week 9: Nutrition & Dysphagia Flashcards
what is nutrition?
a basic component of health
what is nutritional status?
the degree of balance between nutrient intake and nutrient requirements
what may affect nutritional status?
-physiologic
-psychosocial
-developmental
-cultural
-economic factors
what is optimal nutritional status?
achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness
what is under nutritional staus?
occurs when nutritional reserves are depleted or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands
what is over nutritional status?
caused by consumption of nutrients, especially calories, sodium, and fat, in excess of body needs
as people age they are at increased risk to develop ____ nutrition or _____nutrition
under nutrition or over nutrition
-usually under nutrition
major risk factors for malnutrition in older adults:
-poor physical or mental health
-social isolation
-alcoholism
-limited functional ability
-poverty
-polypharmacy→meds = nausea/vomiting
normal physiologic changes in aging adults that directly affect nutritional status include:
-poor dentition
-decreased visual acuity
-decreased saliva production
-slowed gastrointestinal motility
-decreased gastrointestinal absorption
-diminished olfactory & taste sensitivity
what is sarcopenia?
age-related loss of muscle mass
what is sarcopenic obesity?
low muscle mass with excess fat
how do cultural factors and religious practices affect nutrition? why does knowing this help?
foods and eating customs are culturally diverse and that affects what they actively eat
-enables you to suggest improvements or modifications that do not conflict with dietary laws
what is the purpose of the mini-nutritional assessment?
to identify adults and older adults who have or are at risk for developing malnutrition
what components are involved in a mini-nutritional assessment? time frame?
6 items
-appetite and eating
-weight loss
-mobility before admission: LOC
-psychological stress of acute disease
-neuropsychological problems
-BMI or calf circumference: height and weight
normal scores of mini-nutritional assessment?
-normal: 12-14
-at risk: 8-11
-malnutrition: 0-7
what should you do if patient is found to be at risk or is malnourished?
- we must notify the physician to see if they are to be referred to a dietitian
-we must also assess why they are malnourished
what is dysphagia? can it happen at any part of swallowing?
-refers to difficulty swallowing→subjective sensation & increases risk of aspiration = lung issues
-could it happen at any part of swallowing process
what is odynophagia?
pain with swallowing
what are the 4 stages of healthy swallowing? and explain it?
-oral preparation stage: bite & chew
-oral transit stage: food back of the mouth stimulates nerves/muscles to swallow
-pharyngeal stage: food starts to go down pharynx
-esophageal stage: epiglottis closes, covers airway, & food pass larynx
what are 3 common causes of dysphagia and give examples of the 3 types of causes?
-myogenic: aging & muscle spasms
-neurogenic: stroke, parkinson’s disease, & dementia
-obstructive: head/neck cancer, diverticula, enlarged lymph nodes, GERD
what are the warning signs of impaired swallowing?
-wet gurgling vocal quality
-sudden coughing with eating, drinking, or regurgitation
-change in voice (hoarse or gurgling) after swallowing
-pocketing of food in the mouth
what are the complications as a result of dysphagia?
-malnutrition, weight loss, and dehydration
-aspiration pneumonia (bacteria grows, aspirate it and causes pneumonia)
-choking
-psychosocial dysfunction→may need to change texture of food
what is aspiration?
the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract (epiglottis not closing correctly)
what should you do if you suspect someone has aspirated?
-we stop the feeding to the patient
-we notify the ordering healthcare provider for further evaluation of findings
-may refer the patient to a speech therapist
what are the signs/sx of aspiration and how do you assess for it?
-fast breathing, noisy breathing, maybe choking
-coughing, drooling, fever, phlegm, gurgling, wet voice
-AUSCULTATE THE LUNGS
aspiration precaution interventions
-suction close to bedside
-HOB elevated during & at least 30min after meals
-high fowlers during meals
-implement postural changes (e.g. chin-tuck/chin down)
-feed only if alert
-prescribed consistency for pts
-crush medications & give with food
-check for pocketing
-offer liquids after food is eaten
-oral care before and after meals
define oropharyngeal
includes the mouth and pharynx from the soft palate to the upper most aspect of the esophagus
what is oropharyngeal suctioning?
performed whenever assessment suggests impaired swallowing with oral cavity retained food, fluids, saliva, secretions, or to facilitate oral hygiene by either the patient or nurse
