Gero ch. 10

Question 1

Age-related changes involving nutrition

Answer 1

• Wear and tear of teeth
• Increased risk for GERD
• Decreased motility leads to early satiety
• Decreased ability to absorb nutrients
• Decreased amount of taste buds
• Delayed gastric emptying time leads to digestion of food taking longer
• Decreased saliva production

Question 2

Nutrition

Answer 2

• Is a factor in preventing, delaying, and managing chronic illnesses
• Nutrition has the ability to increase your lifespan
• We need a balance of essential nutrients (carbs, fats, protein, vitamins, minerals, and water)
• My Plate for the older adult (recommendations)
• DASH
• Older adults typically need fewer calories because they are not as active but they still need the same or higher levels of nutrients for optimal wellness

Question 3

nutrients

Answer 3

<10% Saturated Fat

45-65% carbs

10-35% protein (older adult might need more)

25g Fiber/daily (what can the pt eat to get fiber)

Vitamins

Question 4

obesity

Answer 4

• associated with increased health care costs, functional impairments, disability, chronic disease, and nursing home admission
• major risk factor for most common disabling conditions, such as osteoarthritis, atherosclerosis, diabetes, and stroke

Question 5

fats

Answer 5

• limit intake of saturated fat and trans fatty acids
• high-fat diets cause obesity and increase the risk of heart disease and cancer

Question 6

protein

Answer 6

• along with vitamin D and calcium, it prevents bone loss and maintain existing bone density, thereby reducing and risk of falls and fractures
• inadequate intake contributes to poor nutritional status, such as reduced muscle mass, strength, and function, and increased motility

Question 7

fiber

Answer 7

• Patients should ensure they drink plenty of fluids with increased fiber diets. If the pt does not take in enough fiber and fluid they are at risk for constipation. Food sources of fiber: raw fruits and veggies, and unrefined cereals
• insufficient fluids also lead to constipation

Question 8

vitamins and minerals

Answer 8

• Vitamin B12 links with anti-aging
• older adults should increase their intake of the crystalline form of vitamin B12 from fortified foods such as whole-grain breakfast cereals
• other food sources include salmon, tuna, grass-fed beef, sardines, eggs, and cottage cheese
• vitamin D is good for preventing osteoporosis and reducing the risk of fracture

Question 9

Proton pump inhibitors

Answer 9

increases risk of vitamin B12 deficiency

Question 10

Older adults who consume five serving of fruits and vegetables

Answer 10

• they have to obtain adequate intake of vitamins A, C, and E and also potassium

Question 11

malnutrition

Answer 11

• geriatric syndrome; too little or too much energy, protein, and nutrients, which can cause adverse effects on a person’s body and its function and clinical outcomes
• occurs when a person has an imbalance between the nutrients they need and those that they receive and can result from overnutrition and undernutrition

Question 12

characteristics of malnutrition

Answer 12

• insufficient energy intake
• weight loss
• loss of muscle mass
• loss of subcutaneous fat
• localized or generalized fluid accumulation that may mask weight loss
• diminished functional status as measured by handgrip strength

Question 13

consequences of malnutrition

Answer 13

• infections
• pressure injuries
• anemia
• hypotension
• impaired cognition
• sarcopenia
• hip fractures

patients that are malnourished are twice as likely to develop pressure injuries and three times as likely to have infections

older adults who are admitted to the hospital with malnutrition are more likely to have longer hospital stays and die before discharge

Question 14

Factor affecting nutrition

Answer 14

• lifelong eating habits
• socialization
• medications
• dysphagia

Question 15

socialization

Answer 15

We all like to go out to eat and enjoy others company.

• If you have a big family or a lot of close friends you might look forward to meal time.
• If you have a lack of support and live alone you might not have the desire to cook or eat.
• If the pt has chronic illness or on certain medication it can alter their desire to eat as well.

Question 16

Dysphagia

Answer 16

• assess the client during mealtime or before giving any oral medications/fluids
• We may have to thicken fluids to make them nectar like, we may have to give smaller bites or smaller amount of fluid to drink at a time, have the patient tuck their chin or turn their head slowly to assist with swallowing
• We have to have suction available at bedside for these patients

Question 17

risk factors of dementia

Answer 17

• cerebrovascular accident
• Parkinson’s disease
• neuromuscular disorders
• dementia
• head and neck cancer
• traumatic brain injury
• aspiration pneumonia
• inadequate feeding technique
• poor dentition

Question 18

collaborative care team

Answer 18

• registered dietitian
• occupational therapist
• physical therapist
• social worker
• speech-language pathologist

