Event 5: How’s Margaret Doing

One Month

It has been one month since Margaret’s dental procedure. She is still avoiding using one side of her mouth when eating and brushing her teeth, and occasionally pulls on her cheek. Although she has some confusion and occasional irritability, she is more cooperative with staff. She is willing to walk with her walker, though she has to stop to rest.

Margaret is pacing less, smiling more. PAINAD score 0 and Mini-Cog™ attempted but unable to be completed due to communication deficits. She requires assist with flossing and initiating brushing her teeth. She has not been combative. She is eating 75% of all her meals in the dining room with other residents of the nursing home. She occasionally pulls at her lip and cheek, but mostly after meals or oral care. She has regained 3 pounds.

After 6 Months

Six months after the dental procedure Margaret seems to be back to her normal self that she was when she was first admitted to Meadow Lane nursing facility she shows no signs of irritability when interacting with staff. She eats regularly and participates in oral health care with tooth brushing and assists for flossing she is back to walking confidently with her walker.

Margaret is participating in some activities with other residents when she is able. PAINAD score 0. She has not been combative. She is eating 100% of all her meals in the dining room with other residents of the nursing home. She will request a snack 2-3 times a week. She has regained 6 pounds. She has been able to go on outings with her grandson to church once a month and has visitors 1-2 times a week.

Oral Health Promotion

Review the elements listed that are important to oral health promotion. We have listed the level of evidence for each strategy.

  • Brush teeth at least once a day if possible (strong evidence)
  • Clean between teeth once a day if possible (strong evidence)
  • Remove and clean dentures at bedtime and then soak them in water (strong evidence)
  • Keep mouth moisturized (Moderate evidence)
  • Visit dentists regularly (Moderate evidence)

Next Steps

Margaret has completed her dental treatment until her next recommended dental exam. She has regained her lost weight, decreased agitation, and decreased pain with PAINAD assessment. The following cover goals and next steps for Margaret.

Oral Care

  • Goal: Margaret will improve her oral hygiene with assist as needed for tooth brushing as part of an oral health program with periodic examination by a dentist.
  • Intervention: Assist with toothbrushing, periodic examination as recommended by a dentist.

Functional Mobility and Cognition

  • Goal(s): Margaret will be as independent as possible in functional mobility with assist as needed. Margaret will participate in daily self care with assist as needed.
  • Intervention: Activity planning for cognitive stimulation and physical activity to promote functional mobility.

Ongoing Assessment

  • Goal: Margaret will be monitored for pain, cognition, functional mobility, oral health and other health concerns as needed.
  • Intervention(s): PainAD, Mini-Cog™, multidisciplinary team assessments by primary care provider, dietitian, pharmacist, social work, rehabilitation therapies and dentist. A formal review of status will be completed every 90 days with a family conference.
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