Nutrition, Oral Health

Question 1

malnutrition definition

Answer 1

• a geriatric syndrome
• faulty or inadequate nutritional status
• undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting, and weight loss

Question 2

nutrition-related changes associated with age (8)

Answer 2

• decreased BMR
• hypogeusia - decreased taste
• hyposmia - decreased smell
• achlorhydria - decreased production of gastric acids
• diminished thirst sensation
• decreased bone density and lean body mass
• xerostomia - decreased saliva production
• increased cholecystokinin (stimulates gallbladder to release bile; leads to early satiety)

Question 3

BMI indicative of malnutrition/mortality in older adults

Answer 3

22

Question 4

clinically significant percent weight changes

Answer 4

> 5% in 1 month
7.5% in 3 months
10% in 6 months

Question 5

3 visceral proteins

Answer 5

albumin, prealbumin, transferrin

Question 6

normal albumin levels

Answer 6

3.5-5.5 g/dL

<3.5 = concern

Question 7

normal prealbumin levels

Answer 7

19.5-35 mg/dL

Question 8

normal transferrin levels

Answer 8

204-360 mg/dL

Question 9

interventions to improve intake (7)

Answer 9

• small frequent meals/snacks
• make food appetizing
• provide assistance
• conducive environment for meals
• alleviate dry mouth
• analgesics, antiemetics, oxygen
• meds to increase appetite - Megestrol

Question 10

complications of parenteral nutrition

Answer 10

• infection, sepsis, death

- fluid/electrolyte imbalance - monitor electrolytes, glucose

Question 11

acute pancreatitis patho

Answer 11

inflammation of pancreas caused by early activation of excessive pancreatic enzymes → auto-digestion

Question 12

acute pancreatitis causes (5)

Answer 12

• alcoholism
• gallstones
• abdominal/operative trauma
• drug use
• infection

Question 13

chronic pancreatitis patho

Answer 13

irreversible, histological changes that causes loss of exocrine and endocrine function of the pancreas

Question 14

major cause of chronic pancreatitis

Answer 14

ETOH use

Question 15

labs for pancreatitis (6)

Answer 15

• increased amylase, lipase, trypsin
• increased bilirubin if biliary obstruction
• increased liver enzymes
• increased glucose
• increased WBC
• decreased calcium, magnesium

Question 16

most reliable diagnostic test for pancreatitis

Answer 16

contrast-induced CT scan

Question 17

acute pancreatitis symptoms (9)

Answer 17

• CARDINAL SIGN: sudden severe epigastric pain after large meals or ETOH
• pain can radiate to back/left shoulder
• biliary symptoms
• malaise, restlessness
• decreased urine output
• decreased bowel sounds
• ascites
• lung involvement
• guarding, acute abdomen

Question 18

chronic pancreatitis symptoms (5)

Answer 18

• periods of exacerbation and remission
• constant, dull epigastric pain
• steatorrhea
• severe weight loss
• onset of DM symptoms

Question 19

acute pancreatitis management (6)

Answer 19

• ABCs
• opioids for pain
• decrease pancreatic stimulation/secretions - NPO, NG suctioning
• progressive diet when not NPO - low fat, high carb/protein
• control fluid/electrolyte imbalances - volume expanders, monitor output
• prophylactic antibiotics for infection prevention

Question 20

chronic pancreatitis management (6)

Answer 20

• long-term pain management
• oral pancreatic enzyme replacement therapy (PERT)
• alcohol rehab
• treat diabetes - oral hypoglycemics, insulin
• nutritional therapy - low fat, high carb/protein; TPN
• cholecystectomy if biliary obstruction

Question 21

oral pancreatic enzyme replacement therapy (PERT) teaching

Answer 21

• take 30 mins-1 hour before meals with full glass of water
• wipe/rinse mouth after
• don’t chew

Question 22

cholelithiasis

Answer 22

gallstones - lodged in neck of cystic duct

Question 23

cholecystitis

Answer 23

inflammation of gallbladder associated with cholelithiasis

Question 24

cholecystitis risk factors

Answer 24

• 4 Fs = female, forty, fat, fertile
• aging
• race/ethnicity
• family history
• diabetes mellitus
• prolonged TPN

Question 25

cholecystitis symptoms (7)

Answer 25

- initial: pain in RUQ, can radiate to right shoulder/scapula - attacks occur 3-6 hours after heavy/high-fat meal or when lying down - diaphoresis - nausea/vomiting - leukocytosis, fever, infection - biliary obstruction symptoms - steatorrhea, jaundice, pruritus, dark amber urine, clay-colored stools - chronic: fat intolerance, dyspepsia, heartburn, flatulence

Question 26

cholecystitis management (6)

Answer 26

- meds - analgesics (Dilaudid, morphine), antibiotics, antiemetics - NPO until symptoms subside - gastric decompression - weight reduction - avoidance of fatty/fried foods - surgery - laparoscopic/traditional cholecystectomy, cholecystostomy

Question 27

t-tube care (8)

Answer 27

- ensure patency of duct until edema subsides - drains 400 mL/day - report if more than 1000 or sudden increase - record drainage q2-4h for 24hrs then q8 - color, amount (initially bloody, then bright yellow to dark green w/ acid odor and thick consistency) - semi-fowler's position - keep drainage bag below level of gallbladder - protect skin around site - monitor for infection - never irrigate, aspirate, clamp without HCP order

Question 28

denture care (3)

Answer 28

- remove at night to let oral tissue rest - brush with hand soap, dishwashing liquid, or denture cleaning paste (avoid regular toothpaste) - soak overnight in water or denture cleaner

Question 29

gingivitis patho/symptoms

Answer 29

- inflammation of gums (but no destruction to periodontal ligament/bone) - tenderness, erythema, bleeding of gums - due to: plaque buildup, changes in hormone levels, oral foreign objects

Question 30

periodontitis patho/symptoms

Answer 30

- destruction of periodontal ligament, loss of supporting bone, tooth loosening - due to chronic plaque and inflammation

Question 31

gingivitis treatment

Answer 31

good oral hygiene, regular dental visits

Question 32

periodontitis treatment (4)

Answer 32

- good oral hygiene, regular dental visits - cessation of tobacco/other irritants - dental referral for deep root scaling - oral antibiotics, topical solutions - chlorhexidine

Question 33

xerostomia patho

Answer 33

- sensation of dry mouth due to decreased salivary flow - causes: common in elderly, patients w/ rheumatic disease, Siorgren's syndrome, after radiation, medications - decreased saliva increases risk for caries and periodontal disease

Question 34

xerostomia management (6)

Answer 34

- avoid inciting meds, irritants (alcohol, caffeine, smoking), sugar-containing drinks/candies - take sips of water, esp. during meals - sugarless gum/mints - saliva substitutes, salivary stimulants (pilocarpine) - meticulous oral hygiene - increased strength topical fluorides (1.1% sodium fluoride)