Question 19

registered dietitian

Answer 19

assesses, plans for, and educate regarding nutrition needs (you would refer a client who has a low albumin level and recently unexplained weight loss)

Question 20

occupational therapist

Answer 20

Assesses and plans for clients to regain ADL skills (you would refer a client who has suffered from a stroke who has difficulty eating now with a fork)

Question 21

physical therapist

Answer 21

Assesses and plans for clients to increase musculoskeletal function, especially of the lower extremities (you would refer a client who just had hip surgery needing assistance to ambulate)

Question 22

social worker

Answer 22

Works with clients and families by coordinating inpatient and community resources to meet psychosocial and environmental needs necessary for discharge and recovery (you would refer a client who has terminal cancer wanting to go home but can’t perform ADLs anymore and the client will need medical equipment like a cane or wheelchair to function)

Question 23

speech-language pathologist

Answer 23

Evaluates and makes recommendations regarding the impact of disorders or injuries on speech, language, and swallowing. Teaching techniques and exercises to improve function (you would refer a client who is having difficulty swallowing a regular diet after a head trauma)

Question 24

feeding tubes

Answer 24

• This is a last resort to improve nutritional status
• Not recommended for patients with advanced dementia
• Can be associated with agitation, increased use of restraints, and worsening of pressure ulcers
  This is addressed in the patient’s end of life wishes
• If the pt is malnourished and fully oriented they have to right to refuse a feeding tube
• We want to make sure we don’t make family feel like they will be starving the patient if they choose to not have a tube placed. We will still try to provide nutrition in any way we can safety

Question 25

Feeding tube - positioning the patient

Answer 25

Fowler's position; HOB should be at least 30 degrees

Question 26

Supplies for feeding tubes

Answer 26

You’ll have a large plunger syringe that holds 60cc, your feeding (it will either be a bolus feeding with one can at a time or continuous) you want your feeding to be at room temperature (check expiration dates) You will want to ascultate for bowel sounds and then monitor for tube placement (test pH of gastric contents ph will be 0-4). You have to monitor for tube placement before you ever give the feeding!!!! You will check for tube placement and then pull gastric contents out of the stomach to see how much you can aspirate. If your volume is over 250 you will call your doctor and ask if he wants you to discard the contents or put them back into the stomach. Once you replace your contents you can administer the feeding. We always flush with tap water before and after a feeding

Question 27

Feeding tube - nursing interventions

Answer 27

If a patient has a continuous feeding you will want to check residuals every 4 hours. Often times patients will complain of diarrhea because the feeding will cause this we use tap water before and after administering feedings or medications to keep the tube from getting clogged.

Question 28

Socioeconomic status

Answer 28

- Poverty rates are higher among African Americans, single older women, and Hispanics - SNAPS food program provides additional assistance to low income families but older adults are less likely to utilize these services- why? Lack of knowledge or lack of resources to apply for this such as transportation, stigma, or they think they don’t qualify

Question 29

Transportation

Answer 29

- There are shelters or food banks available but the pt has to have access to get there. Some restaurants will provide discounted prices for older adults - If a patient is using a walker they are less likely to be able to walk to a store and carry groceries home Older adults might fear using a public bus due to being attacked and feeling unsafe - If the patient has any functional impairments they are less likely able to get out of the home - If a man becomes a widow he or she may not know how to cook meals and will rely on family or friends to eat.

Question 30

Nursing implications

Answer 30

Older adults are less likely to show signs of malnutrition Nutritional status should be assessed upon admission 1st step- perform a nutritional screening 2nd step- perform a nutritional assessment (interview, history, physical exam, lab data, food intake, functional assessment Food intake interview Anthropomorphic measurements - Serum albumin monitoring Albumin is a serum protein- this is a strong prognostic marker and is a lab we look at to assess a patient’s nutritional level - Overcoming barriers to nutrition - 50% of all residents in a long-term care center cannot eat independently - Centers for Medicare and Medicaid require feeding assistants to have training in feeding patients

Question 31

Nursing implications pt. 2

Answer 31

Approaches to enhance nutrition in the long-term care center- P.145 The American Geriatrics Society does not recommend drugs that stimulate appetite to be given to older adults because the risk of side effects are greater than the outcome We want to optimize social support, providing feeding assistance, and set goals with the patient NO OLDER PERSON SHOULD EVER BE HUNGRY OR THIRSTY BECAUSE HE OR SHE CANNOT SHOP, COOK, BUY, OR PREPARE FOOD OR EAT INDEPENDENTLY NO OLDER ADULT SHOULD HAVE TO SUFFER BECAUSE OF A LACK OF ASSISTANCE WITH THESE ACTIVITIES IN WHATEVER SETTING THE PERSON MAY RESIDE