Chapter 15 Hydration and Oral care

Question 1

Hydration Management

Answer 1

• Water is important for thermoregulation and dilution of water-soluble medications, facilitates bowel and renal function, and maintains metabolic processes
• A significant number of older adults drink less than 1 mL of fluid/day, less than the recommended amount of 1500 mL/day
• Adequate fluid consumption and maintenance of fluid balance is essential to health

-Age-related changes affecting hydration
Thirst sensation diminishes
Creatinine clearance declines
Total body water decreases
Loss of muscle mass and increase in fat cells
See Box 15-1 for more changes
-Other contributing factors include medications, functional impairment, and other comorbid conditions like diabetes

Question 2

Dehydration

Answer 2

• Often related to changes of aging in older adults
• Considered a geriatric syndrome
• Significant issues associated with dehydration: thromboembolic complications, kidney stones, constipation, falls, medication toxicity, renal failure, seizure, electrolyte imbalance, hyperthermia, and delayed wound healing

Majority of older people develop dehydration from increase fluid losses combined with decreased fluid intake, related to decreased thirst
Risk factors for dehydration include emotional illness, surgery, trauma, higher physiological demands

Question 3

Dehydration Signs and symptoms

Answer 3

• Often atypical in the older adult
• Skin turgor is not a reliable indicator in older adults
• Look for dry mucous membranes in mouth and nose, furrows on the tongue, orthostasis, speech incoherence, rapid pulse, decreased urine output, extremity weakness, dry axilla, and sunken eyes

Question 4

Dehydration Laboratory tests and urine

Answer 4

• Labs: serum sodium, serum and urine osmolarity, and specific gravity
• Most cases of dehydration have an elevated blood urea nitrogen (BUN); however, there are many other causes for elevation of BUN/creatinine ratio
• Observe urine patterns for changes

Question 5

Dehydration Interventions

Answer 5

• Based on comprehensive assessment, risk identification, and hydration management
• Monitor closely and implementation of intake and output is essential
• Oral hydration is the first treatment approach
• Water is the best fluid to offer

Question 6

Rehydration

Answer 6

• Depends on severity and type of dehydration
• Intravenous
• Replace 50% of loss within first 12 hours or sufficient quantity to relieve tachycardia and hypotension
• Hypodermoclysis
• Infusion of isotonic fluids into the subcutaneous space
• Not for severe dehydration – requiring more than 3 liters

Question 7

Common Oral problems

Answer 7

Xerostomia (mouth dryness) and hyposalivation
30% of older adults affected
Affects eating, swallowing, speaking
More than 400 medications cause hyposalivation
Treatment: review medications, good oral hygiene, adequate water, avoid alcohol and caffeine, over-the-counter oral saliva substitutes

Question 8

Oral Cancers

Answer 8

Occur more frequently later in life
Occur more frequently in men than women
Early detection essential as 60% of cases aren’t diagnosed until Stage 4
Risk factors (Box 15-7)
Tobacco use
Alcohol use
HPV (human papillomavirus) infection
Genetic susceptibility

Question 9

Assessment of oral health

Answer 9

Physical examination of oral cavity and oral health
Federal regulations mandate annual examination for LTC residents
Oral health instrument: The Kayser-Jones Brief Oral Health Status Examination (BOHSE)

Question 10

Interventions for oral health

Answer 10

Promote oral health through teaching persons and caregivers recommended interventions, screening for oral disease, making dental referrals
Provide supervision and evaluation of oral care in hospitals and LTC facilities

Question 11

Dentures

Answer 11

Patient and/or caregiver education of proper cleaning techniques
Tips for best practices: Denture Care (Box 15-12)
Damaged and ill-fitting dentures are a common problem
Only 13% of persons with dentures get an annual dental examination

Question 12

Oral hygiene in hospitals and LTC

Answer 12

Lack of attention to oral hygiene contributes to poor nutrition and negative outcomes
Cleaning teeth with a toothbrush after meals lowers risk of aspiration pneumonia
Crucial in prevention ventilator-associated pneumonia
LTC residents vulnerable secondary to cognitive impairment and dependency on staff to provide good oral care

Question 13

Tube feedings and oral hygiene

Answer 13

Tube feedings are associated with significant pathological colonization in the mouth
Provide oral care twice a day for persons with gastrostomy tubes and brush teeth after each feeding
Only toothbrushes assist in the removal of plaque; use foam swabs to clean mouth of endentulous

Question 14

Which is NOT an age-related change that affects hydration?
A. Thirst sensation diminishes
B. Creatinine clearance declines
C. Total body water decreases
D. Loss of fat cells and increase in muscle mass

Answer 14

D. Loss of fat cells and increase in muscle mass

Question 15

Signs and symptoms of dehydration in an older adult include all of the following except:
A. dry mucous membranes in mouth and nose.
B. decreased skin turgor.
C. dry axilla.
D. speech incoherence.

Answer 15

B. decreased skin turgor.