Symptom: Saliva, Dry and Thick

Initial Grading Reminder

Grade 1: Symptomatic (e.g., dry or thick saliva) without significant dietary alteration; unstimulated saliva flow >0.2 mL/min
Grade 2: Moderate symptoms; oral intake alterations (e.g., copious water, other lubricants, diet limited to purees and/or soft, moist foods); unstimulated saliva 0.1 to 0.2 mL/min
Grade 3: Inability to adequately aliment orally; tube feeding or TPN indicated; unstimulated saliva <0.1 mL/min

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you ever had issues with thick saliva in the past?

Grade the symptom

Ask the patient:

Does your saliva feel thick?  Are you having trouble swallowing? Any choking? Is it leading you to alter your eating/drinking habits? How much fluid are you drinking per day? Have you lost weight? Are you able to eat enough?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you feeling weak, dizzy, or confused (foggy)?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new-onset moderate or worse (or worsening) thickened saliva should be seen.

    Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    Mucositis & Xerostomia - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear uncomfortable?
    • Does the patient appear unwell?
    • Difficulty talking?
    • Licking lips to moisten often?
    • Weight loss?
    • Does the patient appear dehydrated?
    • Does the patient have thrush?
    • Does the patient report?
      • Mouth pain (tongue, gums, buccal mucosa)
      • Mouth sores
      • Difficulty eating
      • Waking during the sleep to sip water
      • Recent dental-related issues
      • Need for dental work (e.g., root canal, tooth extraction)
    • Have symptoms worsened?
    • A history of mouth sores
    • Does patient smoke?
    • Concomitant medications associated with causing dry mouth?
    • Reports of dry mouth often accompany mucositis
    • Other reports of dry membranes (e.g., eyes, nasal passages, vagina)

    Differential Diagnosis

    What do you suspect is the cause of the dry, thick saliva?