Lecture 5 Nutrition and gastrointestinal function

Question 1

Dysphagia

Answer 1

1. Difficulty swallowing, placing the patient at increased risk for aspiration; affects chewing, safety of swallowing, and nutrition.
2. Most commonly caused by neurologic and neuromuscular disorders.
3. Signs and symptoms: Drool, slurred speech, pocketing food, coughing with food/pills.
4. Present in 40-50% of stroke patients, and up to 50% of nursing home residents.

Question 2

Presbyphagia

Answer 2

Slowed swallowing, due to decreased frequency of peristaltic waves.

Question 3

Mini Nutritional Assessment (MNA)

Answer 3

An evidence-based tool to screen for malnutrition in older adults; components include food intake decline, weight loss, mobility status, BMI, etc.

Question 4

Olfaction (the ability to detect and identify odors) is best between the ages of _ and _, and then it gradually declines.

Answer 4

30 and 40 years.

Question 5

Gustatory function

Answer 5

The ability to taste.

Question 6

Age-related changes that may impact nutrition

Answer 6

1. Less efficient chewing.
2. ↓ senses of smell and taste.
3. ↓ saliva secretion.
4. Slower motility.
5. Degenerative changes affecting digestion.
6. Daily intake - need fewer but higher quality calories.

Question 7

The major risk factors impacting nutrition in the older adult are those that _

Answer 7

Interfere with the ability to obtain, prepare, consume, and enjoy food.

Question 8

Xerostomia

Answer 8

Dry mouth due to decreased salivary flow; not considered a normal part of aging, but experienced by 30% of older adults as a side effect of various medications.

Question 9

All medications with _ action (e.g., antidepressants, antipsychotics, antiemetics, antihistamines) are likely to cause xerostomia.

Answer 9

Anticholinergic.

Question 10

A person with Helicobacter pylori infection will experience decreases in _

Answer 10

Gastric acid production (hypochlorhydria).

Question 11

Vitamins and minerals that are absorbed in the small intestine

Answer 11

1. Folate.
2. Calcium.
3. Vitamin B₁₂.
4. Vitamin D.

Question 12

Older adults have an increased tendency to develop _, due to age-related changes in the large intestine.

Answer 12

Constipation.

Question 13

The liver assists digestion by producing and secreting bile, which is essential for utilizing _

Answer 13

Fats.

Question 14

Cholelithiasis

Answer 14

Gallstones - may occur more often in older adults due to diminished bile acid synthesis and increased gallbladder contraction.

Question 15

Without an adequate intake of _, the body will derive energy from fat and protein, causing an increase in serum cholesterol and triglyceride levels and a depletion of water, electrolytes, and amino acids.

Answer 15

Carbohydrates.

Question 16

_ is the nutrient that plays an important role in eye health.

Answer 16

Vitamin A.

Question 17

_ is the risk factor most closely associated with inadequate nutritional intake in older adults in community, acute care, and long-term care settings.

Answer 17

Functional and cognitive impairment.

Question 18

Cardiac dysrhythmias can be produced by low serum levels of _ and _

Answer 18

Magnesium and potassium.

Question 19

Gastroparesis

Answer 19

1. Poor emptying of food from the stomach, notably in diabetics.
2. Signs and symptoms: Nausea/vomiting, reflux, pain, bloating, loss of appetite.

Question 20

Daily protein intake should be at least _ to _ of total daily calories.

Answer 20

10-20%.

Question 21

Carbohydrates should make up about _ of total daily calories.

Answer 21

50%.

Question 22

Dietary fiber vs. functional fiber

Answer 22

Dietary fiber refers to fiber from food intake; functional fiber refers to supplementation with Metamucil, Benefiber, etc.

Question 23

Fats should make up _ to _ of total daily calories.

Answer 23

20-30%.

Question 24

About _ of daily water intake should come from from drinking, and about _ should come from foods.

Answer 24

80%; 20%.

Question 25

Screening for _ prior to hospital discharge is not standardized, and often not performed.

Answer 25

Malnutrition.

Question 26

Characteristics of malnutrition

Answer 26

1. Weakness or lethargy. 2. Unintentional weight loss; failure to thrive. 3. Diminished muscle mass. 4. Marked decrease in subcutaneous fat. 5. Impaired ability to respond to infection. 6. Loss of visceral protein; edema.

Question 27

The normal range of serum albumin is _

Answer 27

3.1 - 4.3 g/dL.

Question 28

Older adults who live alone are at risk for malnutrition in part because people tend to eat _ less when they eat in isolation.

Answer 28

30%.

Question 29

The leading cause of malnutrition in older adults is _

Answer 29

Depression.

Question 30

Constipation can be defined as having _ bowel movements weekly.

Answer 30

Two or fewer.

Question 31

Body mass index (BMI) ranges

Answer 31

18.5 - 25 = normal weight Below 18.5 = underweight 25 - 30 = overweight Above 30 = obese

Question 32

An older adult with anemia would benefit from a diet comprised of _

Answer 32

Legumes, organ meat, and dark green leafy vegetables.

Question 33

The proper diet order for a stroke patient with garbled speech is _

Answer 33

A mechanically altered diet with nectar thick liquids.

Question 34

Cherries, radishes, and watermelon are examples of foods that may cause _ in the older adult.

Answer 34

Gas.

Question 35

Age-related changes impacting the liver

Answer 35

1. Decrease in size. 2. More fibrous. 3. Decreased blood flow.

Question 36

Older adults should drink _ of water per day.

Answer 36

1.5-2 L (6-8 glasses).

Question 37

High caffeine intake impacts _ absorption.

Answer 37

Calcium.