Oral candidiasis

(Thrush stomatitis)

Definition:
It is a fungus infection of
the skin and mucous
membrane of the mouth
characterized by white
patches, resembling milk
curds.

Etiology:
Candida albicans infection is due to:

inadequate sterilization of teats and

bottles.
from mothers breast of the attendants
hand.
Newborns are infected during passage in
birth canal.
The long use of antibiotic therapy.
Infant's auto-infection when he has
candida diaper dermatitis and he touch
the diaper area then put his hands into
mouth.

Assessment:
Mouth contains white patches, which resembles milk
curds (it is difficult to remove and if removed bleeding
occurs).
Also there is discomfort during feeding. But this is
uncommon.
Treatment:
Application of 1ml nystatin (Mycostatin) over the surface
of the oral cavity 4 times a day or every 6 hours to
prevent spread of infection or prolongation of its course.
To prevent relapse, therapy should be continued for at
least 2 days after the lesions disappear.
Another therapy is application of 1% aqueous gentian
violet three times a day. To prevent recurrence treatment
should be continued for one week after recovery.
The disease is treated with good hygiene.
Treat the source of infection, which is usually the mother.

Nursing management:
Nursing care is directed toward
preventing spread of the infection.
Correct application of the
prescribed topical medication.
Good hygienic care is essential to
prevent spread of infection.

Nursing Diagnosis:
Altered oral mucous
membrane related to mouth
infection.
Goal:
Prevent and reduce the effects
of oral ulceration.

Nursing Management:

Apply the ordered medication (nystatin)

after feedings. Distribute it over the
surface of the oral mucosa and tongue
with syringe or an applicator. The
reminder of the dose is deposited in the
mouth to be swallowed by the infant to
treat any lesions in pharynx and
esophagus.
Use disposable applicator or sterilize it if
not disposable.
Absolute cleanliness of all articles, which
enter the infant's mouth, such as, rubber
nipple, pacifier, teats, mother's nipple and
infant toys.

Infant must have his own feeding

equipment to prevent spread of
infection.
Boil reusable nipples, bottles and
pacifier for at least 20 minutes after
thorough washing, as spores are heat
resistant
Medicine dropper may be used, if
nipple irritates the infant.
Rinse infant's mouth with some
sterile water after each feeding and
before applying the medication.

Treat breast nipple to prevent re-infection.

Place clothes over the diaper to prevent selfinfection from buttocks to mouth.
When gentian violet is used, the solution is
applied directly to the patches. The infant is
not allowed to swallow any excess because
the medication is irritating to trachea, larynx
and esophagus. After application the infant is
placed prone for a short time to allow
secretions to flow from the mouth.
Special care is taken when administering this
preparation because gentian violet stains
skin, clothing, bed linens and other objects.
Expected Outcome:
Mouth membrane remains intact.
Ulcers show evidence of healing.

Nursing Diagnosis:
Altered nutrition less than body
requirements related to loss of appetite. Also
discomfort and interference with feeding.
Goal:
Appetite stimulation.
Nursing Management:
Encourage parents to relax pressure placed
on eating.
Allow infant any tolerated food; plan to
improve quality of food selection when
appetite increases.
Take advantage of any hungry period, serve
small snacks.
Allow child to be involved in food preparation
selection.

Outcome Criteria:
The nutritional intake is adequate
Prognosis:
.
Generally very good, recovery
occurs after 3-5 days