Nutrition and Elimination Flashcards
1
Q
What changes can aging adult experience with nutrition ?
A
Slower absorption, decreased appetite, need more nutrient rich foods (quality over quantity),
2
Q
Dysphagia
A
Difficulty Swallowing
3
Q
Hyperphagia
A
Excessive Eating
4
Q
Different Types of Dysphagia
A
Transfer Dysphagia - mouth to Esophagus
Transport Dysphagia - just getting down the esophagus
Delivery - esophagus to stomach
5
Q
What is the name of the cranial nerve that controls tongue movements?
A
Hypoglossal
6
Q
What causes transfer Dysphagia?
A
atrophy of the tongue muscle makes it difficult to swallow, decreased enzymes and functioning of the salivary glands make food hard to swallow and dry.
7
Q
What causes transport dysphagia?
A
Decreased peristalsis due to aging, constriction of the esophagus, decreased mucus production,
8
Q
What causes delivery dysphagia ?
A
Issues with esophageal sphincter - the sphincter is closed when not swallowing.
9
Q
What is Xerostomia ?
A
Dry mouth- decreased saliva production could be indicative of increased fluid intake.
Want to keep mouth moist.
10
Q
NPO
A
Nothing by Mouth - this would be found in orders
11
Q
PO
A
By Mouth - this could be found in medication orders
12
Q
Older adults have an increased need for ____________ nutrition.
A
Quality.
13
Q
What happens to intracellular fluid levels in older adults?
A
Intracellular fluids decrease within the cells so they need increased fluid intake
14
Q
GI changes that occur in older patient ?
A
Reduced absorption, reduced peristalsis, decreased production of hydrochloric acid, reduced taste sensation, esophagus becomes more dilated, reduced intestinal blood flow , decreased stomach motility, emptying time and hunger contractions
15
Q
Why do older adults have a reduced need for nutrients ?
A
Metabolic activities slow down and their BMR decreases… not as much is going on as in the younger adult.
16
Q
Pulmonary Aspiration
A
Food gets into the lungs- this is an increasing concern in older adults
17
Q
What are we worried about when there is reduced intestinal blood flow ?
A
Constipation, not getting adequate nutrient intake
18
Q
Nursing interventions for constipation
A
High Fiber diet - helps to increase peristalsis and bulk up stool. Foods with good fiber -
Suppository - pill inserted into the rectum…
19
Q
Nursing interventions for diarrhea
A
Low fiber diet
20
Q
Why might someone be on a high fiber diet?
A
When stool is stuck or needs to be bulked to be excreted
21
Q
What factors might cause lower adults to consume less fluids?
A
Decreased thirst sensation, decreased mobility, mood changes, more sedentary lifestyle,
22
Q
What are effects of fluid restriction ?
A
Dehydration, increased infection risk, delirium (imbalance of fluid vs electrolytes)
23
Q
Effects of fluid overhydration ?
A
Kidney overload, increased blood pressure (which means heart is pumping faster and more), Renal and Cardiac dysfunction
24
Q
Men older than 50 need how much water ?
How much do women older than 50 need ?
A
- 7 L a day
2. 7 L a day
25
What are components of a nutritional assessment ?
History taking - any aspect of obtaining, preparing, eating and enjoying food
Physical Assessments - BMI and clinical data
Laboratory data - protein status, body vitamin, mineral and trace element status
26
Components of Mini Nutritional Assessment Screening Tool
Physical: decreased food intake, weight loss, mobility
Mental - neuro problems /psychological stressors in past 3 months
Social - what they can afford
Cultural Variables
This all helps us to determine nursing interventions
27
Interventions and services to enhance nutritional status
```
Supplemental nutrition assistance programs: food stamps
Meals on wheels
Shopping and meal prep. assistance
Home health aides for feeding assistance
Congregate eating programs
Nutritional and psychological counseling
Consider ethnic and religious factors
Promote oral health
```
28
What are different types of diets ?
Consistent Carbohydrate (ex: those with diabetes)
High or low Fiber diet
Sodium Restriction: for those with hypertension
Renal Diet: diets that are tailored toward preserving the kidneys. Low fluid intake
29
What is "Advance as Tolerated"
Diet gradually becomes more regular from fluids only to solids. If a patient is coming out of surgery, they would gradually get back to eating regular foods
30
Name some special diets
```
Clear Liquid
Full Liquid
Pureed
Mechanical soft
Thickened Liquids (Dysphagia patients)
```
31
What does a clear liquid diet entail?
Only clear fluids and foods that become fluid at body temperature
32
Full liquid diet ?
Fluids and foods that are normally liquid and foods that turn to liquid when they are room temperature.
