2.3 Nutrition and Fluid Balance, Digestive Flashcards
Elderly Nutrition
Factors affecting nutritional status in Elderly
Factors affecting nutritional status in Elderly
Changes in appetite, taste, smell and GI affect nutrition.
Decreased income contributes to food intake.
Dentures, missing teeth, pain from poor oral hygiene.
Chronic illness/ depression (leads to malnutrition)
Multiple medications
Cognitive impairment/dementia
Living in LTC facility (food not as appealing as home cooked)
Elderly Nutrition Teaching
Teaching Maintain healthy weight Chose nutrient dense foods Oral care BID Avoid processed foods & high fat foods
Elderly Nutrition
Nursing Intervention
Nursing Interventions:
Weigh as directed goal to maintain weight.
Teach nutrient dense foods
Oral care BID Safe swallow strategies.
Encourage socialization during meals.
Good lighting to see food
Use spices to add flavor instead of salt.
Chew food thoroughly to release flavors.
Vary food textures and flavors
Colorful presentations.
Grocery delivery or locate nearby grocery stores.
Meals on wheels for homebound seniors.
Refer eligible to SNAP program (supplemental nutrition assistance program)
Elderly Nutrition
Nutritional needs in Elderly
Nutritional needs in Elderly
Metabolism slows with age less calories needed
Vitamin and mineral needs same.
Iron needs drop for post-menopausal women
Vitamin D (synthesis reduced need sun or supplements)
Vitamin B12 (production of intrinsic factor in gut reduced)
Fluids-about 8 cups/day
Limit alcohol, refined sugars, fat, and salt.
Zinc deficiency can alter taste.
Elderly Nutrition
Nutritional needs in Elderly
Zinc
Zinc deficiency can alter sensitivity of taste receptors. Deficiency heightens ability to taste bitter and sour flavors and reduces sweet and salty sensations leading to more intake of sweet and added salt to food.
Dehydration in Elderly
Risk factor
Risk factors: Purposely restrict their fluids Loose sense of thirst Forget to drink Cannot get fluids on their own No A/C in summer (insensible loss)
Dehydration in Elderly
S/S
S/S Dehydration in elderly
Confusion-change in mental status early s/s dehydration.
Dry Tongue & Mucous membranes (furrowed tongue)
Skin turgor-less reliable (use sternum or inner thigh not arms)
Tachycardia
Subnormal temperature
Pinched facial expression
Hot dry body
Dehydration in Elderly Nursing interventions
Nursing interventions
I & O (1 L body fluid = 1kg/2.2lbs)
Daily weight (3% weight loss sign of dehydration)
Monitor electrolyte levels
Assessment for deficient fluid volume
Encourage fluids (approx. 8 cups sufficient)
Call light in reach
Review orders for NPO status and notify physician for late and canceled tests.
Oral Cancer
Malignancy of the oral mucosa on lips, tongue, floor of the mouth, or oral tissues.
High morbidity and mortality.
40 years old most common.
Oral Cancer Risk Factors
Risk Factors: Smoking Drinking alcohol Chewing tobacco HPV –recent studies have found contributes to risk
Oral Cancer Symptoms
Symptoms
Early: painless ulcer or lesion.
Later: difficulty speaking, swallowing or chewing, swollen lymph nodes, blood-tinged sputum.
Leukoplakia: “white patch” “smoker’s patch”
Erythroplakia: red velvety patch.
Any oral lesion that doesn’t heal/respond to Tx in 1-2 wks.. should be evaluated for malignancy.
Oral Cancer Treatment/ Prevention
Treatment/ Prevention:
Eliminate causative factors (smoking, tobacco, ETOH)
Oral sex and HPV transmission
Regular dental care
Oral Cancer Stages 1-4
Stages I and II are highly curable: Surgery and radiation. Stages III and IV require combination: Surgery, radiation and chemotherapy. Radical neck dissection with tracheostomy
Oral Cancer Post Op Surgery Nursing interventions
Nursing interventions:
Maintain a patent airway
Maintain stable weight and hydration: (I&O, wt..)
PEG tube or gastrostomy if chewing/swallowing difficulties.
Effectively communicate.
Communication boards, patient to write, yes/no questions.
Communicate an increased ability to accept changes in body image.
Oral radiation Effects of oral radiation
Effects of oral radiation
Males may experience permanent loss of hair in the area of their beard.
Skin irritation & lack of salivary function- worse as treatment continues.
Salivary function may not return to normal.
Keep mouth moist.
HOB elevated
Additional fluids.
Esophageal Cancer
Uncommon & High mortality rate
<5% survive 5 years after diagnosis.
