Ch19

Question 1

Differentiate the 2 types of stroke. List factors that place an individual at higher risk for stroke.

Answer 1

1. Ischemic stroke
   - Clogged blood vessels preventing oxygen and nutrients reaching the brain.
2. Haemorrhagic stroke
   - Weakened blood vessels breaks

Risk factors
- High blood pressure, family history, poverty, ethnicity, physical inactivity, excessive use of alcohol, use of drugs.

Question 2

What is sarcopenic obesity and considerations for older adults when contemplating weight loss.

Answer 2

• Sacropenic obesity is when weight is lost as muscle and gained as fat. This can be harmful if there is no plan for regaining and maintaining muscle and organ mass.
• Healthy eating program includes nutrient-dense calories to support loss of fat and minimise bone and muscle loss, Physical activity is the only way to prevent muscle loss, recommending strength based exercise.

Question 3

Discuss nutritional risk factors of the development of constipation, along with nutritional remedies for treatment it.

Answer 3

• Nutrition risk factors: dehydration, low fibre, medications, calcium and other mineral supplements
• Nutritional remedies: increase fibre and fluids. Increased exercise can improve peristalsis and reduce constipation.
• People need fibre, fluid and muscle tone to promote bowel movements. Fibre sources: whole grains, fruits and vegetables.

Question 4

List nutritional strategies to normalise blood pressure for older adults. Discuss some highlights and features of the DASH diet.

Answer 4

• Nutritional strategies: weight management, moderation of alcohol, and limit sodium (while maintaining potassium, magnesium and calcium).
• DASh diet includes decreased sodium (<1500mg per day). Choosing less processed foods can contribute to decreased sodium (added in manufacturing and preservation process).

Question 5

Discuss special concerns for self-management training in older adults with diabetes

Answer 5

1. Fibre and carb recommendations DONT change
2. Diabetic kidney disease DONT reduce protein.
3. Assess diet and supplements to meet requirements.
4. Modify care plan for psychosocial and physical needs.
5. Asking about complementary therapies to enhance nutritional therapies.
6. Use sweeteners to reduce calories and weight gain.

Question 6

Define two types of vitamin B12 deficiency. Identify DRI for B12 for older adults and 3 good food sources.

Answer 6

1. Pernicious anaemia: not enough B12 to make RBC.
2. Atrophic gastritis: inflammation and thinning of stomach lining
   - DRI = 2.4mcg/day
   - Good sources include meat, fish and seafood, poultry, eggs, and dairy.

Question 7

Name 3 characteristics that place elderly at increased risk for dehydration. Identify 5/7 symptoms of dehydration.

Answer 7

1. Increasing risk of dehydration
   - Swallowing problems
   - Dementia
   - Oral health problems
   - Less sensitive to detecting thirst
   - Worried about wetting themselves.
2. Symptoms
   - Upper body weakness
   - Dry mouth and nose
   - Dry tongue
   - Constipation
   - Confusion
   - Sunken appearance of eyes.
   - Speach difficulty

Question 8

Describe palliative care, nutrition in palliative care, and palliative approach to nutrition.

Answer 8

• Palliative care: care provides to someone with terminal or life threatening illness. If you have a condition, palliative care can improve quality of life, reduce physical and psychological symptoms, help a person have a peaceful death and support families. It can also provide treatment for pain management or symptoms e.g. nausea, anxiety, etc.
• Main focus on nutrition in palliative care is reducing worry and improving quality of life.
• Palliative approach to nutrition is dealing with other concerns such as pain, physical or mental/social symptoms before nutrition.

Question 9

Describe the four modules of the Kowhai programme.

Answer 9

Kowhai program provides information and support to family carers of hospice patients.
1. Family health
2. Psychological health
3. Physical health
4. Spiritual health