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Fundamentals of Nursing in the Context of the Older Adult > Nutrition and Elimination > Flashcards

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),

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2
Q

Dysphagia

A

Difficulty Swallowing

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3
Q

Hyperphagia

A

Excessive Eating

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4
Q

Different Types of Dysphagia

A

Transfer Dysphagia - mouth to Esophagus
Transport Dysphagia - just getting down the esophagus
Delivery - esophagus to stomach

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5
Q

What is the name of the cranial nerve that controls tongue movements?

A

Hypoglossal

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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.

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7
Q

What causes transport dysphagia?

A

Decreased peristalsis due to aging, constriction of the esophagus, decreased mucus production,

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8
Q

What causes delivery dysphagia ?

A

Issues with esophageal sphincter - the sphincter is closed when not swallowing.

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9
Q

What is Xerostomia ?

A

Dry mouth- decreased saliva production could be indicative of increased fluid intake.
Want to keep mouth moist.

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10
Q

NPO

A

Nothing by Mouth - this would be found in orders

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11
Q

PO

A

By Mouth - this could be found in medication orders

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12
Q

Older adults have an increased need for ____________ nutrition.

A

Quality.

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13
Q

What happens to intracellular fluid levels in older adults?

A

Intracellular fluids decrease within the cells so they need increased fluid intake

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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

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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.

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16
Q

Pulmonary Aspiration

A

Food gets into the lungs- this is an increasing concern in older adults

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17
Q

What are we worried about when there is reduced intestinal blood flow ?

A

Constipation, not getting adequate nutrient intake

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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…

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19
Q

Nursing interventions for diarrhea

A

Low fiber diet

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20
Q

Why might someone be on a high fiber diet?

A

When stool is stuck or needs to be bulked to be excreted

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21
Q

What factors might cause lower adults to consume less fluids?

A

Decreased thirst sensation, decreased mobility, mood changes, more sedentary lifestyle,

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22
Q

What are effects of fluid restriction ?

A

Dehydration, increased infection risk, delirium (imbalance of fluid vs electrolytes)

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23
Q

Effects of fluid overhydration ?

A

Kidney overload, increased blood pressure (which means heart is pumping faster and more), Renal and Cardiac dysfunction

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24
Q

Men older than 50 need how much water ?

How much do women older than 50 need ?

A
  1. 7 L a day

2. 7 L a day

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25
Q

What are components of a nutritional assessment ?

A

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

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26
Q

Components of Mini Nutritional Assessment Screening Tool

A

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

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27
Q

Interventions and services to enhance nutritional status

A 
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
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28
Q

What are different types of diets ?

A

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

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29
Q

What is “Advance as Tolerated”

A

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

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30
Q

Name some special diets

A 
Clear Liquid
Full Liquid 
Pureed 
Mechanical soft 
Thickened Liquids (Dysphagia patients)
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31
Q

What does a clear liquid diet entail?

A

Only clear fluids and foods that become fluid at body temperature

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32
Q

Full liquid diet ?

A

Fluids and foods that are normally liquid and foods that turn to liquid when they are room temperature.

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33
Q

Pureed diet

A

Blenderized diet made up of liquid and foods blenderized to a liquid. All foods are allowed

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34
Q

Mechanical Soft Diet

A

Regular diet with modifications for texture (chopped, ground, mashed, or soft). Excludes most raw fruits, veggies, and foods w/ seeds, nuts, and dried fruits.

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35
Q

Short term Nutritional Assistance Measures

A

NG and NI tube

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36
Q

Long term nutritional assistance measures

A

Percutaneous endoscopic gastrostomy (PEG-tube)

Percutaneous endoscopic jejunum (PEJ-tube

37
Q

What does TPN stand for?

A

Total Parenteral Nutrition - all nutrition is going directly into GI system.

38
Q

What does PPN stand for ?

A

Peripheral parenteral nutrition (PPN)

39
Q

What is micturation

A

Also known as urination or voiding

40
Q

What is normal urinary function dependent upon?

A

Adequate renal blood flow
Nervous system control
Filtering activities within the kidney
Performance of the urinary tract musculature

41
Q

What are the phases of micturation ?

A

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
Q

What factors can affect frequency of urine elimination ?

A

Fluid intake, physical location, kidney function, mobility issues, pregnancy, prostate issues,

43
Q

What is polyuria ?

A

Excessive output of urine.

