Managing Tissue Necrosis Associated With Oral Carcinoma

Ms. W, a female older adult patient, was diagnosed with squamous cell carcinoma of the left oral cavity and underwent a wide local excision of the lesion with segmental mandibulectomy. About nine months later, she presented with an aggressive local recurrence. Because of the tumor’s location, Ms. W found oral intake to be extremely difficult; therefore, a percutaneous endoscopic gastronomy tube was placed in February 2002. Upon physician assessment in February 2003, the patient had a large exophytic necrotic tumor involving the tongue, floor of the mouth, and buccal mucosa (see Figure 1). The lesion involved the skin of the left cheek and was seeping serosanguineous fluid. Ms. W’s condition deteriorated after she experienced respiratory distress; as a result, she was transferred to an intensive care unit, where she was intubated. Radiation therapy was planned for the patient, but it was evaluated for its impact on the integrity of the oral cavity. What nursing care measures should be instituted to manage tissue necrosis in Ms. W’s oral cavity?