ch 15 - hydration and oral care Flashcards
recommended amount water intake per day older adult
1500 mL
why is water important in the body (4)
- thermoregulation
- dilution of water soluble meds
- facilitates bowel and renal functions
- maintins metabolic processes
age related changes affecting hydration (7)
- thirst sensation diminishes
- creatinine clearance declines
- total body water decreases
- loss of muscle mass and increase in fat cells
- meds
- functional impairment
- comorbidities (ex: diabetes, resp illness, HF)
2 types dehydration
- water loss
- volume depletion
significant issues related to dehydration (10)
- thromboembolisms
- kidney stones
- constipation
- falls
- med toxicity
- renal failure
- seizure
- electrolyte imbalance
- hyperthermia
- delayed wound healing
risk factors for dehydration (8)
- emotional illness
- surgery
- trauma
- higher physiological demands
- meds
- functional deficits
- oral problems
- high environmental temps
S+S dehydration in older adults (9)
- dry mucous membranes nose and mouth
- furrows on tongue
- orthostatic hypoTN
- speech incoherence
- rapid pulse
- decreased urine output
- extremity weakness
- dry axilla
- sunken eyes
what labs communicate dehydration (4)
- hyponatremia
- serum osmolarity (>300)
- increased BUN
- changes in urine (amount, color, osmolality, specific gravity)
2 options for rehydration other than oral intake
- IV
- hypodermoclysis (isotonic fluids in subq space)
tips for rehydrating with IV fluids
- replace 50% of loss within 12 hours (or enough to relieve tachycardia and hypoTN)
- then rehydrate slowly
- monitor for fluid overload
tips for rehydrating through hypodermoclysis
- isotonic fluids into subq space
- not indicated for severe dehydration (more than 3 L over 24 hours)
tips for oral rehydration (7)
- calculate fluid goal (atleast 1500 mL/day)
- provide fluids consistently throughout day (75-80% at mealtimes)
- make fluids accessible at all times
- fluid rounds
- possibly modify container/cup
- allow adequate time for feeding
- monitor I&Os
what can lead to water-loss dehydration? what manifestations are seen?
CAUSE:
-insufficient fluid intake
MANIFESTATIONS:
- increased serum osmolality
- decreased ECF
what can lead to volume-depletion dehydration? what manifestations are seen?
CAUSE:
- V/D
- excessive bleeding/loss of plasma
MANIFESTATIONS:
- rapid dehydration
- electrolyte imbalance
S+S fluid volume overload (4)
- unexplained weight gain
- pedal medema
- JVD
- SOB
risk factors for oral cancer (4)
- smoking
- alcohol
- HPV
- genetic susceptibility
S+S oral/throat cancer
- swelling, bumps, or red spots in mouth
- velvety white, red, or speckled patches
- persistent sores that bleed easily
- unexplained bleeding in mouth
- unexplained pain in face, neck, or mouth
- soreness in back of throat
- difficulty chewing, swallowing, speaking
- hoarseness, chronic sore throat
- dramatic weight loss
- severe pain in one ear
- pain around teeth
risk factors for poor oral health (5)
- economically disadvantaged (poor)
- no insurance
- disabled
- homebound
- institutionalized
Tx xerostomia (5)
- review meds
- good oral hygiene
- adequate water intake
- avoid alcohol and caffeine
- OTC saliva substitutes
oral health assessment tool
kayser-jones brief oral health status exam (BOHSE)
how often should pt receiving tube feeding receive oral care
oral care 2x day
brush teeth after each feeding
interventions to prevent dehydration (3)
- short as possible NPO times before procedures
- adequate hydration after NPO times
- close monitoring and additional fluids for pts with fever, diarrhea, vomiting, or nonfebrile infection
what diseases/illnesses are poor oral health a risk factor for (6)
- dehydration
- malnutrition
- pneumonia
- joint infections
- CVD
- poor glycemic control in DM
why should lemon glycerin swabs not be used (2)
- dry and inhibit salivary production
- promote bacterial growth
