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Gero > Gero-Hydration/Oral Care- Chapter 15 > Flashcards

Gero-Hydration/Oral Care- Chapter 15 Flashcards

1
Q

Why is water important for the body (hydration management) ?

A
  • Thermoregulation
  • Dilution of water-soluble medications
  • Facilitates Bowel/Renal Function
  • Maintains Metabolic processes
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2
Q

A significant number of adults drink less than: daily

3mL
7mL
5mL
1mL

A

-1 mL

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3
Q

What is the recommended amount of fluids that should be consumed by older adults?

A

-1500 mL/day

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4
Q

What are age-related changes affecting hydration?

A
  • Thirst sensation diminishes
  • Creatinine Clearance Decline
  • Total Body water decreases
  • Loss of muscle mass/Increase in fat cells
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5
Q

What are other contributing factors affecting hydration?

A
  • Medications
  • Functional Impairment
  • Comorbid conditions: Diabetes

***Cognitively Impaired patient is more at risk for dehydration.

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6
Q

What complex problem results in reduction of total body water?

A

-Dehydration

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7
Q

Is dehydration considered a geriatric syndrome? T/F

A

-True

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8
Q

What significant issues are associated w/ dehydration ?

A
  • Thromboembolic complications (PE/CLOTS)
  • Kidney stones
  • Falls (dehydration, dizziness, falls)
  • Medication toxicity
  • Renal Failure
  • Seizures (can come from both renal failure and Elect Imbalance)
  • Electrolyte Imbalance
  • Hyperthermia
  • Delayed wound healing
  • Hand pt. something to drink (Encourage ice if patient doesn’t want to drink)
  • How much has the pt. drunk
  • What is the patient drinking
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9
Q

How do older adults become dehydrated?

A

-Increase fluid losses combined w/ decreased fluid intake r/t decreased thirst

***(pt. is not as thirsty or loss in fluid faster N/V/D, breathing faster, to not drinking as much)

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10
Q

What are included in risk factors for dehydration?

A
  • Emotional illness
  • Surgery
  • Trauma
  • Higher physiological demands (must increase fluid intake)
  • Medications: diuretics, laxatives, ACE inhibitors, psychotropics
  • Polypharmacy 4+ meds
  • Functional deficits
  • Communication/comprehension problems
  • Oral problems
  • Dysphagia
  • Delirium
  • Dementia
  • Hospitalization
  • Low body weight
  • Diagnostic procedures requiring fasting
  • Requiring physical assistance at meals
  • Being female
  • Inadequate assistance at meals
  • Diarrhea
  • Fever
  • Vomiting
  • Infections
  • Bleeding
  • Draining wounds
  • Artificial ventilation
  • Fluid restrictions
  • High environment temperatures
  • Multiple comorbidities
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11
Q

What are the S/S of dehydration?

A
  • Atypical
  • Skin turgor (not reliable indicator b/c pt can have loosse/dry skin b/c of aging
  • Dry mucous membranes in nose/mouth
  • Furrows on the tongue
  • Orthostasis
  • Speech incontinence
  • Rapid pulse
  • Decreased urine output
  • Extremity weakness
  • Dry axilla
  • Sunken eyes
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12
Q

What laboratory test and urine test are used to monitor dehydration?

A
  • Serum sodium
  • osmolarity
  • specific gravity
  • Elevated BUN (can be other causes)

-observe urine pattern for changes : Does patient usually go through 4-5 briefs a day to pt. going the day w/o wetting a brief (monitor intake and output)

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13
Q

What should the patient interventions be based on?

A
  • Comprehensive history
  • Risk identification
  • Hydration management
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14
Q

What is the first line treatment approach for dehydration?

A

-Oral hydration

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15
Q

What is the best fluid to offer for dehydration?

A

-Water

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16
Q

What does rehydration depend on?

A

-Severity/Type of dehydration

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17
Q

What does intravenous rehydration replace?

A

-50% of loss within the first 12 hours or sufficient quantity to relieve tachycardia and hypotension.

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18
Q

What is infused with Hypodermoclysis?

A
  • isotonic fluids into the subcutaneous space (do not want that)

**not for severe dehydration requiring more than 3 Liters

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19
Q

When is dental health increasing neglected?

A
  • Advanced age
  • Debilitation
  • Limited Mobility
20
Q

What is poor oral hygiene associated with?

A
  • dehydration
  • malnutrition
  • systemic diseases
21
Q

What are some common oral problems associated w/ dehydration?

