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NURS 401 > Week 9: Nutrition, Hydration And Oral Care > Flashcards

Week 9: Nutrition, Hydration And Oral Care Flashcards

1
Q

Changes in caloric requirements for older adults

A
  • Generally need less calories because Activity decreases and metabolic rate slows down.
  • Still require the same or higher amounts of nutrients
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2
Q

Dietary Recommendations: Fats

A
  • 20-35% of total calories.

- Limit saturated fat and trans fatty acids.

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3
Q

Dietary Recommendations: Protein

A

-Increase to 20-25% total calories for older adults who tends to experience protein deficiency when ill (minimizes fragility)

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4
Q

Dietary Recommendations: Fiber

A

25 grams daily

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5
Q

Dietary Recommendations: Vitamins and minerals

A
  • Consumption of five servings of fruits/vegetables provides adequate A,C,E and K.
  • Changes of aging contribute to decreased absorption of Vit B12
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6
Q

Malnutrition can increase the risk for

A
  • Infection
  • PU
  • Anemia
  • Hip fractures
  • Hypotension
  • Impaired cognition
  • Increased morbidity and mortality
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7
Q

Malnutrition can be related to

A

Inadequate consumption of micro and macro nutrients or a consequence of inflammation

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8
Q

Factors Affecting Fulfillment of Nutritional Needs

A
  • Age-related changes in taste and smell
  • Lifelong eating habits
  • Socialization
  • Chronic diseases and conditions
  • GI disorders
  • Socioeconomic deprivation
  • Transportation
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9
Q

Nutrition screening and assessment includes

A
  • Minimum Data Set—includes risk factors and triggers for further evaluation
  • Interview and physical examination
  • Anthropometrical measurements
  • Weight/height considerations
  • Biochemical analysis/measures of visceral protein
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10
Q

Approaches to enhancing intake in LTC

A
  • Restorative dining rooms
  • Consideration of ethnic food choices
  • Easy access to refreshment stations with juices, water, healthy snacks, and finger foods
  • Family involvement when possible
    -Other considerations: restrictive diets and caloric supplements, pharmacological therapy, patient education, and dysphagia
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11
Q

Risk factors for dysphagia

A
  • Cerebrovascular accident
  • Parkinson’s disease
  • Neuromuscular disorders: amyotropic lateral sclerosis, multiple sclerosis, myasthenia gravis, dystonia
  • Dementia
  • Head and neck cancer
  • Traumatic brain injury
  • Aspiration pneumonia
  • Inadequate feeding technique
  • Poor dentition
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12
Q

Signs and Symptoms of Dysphagia include

A
  • Difficult, labored swallowing
  • Drooling
  • Copious oral secretions
  • Coughing, choking at meals
  • Holding or pocketing of food in the mouth
  • Difficulty chewing
  • Nasal voice or hoarseness
  • Wet or gurgling voice
  • Excessive throat clearing
  • Food or liquid leaking from nose
  • Prolonged eating time
  • Discomfort during swallowing
  • Sensation of something stuck in throat during swallowing
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13
Q

Feeding Tubes

A
  • Do not prevent aspiration or risk of aspiration.

- Interfere with basic psychological, biological and cultural needs associated with eating.

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14
Q

Feeding tubes are not associated with

A
  • Improved survival
  • Reduced incidence of pneumonia
  • Improved function
  • Fewer PU
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15
Q

Feeding tubes are associated with complications including

A
  • Cellulitis
  • Diarrhea
  • Aspiration pneumonia
  • Metabolic problems
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16
Q

Before enteral feedings, what factors should be assessed

A

-Poor nutritional uptake including meal environment, feeding techniques, food preferences, medications and depression.

17
Q

Water is important for

A
  • Thermoregulation
  • Dilution of water-soluble medications
  • Facilitation of bowel and renal function
  • Maintaining metabolic processes
18
Q

What are age related changes that affect hydration?

A
  • Thirst sensation diminishes
  • Creatinine clearance declines
  • Total body water decreases
  • Loss of muscle mass and increase in fat cells
  • Other factors include: medications, functional impairment, other comorbid conditions such as diabetes.
19
Q

Dehydration

A

-Complex problem that results in reduction of total body water.

20
Q

Significant issues associated with dehydration include:

A
  • Thromboembolic complications
  • Kidney Stones
  • Constipation
  • Falls
  • Medication toxicity
  • Renal failure
  • Seizure
  • Electrolyte imbalance
  • Hyperthermia
  • Delayed wound healing
21
Q

Risk factors for dehydration include

A
  • Emotional illness
  • Surgery
  • Trauma
  • Higher physiological demands
22
Q

Signs and Symptoms of Dehydration include

A
  • Often atypical in the older adult
  • Skin turgor is not a reliable indicator in older adults
  • Look for dry mucous membranes in mouth and nose, furrows on the tongue, orthostasis, speech incoherence, rapid pulse, decreased urine output, extremity weakness, dry axilla, and sunken eyes
23
Q

Dehydration: Lab Tests

A
  • Labs: serum sodium, urine specific gravity
  • Most cases of dehydration have an elevated blood urea nitrogen (BUN); however, there are many other causes for elevation of BUN/creatinine ratio
  • Urine color chart may be helpful in monitoring hydration status
  • Better indicator when monitored over a couple of days
24
Q

Dehydration Interventions

A
  • Monitor closely and implantation of intake and output is essential
  • Oral hydration is the first treatment approach
  • Water is the best fluid to offer
25
Q

Rehydration: IV

A

Replace 50% of loss within first 12 hours or sufficient quantity to relieve tachycardia and hypotension

26
Q

Rehydration: Hypodermoclysis

A
  • Infusion of isotonic fluids into the subcutaneous space

- Not for severe dehydration

27
Q

Oral Care

A

-Poor oral health is associated with dehydration, malnutrition and other systemic diseases.

28
Q

Xerostomia

A

Mouth dryness

29
Q

What are common oral problems in older adults?

A

Xerostomia and hyposalivation

30
Q

Treatment for Xerostomia and Hyposalivation

A
  • Review Medications
  • Good oral hygiene
  • Adequate water
  • Avoid alcohol and caffeine
  • Over-the-counter oral salvia substitutes
31
Q

Risk factors for oral cancer include

A
  • Tobacco use
  • Alcohol use
  • HPV infection
  • Genetic susceptibility
32
Q

Assessment of Oral Health

A
  • Physical examination of oral cavity and oral health
  • Federal regulations mandate annual examination for LTC residents
  • Oral health instrument: The Kayser-Jones Brief Oral Health Status Examination (BOHSE)
33
Q

What are interventions for oral health?

A
  • Promote oral health through teaching persons and caregivers recommended interventions, screening for oral disease, making dental referrals
  • Provide supervision and evaluation of oral care in hospitals and LTC facilities
34
Q

Dentures

A
  • Need to give education on proper cleaning techniques

- Damaged and ill-fitting dentures are a common problem

35
Q

Oral Hygiene in Hospitals and LTC

A
  • Cleaning teeth with a toothbrush after meals lowers risk of aspiration pneumonia
  • Crucial in prevention ventilator-associated pneumonia
36
Q

Tube Feeding and Oral Hygiene

A
  • Tube feedings are associated with significant pathological colonization in the mouth
  • Provide oral care every 4 hours for persons with gastrostomy tubes and brush teeth after each feeding
  • Only toothbrushes assist in the removal of plaque; use foam swabs to clean mouth of endentulous

NURS 401 (26 decks)

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