Gero-Hydration/Oral Care- Chapter 15 Flashcards
Why is water important for the body (hydration management) ?
- Thermoregulation
- Dilution of water-soluble medications
- Facilitates Bowel/Renal Function
- Maintains Metabolic processes
A significant number of adults drink less than: daily
3mL
7mL
5mL
1mL
-1 mL
What is the recommended amount of fluids that should be consumed by older adults?
-1500 mL/day
What are age-related changes affecting hydration?
- Thirst sensation diminishes
- Creatinine Clearance Decline
- Total Body water decreases
- Loss of muscle mass/Increase in fat cells
What are other contributing factors affecting hydration?
- Medications
- Functional Impairment
- Comorbid conditions: Diabetes
***Cognitively Impaired patient is more at risk for dehydration.
What complex problem results in reduction of total body water?
-Dehydration
Is dehydration considered a geriatric syndrome? T/F
-True
What significant issues are associated w/ dehydration ?
- 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
How do older adults become dehydrated?
-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)
What are included in risk factors for dehydration?
- 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
What are the S/S of dehydration?
- 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
What laboratory test and urine test are used to monitor dehydration?
- 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)
What should the patient interventions be based on?
- Comprehensive history
- Risk identification
- Hydration management
What is the first line treatment approach for dehydration?
-Oral hydration
What is the best fluid to offer for dehydration?
-Water
What does rehydration depend on?
-Severity/Type of dehydration
What does intravenous rehydration replace?
-50% of loss within the first 12 hours or sufficient quantity to relieve tachycardia and hypotension.
What is infused with Hypodermoclysis?
- isotonic fluids into the subcutaneous space (do not want that)
**not for severe dehydration requiring more than 3 Liters
When is dental health increasing neglected?
- Advanced age
- Debilitation
- Limited Mobility
What is poor oral hygiene associated with?
- dehydration
- malnutrition
- systemic diseases
What are some common oral problems associated w/ dehydration?
- xerostomia (dry mouth)
- hyposalivation
How many older adults are affected by oral problems?
- 30%
What affects does xerostomia and hypo salivation have?
- eating
- swallowing
- speaking
How many medications cause hypo salivation?
-400
What should be considered when treating a patient w/ xerostomia and hypo salivation?
- 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)
When does oral cancers occur?
- more frequently later in life
- more frequently in men
What is the key to prevent/treat oral cancer?
-Early detection
How many oral cancer cases aren’t diagnosed until stage 4?
60%
What are the risk factors associated with oral cancer?
- Tobacco *** (chewing tobacco)
- Alcohol
- HPV infection ***
- Genetics
***Biggest ones
What assessment should be done when checking oral health?
-Physical examination of oral cavity and oral health
What does the federal regulations mandate according to oral health?
-Examination of LTC residents
What oral health instrument is used to examine the oral cavity?
- BOHSE ( BRIEF ORAL HEALTH STATUS EXAMINATION)
How do you as a nurse promote oral health to patients?
- Teaching persons and caregivers recommended interventions, screening for oral disease, making referrals
- provide supervision/evaluation oral care in hospitals and LTC facilities
What should you teach the patient about dentures?
- 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)
- 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. - 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
- Dentures should not be worn at night and replaced in the morning (relieve compression)
What are the most common problems with dentures in aging?
- ill-fitting dentures
- Damaged dentures
WHY?
**CAUSE SLIP/SLIDE = tenderness can cause pain or inhibit pt. from eating.
How many people with dentures receive a annual dental examination?
13%
What does lack of attention to oral hygiene in LTC and hospitals led to?
- poor nutrition
- negative outcomes (diseases maybe gum)
Cleaning dentures with a tooth brush after meals leads to what?
-Aspiration pneumonia
** PROPER WAY: rinse dentures off after meal and place back in mouth
What is crucial in preventing ventilator associated pneumonia?
- Oral hygiene
**take swab clean mouth; keep moist but keep it clean
LTC residents are vulnerable secondary to?
- Cognitive impairment
- Dependency on staff to provide good oral care
Tube feedings are associated w/ what?
- Pathological colonization in the mouth
How many times a day do you provide oral care for a patient with gastrostomy (NGT) tubes and brush teeth after feeding?
-Twice (at least) morning/evening
What are the mouth swabs used for?
- clean mouth of endentulous (lacking teeth)
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
Loss of fat cells and increase in muscle mass
WRONG: loss of muscle mass increase in fat cells
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
Decreased skin turgor
WRONG: pt. skin can become dry/ loose with aging “NOT A KEY INDICATOR”