A
  • xerostomia (dry mouth)

- hyposalivation

22
Q

How many older adults are affected by oral problems?

A
  • 30%
23
Q

What affects does xerostomia and hypo salivation have?

A
  • eating
  • swallowing
  • speaking
24
Q

How many medications cause hypo salivation?

A

-400

25
Q

What should be considered when treating a patient w/ xerostomia and hypo salivation?

A
  • Review medication (Are we on something that can be changed that’s causing it. Does the good of meds out weigh the change that it is causing)
  • Good oral hygiene
  • Adequate water
  • Avoid alcohol/ caffeine
  • OTC oral saliva substitutes (swab/wet them moisten mouth-short term affect)
26
Q

When does oral cancers occur?

A
  • more frequently later in life

- more frequently in men

27
Q

What is the key to prevent/treat oral cancer?

A

-Early detection

28
Q

How many oral cancer cases aren’t diagnosed until stage 4?

A

60%

29
Q

What are the risk factors associated with oral cancer?

A
  • Tobacco *** (chewing tobacco)
  • Alcohol
  • HPV infection ***
  • Genetics

***Biggest ones

30
Q

What assessment should be done when checking oral health?

A

-Physical examination of oral cavity and oral health

31
Q

What does the federal regulations mandate according to oral health?

A

-Examination of LTC residents

32
Q

What oral health instrument is used to examine the oral cavity?

A
  • BOHSE ( BRIEF ORAL HEALTH STATUS EXAMINATION)
33
Q

How do you as a nurse promote oral health to patients?

A
  • Teaching persons and caregivers recommended interventions, screening for oral disease, making referrals
  • provide supervision/evaluation oral care in hospitals and LTC facilities
34
Q

What should you teach the patient about dentures?

A
  • Proper cleaning techniques
    1. take dentures out/ ask (observe ability to remove)
    2. Inspect oral cavity
    3. Rinse dentures after each meal to remove soft debris (DO USE TOOTHPASTE)
  1. Once each day remove dentures and brush thoroughly (acrylic denture tooth brush b/c softer)
    - brush over sink lined w/ face cloth/ half filled w/ water (prevent breakage)
    - hold dentures securely & DO NOT use commercial tooth powder use water, mild soap, sodium bicarbonate
    - clean clasp with regular toothbrush with partial removable dentures.
  2. Rinse dentures thoroughly & place in a denture cleaning solution and allow to soak overnight or at least a few hours. Rinse in the morning / use denture paste
  3. Dentures should not be worn at night and replaced in the morning (relieve compression)
35
Q

What are the most common problems with dentures in aging?

A
  • ill-fitting dentures
  • Damaged dentures

WHY?

**CAUSE SLIP/SLIDE = tenderness can cause pain or inhibit pt. from eating.

36
Q

How many people with dentures receive a annual dental examination?

A

13%

37
Q

What does lack of attention to oral hygiene in LTC and hospitals led to?

A
  • poor nutrition

- negative outcomes (diseases maybe gum)

38
Q

Cleaning dentures with a tooth brush after meals leads to what?

A

-Aspiration pneumonia

** PROPER WAY: rinse dentures off after meal and place back in mouth

39
Q

What is crucial in preventing ventilator associated pneumonia?

A
  • Oral hygiene

**take swab clean mouth; keep moist but keep it clean

40
Q

LTC residents are vulnerable secondary to?

A
  • Cognitive impairment

- Dependency on staff to provide good oral care

41
Q

Tube feedings are associated w/ what?

A
  • Pathological colonization in the mouth
42
Q

How many times a day do you provide oral care for a patient with gastrostomy (NGT) tubes and brush teeth after feeding?

A

-Twice (at least) morning/evening

43
Q

What are the mouth swabs used for?

A
  • clean mouth of endentulous (lacking teeth)
44
Q

What is NOT an age-related change that affects hydration ?

Thirst sensation diminishes
Creatinine clearance declines
Total body water decreases
Loss of fat cells and increase in muscle mass

A

Loss of fat cells and increase in muscle mass

WRONG: loss of muscle mass increase in fat cells

45
Q

S/S of dehydration in an older adult include all of the following except?

Dry mucous membranes in mouth/nose
Decreased skin turgor
Dry axilla
Speech Incontinence

A

Decreased skin turgor

WRONG: pt. skin can become dry/ loose with aging “NOT A KEY INDICATOR”

Gero (7 decks)

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