44
Q

What is oliguria ?

A

A low output of urine (24 hour output < 400 ml)

45
Q

What is anuria ?

A

Complete kidney shutdown, renal failure; 24-hour output < 50ml

46
Q

Nocturia ?

A

Voiding 2 or more times a night

47
Q

What is urgency ?

A

Feeling that the person must void

48
Q

Frequency

A

Increased incidence of voiding

49
Q

Dysuria

A

Voiding that is painful or difficult

50
Q

Urinary retention

A

Emptying of the bladder is impaired, the bladder becomes over distended

51
Q

Neurogenic Bladder

A

person does not perceive bladder fullness and is unable to control the urinary sphincters due to dysfunctional neurological function

52
Q

Incontinence

A

Involuntary loss of urine

53
Q

What are some decreased GU changes that occur with aging?

A

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
Q

What are ways to collect and measure urine output ?

A

Bedpan, urinal, catheter

55
Q

What are you assessing for urine?

A

Color - clear, hazy, cloudy
Clarity- straw, yellow, red-orange, red, orange, brown
Odor - no odor, foul, sweet

56
Q

What is hematuria?

A

Blood in the urine

57
Q

What is proteinuria?

A

Protein in the urine

58
Q

What is pyuria ?

A

Pus in the urine

59
Q

What are reasons for urinary catheterization ?

A

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
Q

What are CAUTIS?

A

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
Q

What is urinary incontinence ?

A

The complaint of any involuntary leakage of urine

62
Q

Different types of incontinence

A 
Urge Incontinence
Stress Incontinence
High Post-Void Residual Incontinence (overflow incontinence)
Transient Incontinence
Mixed Incontinence
Functional Incontinence
Reflex Incontinence
Total Incontinence
63
Q

Transient Incontinence

A 
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
Q

Urge Incontinence

A 
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
Q

Stress incontinence

A

Involuntary loss of urine (coughing, laughing, standing, exercising)
Cause
Childbirth, Menopause, Chronic Constipation
Not a complication of normal aging
Treatment
Kegal Exercises
Surgery

66
Q

Overflow Incontinence

A

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
Q

What is the only type of incontinence for which a urinary catheter may be used ?

A

Overflow Incontinence

Patient may require indwelling catheterization or
Intermittent urethral catheterization

68
Q

Functional Incontinence

A 
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
Q

What are some quality of life issues associated with incontinence ?

A 
Changed social patterns 
Isolation 
depression
altered lifestyles 
impaired sexual function
70
Q

What is the problem with using absorbent products for incontinence ?

A

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
Q

What are some nursing interventions to manage urinary incontinence in the older adult ?

A

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
Q

Nocturia Interventions

A

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
Q

Primary purpose of peristalsis

A

These contractions of the circular and longitudinal muscles of the intestine move waste products along the length of the intestine continuously.

74
Q

What body system controls peristalsis?

A

The autonomic nervous - parasympathetic nervous system stimulates movement while the sympathetic system inhibits movement

75
Q

How much of our ingested food waste is excreted in the stool within 24 hours?

A

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
Q

How often does mass peristalsis sweeps occur every 24 hours?

A

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
Q

Age related changes affecting defecation

A

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
Q

Factors influencing elimination

A 
Daily patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia
79
Q

Elimination pathologies affecting the older adult

A

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
Q

What are foods affecting bowel elimination?

A

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
Q

Primary prevention strategies for Constipation

A 
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
Q

What are laxatives ?

A

Drugs that induce emptying of the intestinal tract

83
Q

What are enemas ?

A

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
Q

What are suppositories ?

A

Solid substance that melts at body temperature - inserted into rectum

85
Q

Laxatives/enemas/suppositories all do what ?

A

Empty the colon of feces

Use laxatives/enemas/suppositories cautiously

86
Q

What is a digital removal of fecal impaction

A

Inserting a gloved finger into the rectum to dig out feces

87
Q

What are different bowel diversions?

A

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
Q

Feces Color , Texture, and OdorNormal versus Abnormal

A 
Soft
Hard
Formed
Loose 
Liquid
Brown, green, red, black
Foul
Soft
Hard
Formed
Loose 
Liquid
Brown, green, red, black
Foul
89
Q

What type of stool are you likely to see from an ileostomy ?

A

Liquid fecal content

Fundamentals of Nursing in the Context of the Older Adult (8 decks)

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