may be malnourished even before surgery and
after the surgery also there may be chance to become
malnourished. For which nurse must observe for tolerance of the
feedings and adjust the amount, time and formula if nausea,
vomiting, diarrhea or distension occurs. The patient usually
instructed about the tube feedings. When the patient can swallow,
small amount of water is given. Close observation for choking is
essential. Suction may be necessary to prevent aspiration. While
managing the patient undergoing for surgery for oral cancer, the
nurse can follow the undermentioned guidelines for care.

• Preoperative
- Clarify the patient's knowledge of changes expected after
surgery.
- Explain expected postoperative measures including suctioning,
nasogastric tube, etc.
- Provide opportunities for the patient to begin to
express feelings about changes in body image. • Postoperative
1. Monitoring
Assess facial movement for facial nerve damage (if parotid gland
excised); ask the patient to raise the eyebrows, frown, smile, show
the teeth, pucker the lips.
Assess the degree and character of drainage.
- Amount of drainage and presence of blood should be mentioned.
- Hemorrhage may occur with wide resection of tongue.
2. Maintaining an adequate airway
• Gauze wick may be used to direct salive into an esnesis basin.
• Maintain patency of drainage tubes if used.
3. Promoting oral hygiene and comfort
Clean involved areas of the mouth with a cotton applicator
moistened with 11202 and saline.
Mouth irrigations.
- Use sterile equipment.
- Use a solution of sterile water, diluted H..O,,
normal saline, or sodium bicarbonate.
- Avoid commercial mouthwashes.
- Protect any dressings from getting wet.
- A catheter may be inserted along the side of the cheek and the
solution injected with gentle pressure; a spray may also be used.
- Give analgesia as indicated (pain is not usually severe).
4. Promoting nutrition
• Tube feedings will be used initially with hemiglossectomy.
• Oral fluids: Place in back of throat with asepto syringe or feeding
up with attached tubing.
Eating soft foods.
- Encourage the patient to feed self when possible. - Teach the
patient to drink clear water after all meals to cleanse the mouth.
- Avoid using a fork, which may traumatize new tissue.
- Avoid very hot or cold foods (hot foods may irritate new tissue
cold foods may cause facial pain or paralyze oral function.
5. Promoting speech
• Limit patient's response ixtudally to yes or no, which can be
answered by gestures.
• When ability speech returns, encourage patient to speak slowly.
• Listen carefully and validate communication before acting on
requests.
• Speak in a soft, dear voice.
• Refer the patient to a speech therapist if needed.
• Place the patient in sidelying position initially.
• Place the patient in Fowler's position when fully

6. Promoting body image

alert. • Prepare all visitors for visible outcomes of surgery.
• Suction the mouth (except for lop .surgery).
• Include the family in all teaching.
Encourage the patient to ventilate feelings about changes.
Encourage socialization with others.

Nursing Management of Oral Cancer Nursing assessment

Subjective and objective data should be collected as follows: The
subjective data include;
• Important health information:
- Past health history: Recurrent herpetic lesions, syphilis, and
exposure to sunlight.
- Medications: Use of immune suppressants.
- Surgical or other treatment—Removal of prior tumors.
• Functional health patterns:
- Health perception—health management:
Use of alcohol and tobacco, pipe smoking; Poor oral hygiene.
• Nutritional metabolic: Reduction in oral intake, weight loss,
difficulty in chewing, increased salivation, intolerance to certain
foods and temperatures of foods.
• Cognitive-perceptual: Mouth or tongue soreness or pain,
toothache earache, neck stiffness, dysphagia, difficulty in
speaking.

The objective data includes:

• Tntegumentary: Indurated, painless ulcer on lips painless
neckmasses
• Gastrointestinal: Areas of thickening or roughness, ulcers,
leukoplakia, or erythroplasia on the tongue, increased salivation,
drooling, slurred speech, foul breath odor.

Nursing Diagnosis
Nursing diagnosis for the patients with oral cancer may include the
following;
Altered nutrition; Less than body requirement related to oral pain,
difficulty in chewing, and swallowing, surgical resection, and
radiation therapy.
• Pain related to tumor and surgical radiation.
• Anxiety related to diagnosis of cancer, uncertain future, potential
for disfiguring surgery, recurrence bronchoscopy.
• Ineffective individual coping related to body image change,
smoking and alcohol cessation.
• Altered health maintenance related to lack of knowledge of
disease process and therapeutic regimen, and unavailability of
support systems.

Planning
The objective of oral cancer patient will include that the patient
will:
• Have a patent airway.
• Be able to communicate.
• Have adequate nutritional intake to promote healing. • Have
relief of pain and discomfort.

Implementation
The nurse should take preventive measures such as:
• Teach clients to avoid excessive use of tobacco, alcohol, hot and
spicy foods and drinks.
• Encourage use of sunscreen during exposure to sunlight.
• Screen smokers and drinkers of alcohol and teach them to stop
smoking and to limit alcohol intake.
• Ensure that client fix broken teeth and improperly-fitting
dentures.
• Teach persons at risk to observe for manifestation of cancer.
• Ensure that client's tumor is excised and followed with
chemotherapy and radiation as indicated.
• Provide nutritional support with tube feedings or feedings
through precaution endoscopic gastrostomy and gastrostomy tube.

Evaluation
The expected outcomes (objectives) that the patient with oral
cancer will:
• Maintain airway.
• Be able to communicate.
• Have adequate nutritional intake.
• Have relief of pain and discomfort.