8. GI/GU Flashcards
1
Q
Age related changes to digestive system
A
mouth:
- less strength of teeth=loss of teeth
- decreased salivary flow=dry mouth
- changes to oral mucosa= dry mouth or nutritional deficiencies
esophagus and stomach:
- esophageal stiffening
- less peristaltic waves and slower swallowing
- reduced gastric secretions = reduced absorption of nutrients and potential risk for developing bacterial growth in the intestine
- reduced gastric emptying
intestinal tract:
- shortening and flattening of villi = reduced absorption of some nutrients (vit B12, D, calcium, folate)
- reduced secretion of mucus in large intestine
- reduced perception of rectal wall distention
- decreased elasticity of rectal wall
liver:
-reduced blood flow to liver
pancreas:
-decreased responsiveness of pancreatic beta cells to glucose= high risk of developing type 2 diabetes
gallbladder:
- structural changes = susceptibility to gallstones
- higher levels of cholecystokinin can reduce appetite
summary:
- less effective chewing
- reduced taste and smell
- reduced saliva rt meds
- slower swallowing
- slower gastric and intestinal motility
- need fewer but higher quality calories
- decreased responsiveness of pancreatic beta cells to glucose= type 2 diabetes
2
Q
Consequences of the age related changes
A
- poor absorption of nutrients
- risk of choking
- risk of malnourishment
- constipation
- susceptibility to develop type 2 diabetes
- susceptibility to develop gallstones/cholelithiasis
3
Q
Dietary Reference Intake (DRI)
A
a standard for meeting basic nutrient requirements
DRI’s that change with aging:
- calcium increases
- vit D increases
- iron decreases (menopause)
- reduced caloric intake rt reduced muscle mass and PA
- double fibre intake
4
Q
Risk factors to nutritional impairments
A
- functional and cog impairments
- recent hospitalization, move to nursing home
- presence of pressure ulcer
- polypharmacy (side effects or adverse reactions)
- psychosocial factors ex depression
- smoking
Functional impairments led to:
- poor oral hygiene
- poor oral intake if pt is dependent on being fed
- dysphagia
5
Q
3 pathologic conditions affecting digestive wellness
A
- Constipation
- normal 3x/day, 1-2x/week
- caused by risk factors, not age-related changes
- increase water and fiber will help age-related physical inactivity
risk factors:
- reduced functional mobility
- pathologic conditions (ex hypothyroidism)
- adverse reactions (analgesia effects)
- poor dietary habits. (low fiber, high calorie)
- . GERD
- Gastroesophageal reflux disease (heartburn)
- digestive disorder affects the lower esophageal sphincter, (the ring of muscle between the esophagus and stomach) -Lining is inflamed by the stomach acid
- Interventions:
- Smaller meals,
- type of food and drink,-upright position head of the bed (do not pile pillows),
- eat 3-4 hours before lying down,
- maintain healthy weight to reduce intra-abdominal pressure on the stomach, ——avoid acidic foods,
- no smoking to relax the lower esophageal sphincter. –Tums as an OTC antiacid medication. (Or acid production prohibitors medications)
- Diverticulitis: A disease. presence of small sacs in the colon. No symptoms but associated with constipation or diarrhea. Less than 1 cm in diameter but can grow. Can becomes inflamed/infected and lead to fever, pain in LLQ, constipation, bloating. Common in low fiber diets. Straining during pooping can cause extra pressure against colon wall and then the ballooning of the colon. TO AVOID: CONSUME fluids, fiber to soften stool
6
Q
C. Diff
A
Clostridium Difficile infection
- c. diff is a bacterium that causes diarrhea and more severe intestinal conditions ex colitis
- diagnosed by stool sample
- risk factors: recent antibiotic use, hx of c. diff infection
- c. diff is a frequent cause of hospitalization in elderly
- fatality increases with age
7
Q
Stroke
A
- permanent brain injury from disrupted blood flow to a part of the brain
- disabilities result and are rt location and whether ischemic or hemorrhagic
- most common disability is dysphagia= leads to aspiration when eating liquids in particular
8
Q
Assessment
A
- eating patterns, nutritional intake, supplements
- oral care habits