Most tumors in lower 1/3 of esophagus
Esophageal Cancer Risk factors
Risk factors Cigarette & Chronic ETOH abuse primary. Opiate smoking Ingested carcinogens Chronic Reflux Physical mucosal damage (hot tea, radiation damage)
Esophageal Cancer Symptoms
Symptoms: Most common: Progressive dysphagia and recent weight loss. CA advanced by time this s/s presents (60% of esophagus occluded from tumor). Anemia GERD-like symptoms Anorexia Chest pain Persistent cough
Esophageal Cancer Goal & Diagnosis
Goal:
Control dysphagia and maintain nutrition regardless of treatment.
Diagnosis
Bronchoscopy
Barium swallow
Chest X-ray, CT scan, MRI look for metastasis.
Esophageal Cancer Treatment
Treatment:
Radiation therapy, and/or chemotherapy
Esophagectomy and possible anastomosis of the stomach to remaining esophagus.
NG tube often post op placed in OR.
Esophageal Cancer Complications
Complications:
Anastomosis leak
Respiratory complications (pneumonia, acute respiratory distress syndrome).
Gastric necrosis or bleeding
Infection and sepsis.
If NG tube removed, DO NOT REPLACE. CALL DR.
Do not move or manipulate NG- disrupts sutures
**After surgery high risk for aspiration and airway management r/t disruption of esophagus and incision into the thoracic cavity.
Stomach Cancer
Usually advanced when diagnosed & metastases present. Poor prognosis
Stomach Cancer Risk factor
Risk factors:
H. pylori infection is major risk factor. 60-90%
Genetic
Chronic gastritis
Gastric polyps
Carcinogens in the diet (smoked foods and nitrates)
History of partial gastric resection.
Helicobacter pylori(H. pylori)
type of bacteria. These germs can enter your body and live in your digestive tract. After many years, they can cause sores, called ulcers, in the lining of yourstomachor the upper part of your small intestine. For some people, an infection can lead tostomach cancer. Infection withH. pyloriis common
Stomach Cancer Symptoms
Symptoms: Early symptoms: very few. Vague: feeling of early satiety, anorexia, indigestion and vomiting. Ulcer-like pain unrelieved by antacids after meals. Advanced disease – metastases present Weight loss Cachectic (malnourished and poor health) Palpable abdominal mass Occult blood in stool
Stomach Cancer Diagnosis
Diagnosis Anemia may be first symptom (CBC) Upper GI with barium swallow x-ray Ultrasound Upper endoscopy with visualization and biopsy of lesion= provides definitive diagnosis
Stomach Cancer Treatment
Treatment
Removal of part or all of stomach (partial or total Gastrectomy primary Tx)
Stomach Cancer Post op Nursing care
Post op Nursing care:
Assess NG tube & suction as ordered.
Do not replace or move tube. Call Dr.
Assess color, amount and odor of gastric drainage. Initial NG output is bright red then to green-yellow over 2-3 days. If excessive amount of bright red, call Dr.
Monitor bowel sounds and distention.
Encourage ambulation
Monitor weight (significant wt.. loss common)
Stomach Cancer Post op Nursing care
Nutritional problems following surgery
Nutritional problems following surgery:
Folic acid, calcium, vitamin D absorption decreased.
Stomach Cancer Complications of gastrectomy
Complications of gastrectomy:
Dumping syndrome is common
Food eaten enters small intestine too quickly
Gastric surgery makes it more difficult to regulate movement.
Stomach Cancer S/S
S/S: occurs 5-30 min after eating.
Full feeling, Abd cramping/pain
Nausea or vomiting
Severe diarrhea
Sweating, flushing, or light-headedness, rapid heartbeat.
Loud hyperactive bowel sounds
Hyperosmolar chyme in the jejunum causes rapid rise in glucose and release of excessive insulin. Hypoglycemia common 2-3h after meals.
Stomach Cancer Dumping syndrome management:
Dumping syndrome management:
Small frequent meals
Liquids and solids taken at separate times not together
Increase protein and fats (they exit stomach more slowly)
Reduce CHO’s, especially simple sugars.
Recumbent/ semi-recumbent 30-60 min after meals
Monitor nutritional status
Anemia common r/t decreased iron absorption
B12 deficiency r/t stomach cells decreased prod intrinsic factor.
Folic acid deficiency
Decreased absorption of Vitamin D and calcium.
What’s does the liver do?
Metabolism of proteins, carbs, fats
Metabolism of drugs & steroid hormones
Detoxifies ETOH & Toxic Substances
Converts Ammonia to urea
Synthesizes blood proteins -(Albumin & Clotting factors)
Ammonia, a toxic by-product of protein metabolism is converted to urea in the liver then is eliminated by the kidneys. The liver produces bile-an essential substance for absorbing fats and eliminating bilirubin from the body. Minerals and fat soluble vitamins are store in the liver as is glycogen (stored carbohydrate for energy reserves).
