CH 18: Digestion and Bowel Elimination Flashcards
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
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
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
dry mouth
Xerostomia
causes of xerostomia
reduced saliva, meds, mouth breathing, altered cognition
interventions for xerostomia
frequent mouth care
saliva substitutes
sipping water
sugarless candy/gum
dental problems come from
wear and tear
increased brittleness
finances
poor diet
aging
meds
dental problems can impact
food intake and appetite malnutrition
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
causes of dysphagia in older adults
GERD, mechanical obstructions, and neuro disorders
types of dysphagia
Can be oropharyngeal or esophageal with varying symptoms
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.
cause of hiatal hernia in older adults
Incidence increases with age; due to low-fiber diet
symptoms of hiatal hernia
heartburn
dysphagia
belching
vomiting
regurgitation
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
causes of esophageal cancer in older adults
connected to poor oral hygiene
smoking
alcohol
GERD (Barrett’s esophagus)
symptoms for esophageal cancer
dysphagia,
weight loss,
thirst,
excessive salivation,
hiccups,
anemia,
chronic
bleeding
interventions for esophageal cancer
Late diagnosis usually leads to surgical resection,
radiation,
chemo,
laser therapy,
photodynamic
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)