33
Pureed diet
Blenderized diet made up of liquid and foods blenderized to a liquid. All foods are allowed
34
Mechanical Soft Diet
Regular diet with modifications for texture (chopped, ground, mashed, or soft). Excludes most raw fruits, veggies, and foods w/ seeds, nuts, and dried fruits.
35
Short term Nutritional Assistance Measures
NG and NI tube
36
Long term nutritional assistance measures
Percutaneous endoscopic gastrostomy (PEG-tube)
| Percutaneous endoscopic jejunum (PEJ-tube
37
What does TPN stand for?
Total Parenteral Nutrition - all nutrition is going directly into GI system.
38
What does PPN stand for ?
Peripheral parenteral nutrition (PPN)
39
What is micturation
Also known as urination or voiding
40
What is normal urinary function dependent upon?
Adequate renal blood flow
Nervous system control
Filtering activities within the kidney
Performance of the urinary tract musculature
41
What are the phases of micturation ?
Phase I: Filling and Storage
Urine stored in the bladder until pressure stimulates special stretch sensory nerve endings in bladder wall (adults 250-450 ml)
Phase II: Bladder emptying
Stretch receptors transmit impulses to the spinal cord voiding reflex center
Internal sphincter relaxes stimulating the urge to void
Conscious portion of brain relaxes the external urethral sphincter muscle
Urine is eliminated through urethra
42
What factors can affect frequency of urine elimination ?
Fluid intake, physical location, kidney function, mobility issues, pregnancy, prostate issues,
43
What is polyuria ?
Excessive output of urine.
44
What is oliguria ?
A low output of urine (24 hour output < 400 ml)
45
What is anuria ?
Complete kidney shutdown, renal failure; 24-hour output < 50ml
46
Nocturia ?
Voiding 2 or more times a night
47
What is urgency ?
Feeling that the person must void
48
Frequency
Increased incidence of voiding
49
Dysuria
Voiding that is painful or difficult
50
Urinary retention
Emptying of the bladder is impaired, the bladder becomes over distended
51
Neurogenic Bladder
person does not perceive bladder fullness and is unable to control the urinary sphincters due to dysfunctional neurological function
52
Incontinence
Involuntary loss of urine
53
What are some decreased GU changes that occur with aging?
Decreased bladder capacity, decrease in nephrons, weaker bladder muscles,decreased tubular function, decreased size of renal mass,
between ages 20 and 90, renal blood flow decreases 53% and glomerular filtration rate decreases 50%
54
What are ways to collect and measure urine output ?
Bedpan, urinal, catheter
55
What are you assessing for urine?
Color - clear, hazy, cloudy
Clarity- straw, yellow, red-orange, red, orange, brown
Odor - no odor, foul, sweet
56
What is hematuria?
Blood in the urine
57
What is proteinuria?
Protein in the urine
58
What is pyuria ?
Pus in the urine
59
What are reasons for urinary catheterization ?
Relieving urinary retention
Obtaining a sterile urine specimen
Obtaining a urine specimen (when usual methods can’t be used)
Emptying bladder before, during, or after surgery
Monitoring critically ill patients
Increasing comfort for terminally ill patients
60
What are CAUTIS?
Catheter Associated Urinary Tract Infections
35 – 40% of all nosocomial infections are CAUTI’s.
50% of patients develop bacteriuria (bacteria in the urine) within the first 24 hours of being catheterized
61
What is urinary incontinence ?
The complaint of any involuntary leakage of urine
62
Different types of incontinence
```
Urge Incontinence
Stress Incontinence
High Post-Void Residual Incontinence (overflow incontinence)
Transient Incontinence
Mixed Incontinence
Functional Incontinence
Reflex Incontinence
Total Incontinence
```
63
Transient Incontinence
```
D = delirium or acute confusion
I = infections (UTI)
A = atrophic vaginitis
P = pharmocologic agents
P = psychiatric disorders (depression; sedative and antianxiety agents)
E = endocrine disorders
R = restricted mobility
S = stool impaction
```
Transient incontinence appears suddenly and lasts for 6 months or less- usually caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment such as the use of diuretics or intravenous fluid administration.
64
Urge Incontinence
```
Sudden need to urinate
Caused by bladder contractions
Bladder may not be full
Over active Bladder
Causes
Inflammation, infection, neurological disease
BPH, “Overactive bladder”
Treated with anticholinergic medicines
May increase symptoms of dementia
```
65
Stress incontinence
Involuntary loss of urine (coughing, laughing, standing, exercising)
Cause
Childbirth, Menopause, Chronic Constipation
Not a complication of normal aging
Treatment
Kegal Exercises
Surgery
66
Overflow Incontinence
Overflow Incontinence (High Post-Void Residual)
Excessive accumulation of urine in the bladder
Causes urine leakage
Cause
BPH, neurologic disease, tumors, spinal cord injury
Treatment
Alpha-1-adrenergic blocking agents: relax striated and smooth muscle (Cardura, Flomax)
Side Effects: Orthostatic hypotension, bradycardia, arrhythmia
67
What is the only type of incontinence for which a urinary catheter may be used ?
