Nutrition, Oral Health Flashcards
malnutrition definition
- a geriatric syndrome
- faulty or inadequate nutritional status
- undernourishment characterized by insufficient dietary intake, poor appetite, muscle wasting, and weight loss
nutrition-related changes associated with age (8)
- 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)
BMI indicative of malnutrition/mortality in older adults
22
clinically significant percent weight changes
> 5% in 1 month
7.5% in 3 months
10% in 6 months
3 visceral proteins
albumin, prealbumin, transferrin
normal albumin levels
3.5-5.5 g/dL
<3.5 = concern
normal prealbumin levels
19.5-35 mg/dL
normal transferrin levels
204-360 mg/dL
interventions to improve intake (7)
- small frequent meals/snacks
- make food appetizing
- provide assistance
- conducive environment for meals
- alleviate dry mouth
- analgesics, antiemetics, oxygen
- meds to increase appetite - Megestrol
complications of parenteral nutrition
- infection, sepsis, death
- fluid/electrolyte imbalance - monitor electrolytes, glucose
acute pancreatitis patho
inflammation of pancreas caused by early activation of excessive pancreatic enzymes → auto-digestion
acute pancreatitis causes (5)
- alcoholism
- gallstones
- abdominal/operative trauma
- drug use
- infection
chronic pancreatitis patho
irreversible, histological changes that causes loss of exocrine and endocrine function of the pancreas
major cause of chronic pancreatitis
ETOH use
labs for pancreatitis (6)
- increased amylase, lipase, trypsin
- increased bilirubin if biliary obstruction
- increased liver enzymes
- increased glucose
- increased WBC
- decreased calcium, magnesium
most reliable diagnostic test for pancreatitis
contrast-induced CT scan
acute pancreatitis symptoms (9)
- 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
chronic pancreatitis symptoms (5)
- periods of exacerbation and remission
- constant, dull epigastric pain
- steatorrhea
- severe weight loss
- onset of DM symptoms
acute pancreatitis management (6)
- 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
chronic pancreatitis management (6)
- 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
oral pancreatic enzyme replacement therapy (PERT) teaching
- take 30 mins-1 hour before meals with full glass of water
- wipe/rinse mouth after
- don’t chew
cholelithiasis
gallstones - lodged in neck of cystic duct
cholecystitis
inflammation of gallbladder associated with cholelithiasis
cholecystitis risk factors
- 4 Fs = female, forty, fat, fertile
- aging
- race/ethnicity
- family history
- diabetes mellitus
- prolonged TPN
cholecystitis symptoms (7)
- 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
cholecystitis management (6)
- meds - analgesics (Dilaudid, morphine), antibiotics, antiemetics
- NPO until symptoms subside
- gastric decompression
- weight reduction
- avoidance of fatty/fried foods
- surgery - laparoscopic/traditional cholecystectomy, cholecystostomy
t-tube care (8)
- 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
denture care (3)
- 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
gingivitis patho/symptoms
- 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
periodontitis patho/symptoms
- destruction of periodontal ligament, loss of supporting bone, tooth loosening
- due to chronic plaque and inflammation
gingivitis treatment
good oral hygiene, regular dental visits
periodontitis treatment (4)
- good oral hygiene, regular dental visits
- cessation of tobacco/other irritants
- dental referral for deep root scaling
- oral antibiotics, topical solutions - chlorhexidine
xerostomia patho
- 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
xerostomia management (6)
- 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)