- environmental or social support factors affecting getting, preparing, intaking food
- symptoms of gastrointestinal (GI) dysfunction
Assessment tools:
- Daily bowel movement record
- 48/6 preadmission screening questionnaire (eating and drinking, going to the toilet)
- malnutrition screening tool
- acute care swallowing screening tool (SST)
9
Q
Interventions and health promotion activities
A
- assist with oral hygiene
- evaluate and care for dentures before meals
- ensure no protein-energy malnutrition occurs dt high carb diet in nursing homes
- ensure access to fluids and healthy snacks (high in fiber)
- monitor bowel movement consistency and frequency regularly
- use PA and fiber before pharmacologic treatment for constipation
- ensure pts with functional disabilities who require assistance are properly positioned and are adequately fed at meal times
10
Q
related changes affecting urinary function
A
kidneys:
- renal function declines at approx 1%/ yr after age 30-40
- reduced ability to conserve Na+ in response to salt restriction = risk for electrolyte imbalance ex hyponatremia
bladder and urinary tract: -loss of smooth muscle in the urethra -relaxation of the pelvic floor muscles -reduced urethral resistance and diminished sphincter tone RESULT: risk for urinary incontinence
additional changes:
- later sensation of bladder fullness when it is in fact full dt changes in the cerebral cortex
- diminished estrogen support post-menopause= loss of tone, strength, collagen support that can predispose the urinary system to leakage
- lower estrogen can also increase bladder sensitivity with more urgency to void
- decreased thirst perception=dehydration
11
Q
risk factors for urinary wellness
A
- limited fluid intake
- dietary factors ex caffeine- causes diuresis or urinary urgency; chocolate/sugar- causes bladder irritation
- medication effects ex diuretics
- caregiver strain causing fewer interventions ex less toileting
- functional and environmental limitations ex inability to get to bathroom independently or too far away
- haering/vision impairment
- obesity, smoking
12
Q
risk factors for urinary wellness
A
- limited fluid intake
- dietary factors ex caffeine- causes diuresis or urinary urgency; chocolate/sugar- causes bladder irritation
- medication effects ex diuretics
- caregiver strain causing fewer interventions ex less toileting
- functional and environmental limitations ex inability to get to bathroom independently or too far away
- hearing/vision impairment
- obesity, smoking
13
Q
functional consequences
A
- incontinence= psychological effects
- altered renal function= fluid and electrolyte imbalance = increased water-soluble drug interactions
- bladder retains residual urine after voiding = UTI
- nocturia= sleep disturbance, falls
14
Q
3 Pathologic conditions
affecting GI/urinary wellness
A
- Benign prostatic hyperplasia (BPH)
- enlarged prostate compresses on urethra= obstruction
- overtime, bladder wall gets thinner and less elastic
- leads to urinary retention, UTI
- complete obstruction= hydronephorosis and kidney damage
- symptoms:
- decreased urine flow
- incomplete bladder emptying
- urinary urgency and frequency
- treatment:
- meds, surgery - UTI
- risk factors: urinary incontinence, impaired functional and cognitive, age, indwelling catheter
- symptoms: behaviour and mental status changes, pain, urinary frequency, dysuria (pain)
- treatment: antibiotics and prevention - Paraphimosis
- a urologic emergency when retracted foreskin cannot be returned to normal position
- symptoms: pain or agitation in a cog. impaired male
- complication: gangrene and amputation of glans penis if not recognized and treated
- treatment: manual return of foreskin or surgery in extreme cases
15
Q
Assessment
A
- ask about risk factors
- assess risk factors that increase risk for incontinence
- assess symptoms of urinary elimination dysfunction
- determine if any urinary incontinence currently or in medical hx
- if urinary incontinence exists: encourage use of.a bladder diary to track fluid intake and time of urination
- use the bladder diary to identify potential causes and interventions for incontinence
- urinalysis, urine culture and sensitivity, BUN, Creatinine, eGFR