Overflow Incontinence
Patient may require indwelling catheterization or
Intermittent urethral catheterization
68
Functional Incontinence
```
Inability to reach toilet or adjust clothing
Cause
Mobility deficits, visual loss, dexterity, dementia, severe depression, medications (sedatives)
Caregiver inattention
Toilet inaccessible
Treatment
Treat underlying cause
Assist with mobility
```
Can't reach the toilet in time because of limitations
69
What are some quality of life issues associated with incontinence ?
```
Changed social patterns
Isolation
depression
altered lifestyles
impaired sexual function
```
70
What is the problem with using absorbent products for incontinence ?
This builds a perception that incontinence cannot be treated
Increased risk for Skin breakdown
and Increased risk for UTI
Long-term use not recommended until a full assessment has been completed with a health care provider.
71
What are some nursing interventions to manage urinary incontinence in the older adult ?
Maintain fluid intake
Provide easy access to the bathroom
Assess factors that influence voiding
Use assistive devices when necessary (examples?)
Use collection devices when necessary (examples?)
Encourage safety when ambulating (how?)
Encourage performance of kegel exercises several times daily
Encourage participation in a bladder retraining program
72
Nocturia Interventions
Nocturia is having to urinate frequently at night
Ensure easy access to the bathroom or commode.
Use night light.
Discourage fluid intake at bedtime.
Discourage alcohol use before bedtime.
Evaluate med. Regimen.
Use clothing that is easily removed for voiding
Keep assistive devices readily available
Evaluate gait and ability to ambulate safely
Asses for urinary tract infection
73
Primary purpose of peristalsis
These contractions of the circular and longitudinal muscles of the intestine move waste products along the length of the intestine continuously.
74
What body system controls peristalsis?
The autonomic nervous - parasympathetic nervous system stimulates movement while the sympathetic system inhibits movement
75
How much of our ingested food waste is excreted in the stool within 24 hours?
one third to one half of ingested food waste is normally excreted in the stool within 24 hours, and the remainder within the next 24 - 48 hours
76
How often does mass peristalsis sweeps occur every 24 hours?
Occur one to four times each 24 hour period in most people, propelling the fecal mass forward.
This often occurs after food has been ingested, accounting for the urge to defecate that often occurs after meals.
77
Age related changes affecting defecation
Slowing of GI motility with increased stomach emptying time
Decreased colonic peristalsis
Decreased muscle tone/incontinence
Weakening of intestinal walls
Reduced sensation for signal to defecated
78
Factors influencing elimination
```
Daily patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia
```
79
Elimination pathologies affecting the older adult
Constipation
Common chronic problem for older adults
Diarrhea
Fecal impaction
Prolonged retention or
Accumulation of fecal material that forms a hardened mass in the rectum
Fecal incontinence
Involuntary passing of stool or flatus
Can result from physiologic or lifestyle changes
80
What are foods affecting bowel elimination?
Constipating foods: Cheese, lean meat, eggs, pasta
Foods with laxative effect: Fruits and vegetables, bran, chocolate, alcohol, coffee
Gas-producing foods: Onions, cabbage, beans, cauliflower
81
Primary prevention strategies for Constipation
```
Maintenance of regular bowel routines
Respond to urge to defecate
25-38 grams of fiber/day
Increase fluid intake:
1500-2000ml of fluid/day
Adjust diet – add fiber
```
82
What are laxatives ?
Drugs that induce emptying of the intestinal tract
83
What are enemas ?
Inserting a solution into the large intestine to remove feces
Tap water enema
Normal saline enema
Hypertonic solution enema (Fleet enema most common)
Soapsuds enema
84
What are suppositories ?
Solid substance that melts at body temperature - inserted into rectum
85
Laxatives/enemas/suppositories all do what ?
Empty the colon of feces
Use laxatives/enemas/suppositories cautiously
86
What is a digital removal of fecal impaction
Inserting a gloved finger into the rectum to dig out feces
87
What are different bowel diversions?
Ostomy
Surgically formed opening from the inside of an organ to the outside
Ileostomy
Liquid fecal content from the ileum of the small intestine
Colostomy
Permits formed feces in the colon to exit through the stoma
88
Feces Color , Texture, and OdorNormal versus Abnormal
```
Soft
Hard
Formed
Loose
Liquid
Brown, green, red, black
Foul
Soft
Hard
Formed
Loose
Liquid
Brown, green, red, black
Foul
```
89
What type of stool are you likely to see from an ileostomy ?
Liquid fecal content
