Drooling
Drooling: Excerpt from Nursing: Interpreting Signs and Symptoms
Drooling—the flow of saliva from the mouth—results from a failure to swallow or retain saliva or from excess salivation. It may stem from facial muscle paralysis or weakness that prevents mouth closure, from neuromuscular disorders or local pain that causes dysphagia or, less commonly, from the effects of drugs or toxins that induce salivation. Drooling may be scant or copious (up to 1 L daily) and may cause circumoral irritation. Because it signals an inability to handle secretions, drooling warns of potential aspiration.
History and physical examination
If you observe the patient drooling, first determine the amount. Is it scant or copious? When did it begin? Ask the patient if his pillow is wet in the morning. Also, inspect for circumoral irritation.
Then explore associated signs and symptoms. Ask about sore throat and difficulty swallowing, chewing, speaking, or breathing. Have the patient describe pain or stiffness in the face and neck and muscle weakness in the face and extremities. Has he noticed mental status changes, such as drowsiness or agitation? Ask about changes in vision, hearing, and sense of taste. Also ask about anorexia, weight loss, fatigue, nausea, vomiting, and altered bowel or bladder habits. Has the patient recently had a cold or other infection? Was he recently bitten by an animal or exposed to pesticides? Finally, obtain a complete drug history.
Next, perform a physical examination. Take the patient's vital signs. Inspect for signs of facial paralysis or abnormal expression. Examine the mouth and neck for swelling, the throat for edema and redness, and the tonsils for exudate. Note foul breath odor. Examine the tongue for bilateral furrowing (trident tongue). Look for pallor and skin lesions and for frontal baldness. Carefully assess any bite or puncture marks.
Assess cranial nerves II through VII, IX, and X. Then check pupillary size and response to light. Assess the patient's speech. Evaluate muscle strength, and palpate for tenderness or atrophy. Also, palpate for lymphadenopathy, especially in the cervical area. Observe the patient's ability to swallow, and assess his gag reflex. Test for poor balance, hyperreflexia, and a positive Babinski's reflex. Also, assess sensory function for paresthesia.
Medical causes
Bell's palsy.With Bell's palsy, drooling accompanies the gradual onset of facial hemiplegia. The affected side of the face sags and is expressionless, the nasolabial fold flattens, and the palpebral fissure (the distance between the upper and lower eyelids) widens. The patient usually complains of pain in or behind the ear. Other cardinal signs and symptoms include unilateral diminished or absent corneal reflex, decreased lacrimation, Bell's phenomenon (upward deviation of the eye with attempt at lid closure), and partial loss of taste or abnormal taste sensation.
Esophageal tumor.With an esophageal tumor, copious and persistent drooling is typically preceded by weight loss and progressively severe dysphagia. Other signs and symptoms include substernal, back, or neck pain and blood-flecked regurgitation.
Ludwig's angina.With Ludwig's angina, moderate to copious drooling stems from dysphagia and local swelling of the floor of the mouth, causing tongue displacement. Submandibular swelling of the neck and signs of respiratory distress may also occur.
Myotonic dystrophy.Facial weakness and a sagging jaw account for constant drooling with this disorder. Other characteristic findings include myotonia (inability to relax a muscle after its contraction), muscle wasting, cataracts, testicular atrophy, frontal baldness, ptosis, and a nasal, monotone voice.
Peritonsillar abscess.A severe sore throat causes dysphagia with moderate to copious drooling with this abscess. Accompanying signs and symptoms are a high fever, rancid breath, and enlarged, reddened, edematous tonsils that may be covered by a soft, gray exudate. Palpation may reveal cervical lymphadenopathy.
Pesticide poisoning.Toxic effects of pesticides may include excess salivation with drooling. Other effects are diaphoresis, nausea and vomiting, involuntary urination and defecation, blurred vision, miosis, increased lacrimation, fasciculations, weakness, flaccid paralysis, signs of respiratory distress, and coma.
Rabies.When this acute central nervous system infection advances to the brain stem, it causes drooling, or “foaming at the mouth.” Drooling stems from excessive salivation, facial palsy, or extremely painful pharyngeal spasms that prohibit swallowing. Rabies is accompanied by hydrophobia in about 50% of cases. Seizures and hyperactive deep tendon reflexes may also occur before the patient develops generalized flaccid paralysis and coma.
Seizures (generalized).Generalized seizures are tonic-clonic muscular reactions that cause excessive salivation and frothing at the mouth accompanied by loss of consciousness and cyanosis. In the unresponsive postictal state, the patient may also drool.
Nursing considerations
▪ Be alert for aspiration in the drooling patient and position him upright or on his side.
▪ Provide frequent mouth care, and suction as necessary to control drooling.
▪ Assist with meticulous skin care, especially around the mouth and in the neck area, to prevent skin breakdown.
▪ Provide a covered, opaque collecting jar to decrease odor and prevent possible transmission of infection.
▪ Keep tissues handy and drape a towel across the patient's chest at mealtime.
Patient teaching
▪ Teach the patient good oral hygiene and skin care.
▪ Show the patient exercises to help strengthen facial muscles, if appropriate.
▪ Explain to the patient his diagnosis and the treatment plan.
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
More About Bell's Palsy
More Medical Textbooks Online about Bell's Palsy
Review other book chapters online related to Bell's Palsy:
Medical Books Excerpts
- Drooling
- "In A Page: Pediatric Signs and Symptoms" (2007)
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- Drooling
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Drooling
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Drooling
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: FACIAL PARALYSIS (Differential Diagnosis in Primary Care)
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