Candidiasis: Causes Symptoms Diagnosis Treatment and Complications By Nurses Note

Candidiasis

Candidiasis is an opportunistic fungal infection commonly caused by Candida albicans. It may be localized in the mouth and pharynx, but may also occur in the oesophagus . Candidiasis can become a source of systemic dissemination, particularly in high-risk persons.

Pathophysiology and Etiology of Candidiasis

1. Commonly seen in individuals with immunosuppression from disease states or treatment regimens such as diabetes, cancer, or HIV and those receiving radiation therapy and/or chemotherapy.

2. May be caused by altered oral environment from xerostomia, use of inhaled steroids for asthma and COPD, or chronic antibiotic therapy, preexisting infections, poor oral hygiene or nutritional status, or wearing dentures

Clinical Manifestations of  Candidiasis

1. Oral examination reveals diffuse, white, painless plaques. Underlying mucosa may be erythematous.

2. May be asymptomatic but may result in mild oral discomfort, burning, or alterations in taste.

3. Patients with disease spread beyond the oral cavity may present with chest pain, pain and difficulty with swallowing, or hoarseness.

Diagnostic Evaluation of Candidiasis

1. Microscopic smear of plaques shows characteristic hyphae.

2. Oral fungal culture positive for C. albicans.

3. Occasionally, biopsy of lesions may be necessary to rule out leukoplakia (premalignant plaques).

Management of Candidiasis

1. Topical antifungal medications such as nystatin suspension or clotrimazole troches are most often used.

2. Systemic treatment is indicated if topical agents fail or for esophageal cases with fluconazole, ketoconazole, or ampho￾tericin B.

3. Topical oral rinses or preparations containing combinations of hydrocortisone, diphenhydramine, antifungals, or antibiotics may be used to enhance healing and to lessen discomfort.

4. Viscous lidocaine may be used topically to coat the oral mucosa before meals to lessen pain and enhance oral intake.

5. Oral prostheses may also be treated to avoid harboring and reintroducing infection.

Complications of Candidiasis

1. Candidal infection throughout the GI tract.

2. Candidal sepsis in patients who are immunocompromised.

Nursing Assessment of Candidiasis

1. Carefully examine oral cavity daily to monitor lesions as well as response to prescribed antifungal therapy.

2. Assess level of pain; administer analgesics, as prescribed; and monitor response to analgesics.

3. Assess nutritional status and effect of pain on oral intake. Monitor oral intake, nutritional and hydration status, weight loss/gain, signs of dehydration.

4. Teach patients that are prescribed inhaled steroid therapy for asthma/COPD to rinse mouth after each use to prevent oropharyngeal candidiasis.

Nursing Diagnoses of Candidiasis

1. Imbalanced Nutrition: Less Than Body Requirements related to oral discomfort.

2. Deficient Knowledge related to antifungal therapy.

Nursing Interventions of Candidiasis

Attaining Adequate Nutrition

1. Administer analgesics, as prescribed, 30 to 60 minutes before meals.

2. Provide soft foods, soothing liquids; avoid temperature extremes.

3. Provide gentle suctioning if pain becomes so severe that patient cannot handle secretions and provide intravenous (IV) fluids.

Ensuring Adequate Therapy

1. Administer antifungal agents, as prescribed. Observe the patient for proper use of topical preparation.

  a. Make sure that mouth is clean and free of food debris before administering drug.

  b. For swish-and-swallow preparations, tell the patient to wish and hold in mouth for at least 5 minutes before swallowing.

  c. For troches, have the patient suck until dissolved.

 2. Observe for signs and symptoms of systemic drug adverse effects: nausea, vomiting, diarrhea. Renal, bone marrow, cardiovascular, hepatic, or neurologic toxicities may occur in patients receiving systemic therapy with underlying chronic disease states.

 3. Explain the importance of continuing therapy for duration prescribed.

Patient Education and Health Maintenance

 1. Instruct high-risk patients about daily oral examination and signs and symptoms to observe.

 2. Teach the patient to avoid highly seasoned foods, extremes in temperature, alcoholic beverages, and smoking, all of which irritate the oral mucosa.

 3. Encourage good oral hygiene.

 4. May need to refrain from wearing dentures due to oral discomfort.

 5. Encourage the patient on long-term systemic antifungal therapy to follow up for liver function test monitoring, as directed.

Evaluation: Expected Outcomes

1. Adequate intake of liquids and soft foods as evidenced by stable body weight, signs of dehydration.

 2.Swishes oral suspension for 10 minutes before spitting or swallowing.