week 9: Nutrition & Dysphagia

Question 1

what is nutrition?

Answer 1

a basic component of health

Question 2

what is nutritional status?

Answer 2

the degree of balance between nutrient intake and nutrient requirements

Question 3

what may affect nutritional status?

Answer 3

-physiologic
-psychosocial
-developmental
-cultural
-economic factors

Question 4

what is optimal nutritional status?

Answer 4

achieved when sufficient nutrients are consumed to support day-to-day body needs and any increased metabolic demands due to growth, pregnancy, or illness

Question 5

what is under nutritional staus?

Answer 5

occurs when nutritional reserves are depleted or when nutrient intake is inadequate to meet day-to-day needs or added metabolic demands

Question 6

what is over nutritional status?

Answer 6

caused by consumption of nutrients, especially calories, sodium, and fat, in excess of body needs

Question 7

as people age they are at increased risk to develop ____ nutrition or _____nutrition

Answer 7

under nutrition or over nutrition
-usually under nutrition

Question 8

major risk factors for malnutrition in older adults:

Answer 8

-poor physical or mental health
-social isolation
-alcoholism
-limited functional ability
-poverty
-polypharmacy→meds = nausea/vomiting

Question 9

normal physiologic changes in aging adults that directly affect nutritional status include:

Answer 9

-poor dentition
-decreased visual acuity
-decreased saliva production
-slowed gastrointestinal motility
-decreased gastrointestinal absorption
-diminished olfactory & taste sensitivity

Question 10

what is sarcopenia?

Answer 10

age-related loss of muscle mass

Question 11

what is sarcopenic obesity?

Answer 11

low muscle mass with excess fat

Question 12

how do cultural factors and religious practices affect nutrition? why does knowing this help?

Answer 12

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

Question 13

what is the purpose of the mini-nutritional assessment?

Answer 13

to identify adults and older adults who have or are at risk for developing malnutrition

Question 14

what components are involved in a mini-nutritional assessment? time frame?

Answer 14

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

Question 15

normal scores of mini-nutritional assessment?

Answer 15

-normal: 12-14
-at risk: 8-11
-malnutrition: 0-7

Question 16

what should you do if patient is found to be at risk or is malnourished?

Answer 16

• we must notify the physician to see if they are to be referred to a dietitian
  -we must also assess why they are malnourished

Question 17

what is dysphagia? can it happen at any part of swallowing?

Answer 17

-refers to difficulty swallowing→subjective sensation & increases risk of aspiration = lung issues
-could it happen at any part of swallowing process

Question 18

what is odynophagia?

Answer 18

pain with swallowing

Question 19

what are the 4 stages of healthy swallowing? and explain it?

Answer 19

-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

Question 20

what are 3 common causes of dysphagia and give examples of the 3 types of causes?

Answer 20

-myogenic: aging & muscle spasms
-neurogenic: stroke, parkinson’s disease, & dementia
-obstructive: head/neck cancer, diverticula, enlarged lymph nodes, GERD

Question 21

what are the warning signs of impaired swallowing?

Answer 21

-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

Question 22

what are the complications as a result of dysphagia?

Answer 22

-malnutrition, weight loss, and dehydration
-aspiration pneumonia (bacteria grows, aspirate it and causes pneumonia)
-choking
-psychosocial dysfunction→may need to change texture of food

Question 23

what is aspiration?

Answer 23

the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract (epiglottis not closing correctly)

Question 24

what should you do if you suspect someone has aspirated?

Answer 24

-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

Question 25

what are the signs/sx of aspiration and how do you assess for it?

Answer 25

-fast breathing, noisy breathing, maybe choking
-coughing, drooling, fever, phlegm, gurgling, wet voice
-AUSCULTATE THE LUNGS

Question 26

aspiration precaution interventions

Answer 26

-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

Question 27

define oropharyngeal

Answer 27

includes the mouth and pharynx from the soft palate to the upper most aspect of the esophagus

Question 28

what is oropharyngeal suctioning?

Answer 28

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