Liver regeneration
Your liver is the only organ in your body capable of regenerating. After a 75% ablation of its total mass, your body needs 4 months to regain its initial weight. A liver in good health at 80 works as efficiently as it did at the age of 20.
Liver Functions Essential functions
Essential functions:
Metabolism of proteins, fats, CHO.
Liver Functions Other functions
Other functions:
Produces bile for fat absorption & eliminates bilirubin from body.
Detoxifies ETOH & other toxic substances.
Inactivates drugs/limits duration of effects
Metabolism of steroid hormones (testosterone, estrogen etc.) & most drugs.
Makes blood proteins (albumin & clotting factors).
Ammonia (product of protein metabolism) is converted to urea for kidneys to excrete.
Minerals and fat soluble vitamin storage (stored as glycogen for energy use).
Stores iron as ferritin which is released as needed for RBC production.
LIVER METABOLIC AND DIGESTIVE FUNCTIONS
LIVER METABOLIC AND DIGESTIVE FUNCTIONS:
Secretes bile
Stores fat soluble vitamins ADEK
Metabolizes bilirubin
Stores blood and releases blood into the general circulation during hemorrhage
Synthesizes PT, fibrinogen, and factors for clotting.
Synthesizes fats from CHO and proteins for energy use or storage into adipose tissues.
Glucose release during hypoglycemia
Alters chemicals to make them less toxic —-filters
Stores iron as ferritin which is released as needed for RBC production.
Common Manifestations of Liver Disorders
3 primary effects of liver disorders regardless of cause. Manifestations: Hepatocellular failure Jaundice Portal Hypertension
Hepatocellular Failure Liver is vital to
Liver is vital to: Digestion & metabolism of nutrients. Production of plasma proteins Clotting proteins Albumin Metabolism & excretion of bilirubin, steroid hormones, toxins & ammonia.
Note: Albumin keeps fluid in the vessels. Low albumin=fluid leaks out of vessels causing edema/ascites.
Hepatocellular Failure Impaired function of liver cell causes
Impaired function of liver cell causes:
Decreased production of albumin r/t impaired protein metabolism.
Decreased production of clotting factors.
Decreased bile production which impairs absorption of lipids & fat soluble vitamins. (Vit. K affects production of clotting factors).
Impaired metabolism of steroid hormones (estrogen & testosterone) causing:
Feminization of men
Irregular menses in women.
Hepatocellular Failure / Jaundice
what is it
RBC’s breakdown & form bilirubin.
When bilirubin can’t be emulsified & digested through bile it builds up causing yellow appearance.
Hepatocellular Failure / Jaundice
Accumulation of bilirubin in tissues caused by disruption in metabolism of bilirubin = yellow color reflected in skin, mucus membranes, sclera
Signs and symptoms: 1st noticeable in sclera of eyes then skin
Hepatocellular Failure Portal Hypertension
Portal Hypertension:
Impaired blood flow through liver increases pressure venous system that drains the GI tract, spleen & surface veins of the abdomen causing:
Veins in GI tract & abdominal wall to dilate causing:
Appetite suppression
Formation of collateral vessels in esophagus, rectum, & stomach
Esophageal varices, hemorrhoids, caput medusa.
Ascites: increased pressure in Abd vessels causes fluid to leak out. Worsened by low albumin levels.
Hepatic encephalopathy: build up of ammonia waste product causing mental status changes.
Cerebral edema (late disease) causing IICP.
Diagnostic Studies of Hepatic Function. Lab
Labs: enzymes released when liver cells are damaged. Will see elevation in:
ALT (Alanine Aminotransferase)
AST (Aspartate Aminotransferase)
ALP (Alkaline Phosphastase)
Diagnostic Studies of Hepatic Function Bilirubin
Bilirubin: Total, Direct (conjugated) , Indirect (unconjugated)
Bilirubin formed by breakdown of Hgb from old RBCs that is carried to liver through plasma to be excreted in the bile.
Direct: elevation usually r/t stones, tumors
Indirect: associated with increased RBC destruction
Direct (conjugated) bilirubin
Direct (conjugated) bilirubin: Increased levels usually result of
Obstructive jaundice from stones or tumor or
Damage to liver cells.
Indirect (unconjugated) bilirubin
Indirect (unconjugated) bilirubin:
Associated with increased destruction of RBC
Bilirubin- Box 25-2 p. 723- Lemone: Indirect increased with RBC hemolysis eg: transfusion reaction, sickle cell disease
Direct increase cirrhosis, Hepatitis; Total Bili increase with liver disease
