CH 18: Digestion and Bowel Elimination Flashcards by Tyece Henry

effects of aging on GI health

Tongue atrophies _ decreased taste sensation
Changes in taste sensation _ xerostomia, smoking, meds, diseases
Decreased saliva production _ difficulty with swallowing
Thinning of oral mucosa & weak mastication muscles _ decreased chewing efficiency
Gingival recession _ loosens tooth support
Presbyesophagus: weak esophageal contractions _ weakness of LES
Decreased esophageal and stomach motility _ food stays in upper GI longer _ indigestion, aspiration
Decreased elasticity of stomach _ reduces amount of food the stomach can accommodate
Reduced HCl, pancreatic, and pepsin acid _ gastric irritation, decreased mineral absorption, altered digestion of fats
Meds, inactivity, decreased peristalsis, reduced food and fluid _ Increased constipation
Decreased sensory perception _ unnoticed signal for bowel elimination; incomplete bowel emptying
Decreased liver size (but function remains stable) & reduced hepatic blood flow
Pancreas will atrophy and become fibrotic _ Reduced pancreatic secretions

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GI health promotion in older adults

Increased fluid intake
Diet (fiber, fruits, veggies)
Establish a regular bowel pattern (preferably after breakfast)
Increased activity
Encourage complete bowel emptying
Astute assessment
Dental hygiene/Oral care

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interventions and education for oral health in older adults

Brush all tooth surfaces and tongue twice a day with soft-bristled toothbrush and fluoridated toothpaste
Floss between teeth daily
Avoid mouthwash with alcohol
Avoid swabsticks (dry oral mucosa)
Remove dentures at night and soak them in water
Clean dentures and gums before putting dentures in the mouth
Use sugar free candy & gum
Visit a dentist every 6 months
Fluoride treatments to improve tooth enamel

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dry mouth

Xerostomia

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causes of xerostomia

reduced saliva, meds, mouth breathing, altered cognition

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interventions for xerostomia

frequent mouth care
saliva substitutes
sipping water
sugarless candy/gum

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dental problems come from

wear and tear
increased brittleness
finances
poor diet
aging
meds

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dental problems can impact

food intake and appetite  malnutrition

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interventions for dental problems

regular dental care and exams
consider finances of dental care
brushing (not swabs)
daily flossing
denture care
avoid trauma & commercial mouthwash (dilute)
further evaluate all lesions

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causes of dysphagia in older adults

GERD, mechanical obstructions, and neuro disorders

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types of dysphagia

Can be oropharyngeal or esophageal with varying symptoms

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interventions for dysphagia

assessment of the symptoms
observe food intake
SLP
soft diet with thickened liquids
eat in upright position
ingest small bites at a time
verbal cues
monitor weight
suction available, etc.

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cause of hiatal hernia in older adults

Incidence increases with age; due to low-fiber diet

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symptoms of hiatal hernia

heartburn
dysphagia
belching
vomiting
regurgitation

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interventions of hiatal hernia

weight reduction
bland diet
5-6 small meals,
sleep on side position
meds
sit up1 hour after eating
don’t eat 2 hours before bed
smoking cessation
avoid irritants

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causes of esophageal cancer in older adults

connected to poor oral hygiene
smoking
alcohol
GERD (Barrett’s esophagus)

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symptoms for esophageal cancer

dysphagia,
weight loss,
thirst,
excessive salivation,
hiccups,
anemia,
chronic
bleeding

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interventions for esophageal cancer

Late diagnosis usually leads to surgical resection,
radiation,
chemo,
laser therapy,
photodynamic

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causes of peptic ulcer

meds that increase gastric secretions,
stress,
diet (spicy or citrus foods),
smoking,
alcohol/beer,
caffeine,
H. Pylori

s/s of peptic ulcer in older adults

pain,
bleeding,
obstruction,
perforation

interventions of peptic ulcer

address causes
meds
dietary changes

causes of stomach cancer

Cigarette use
ethnicity
intake of red meats

s/s of stomach cancer

anorexia,
epigastric pain,
weight loss,
anemia,
but can be insidious and mistaken for indigestion

interventions for stomach cancer

surgery
partial or total gastrectomy

diverticulosis vs diverticulitis

Diverticulosis occurs when small defects in the muscle of the wall of the large intestine or colon allow small pockets or pouches (diverticula) to form. Diverticulitis is infection or inflammation of these abnormal pouches. Together, these conditions are called diverticular disease

diverticulosis causes

Common in older adults due to chronic constipation, obesity, hiatal hernia, low-fiber and fluid intake, and atrophy of muscle walls

interventions for diverticulosis

increase in dietary fiber weight reduction avoidance of constipation

causes of diverticulitis

Occurs frequently with older men; due to overeating, straining, alcohol, irritating foods

interventions for diverticulitis

reducing infection, rest, providing nutrition, relieving discomfort, IV therapy, low-residue diet, NPO, surgery – colectomy or temporary colostomy

s/s of colorectal cancer

bloody stools, bowel pattern changes, unexplained weight loss, anorexia, nausea, abdominal pain, anemia

colostomy as treatment for colorectal cancer

Can cause issues for older adults – threatens positive self-concept Further separates them from society’s view of normal Major adjustment with dependency Reduced energy, arthritic fingers, slow movement, and poor eyesight contribute to care Continued follow-up

causes of chronic constipation

inactive lifestyle, low fiber and fluids, depression, laxative abuse (damaging the nerves), certain meds, dulled sensation of defecation, failure to allow complete bowel emptying can lead to fecal impaction

interventions for chronic constipation

high fiber diet, fluid intake, regular activity, regular bowel elimination time (mornings), meds (after all else fails)

important nursing considerations for laxatives

provide thorough education on the use of laxatives in order to prevent abuse and avoid a fluid and electrolyte imbalance

interventions for flatulence

knee-chest for pain, avoid flatus producing foods, sit upright after a meal, increased activity

what is an intestinal obstruction and what are the causes

Impairment of GI flow due to cancer, adhesions, hernias, diverticulitis, UC, paralytic ileus

interventions of intestinal obstruction

must be prompt, bowel decompression, surgery; maintain F&E balance and ensure comfort

tx of fecal impaction

due to constipation prevent constipation, digital removal (consult facility), enema, hydrogen peroxide in a rectal tube

most common individuals with fecal incontinence

institutionalized older adults with fecal impaction who are physically/cognitively impaired

causes of fecal incontinence

decreased contractile strength, impaired automaticity of sphincters, loss of cortical control, decreased space in colon

interventions for fecal incontinence

assess for presence of impaction, bowel retraining, meds, surgery

symptoms of acute appendicitis for older adults

Severe pain occurring in younger people MAY NOT occur with older adults. Older adults have minimal, referred pain; minimal fever and absence of leukocytosis  delayed diagnosis and treatment

interventions for acute appendicitis

prompt surgery

primarily affected age groups for pancreatic cancer

70-79 years old

symptoms of pancreatic cancer

Fever may not be present; generalized symptoms (anorexia, weakness, weight loss, nausea/vomiting, dyspepsia, belching, diarrhea, constipation, obstructive jaundice)

interventions for pancreatic cancer

surgery poor prognosis

biliary tract disease treatment

Cholelithiasis = gallstones increase with age shock wave lithotripsy (stones); surgery (cancer; poor prognosis)