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Fundamentals of Nursing in the Context of the Older Adult > Nutrition and Elimination > Flashcards

Flashcards in Nutrition and Elimination Deck (89)
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1

What changes can aging adult experience with nutrition ?

Slower absorption, decreased appetite, need more nutrient rich foods (quality over quantity),

2

Dysphagia

Difficulty Swallowing

3

Hyperphagia

Excessive Eating

4

Different Types of Dysphagia

Transfer Dysphagia - mouth to Esophagus
Transport Dysphagia - just getting down the esophagus
Delivery - esophagus to stomach

5

What is the name of the cranial nerve that controls tongue movements?

Hypoglossal

6

What causes transfer Dysphagia?

atrophy of the tongue muscle makes it difficult to swallow, decreased enzymes and functioning of the salivary glands make food hard to swallow and dry.

7

What causes transport dysphagia?

Decreased peristalsis due to aging, constriction of the esophagus, decreased mucus production,

8

What causes delivery dysphagia ?

Issues with esophageal sphincter - the sphincter is closed when not swallowing.

9

What is Xerostomia ?

Dry mouth- decreased saliva production could be indicative of increased fluid intake.
Want to keep mouth moist.

10

NPO

Nothing by Mouth - this would be found in orders

11

PO

By Mouth - this could be found in medication orders

12

Older adults have an increased need for ____________ nutrition.

Quality.

13

What happens to intracellular fluid levels in older adults?

Intracellular fluids decrease within the cells so they need increased fluid intake

14

GI changes that occur in older patient ?

Reduced absorption, reduced peristalsis, decreased production of hydrochloric acid, reduced taste sensation, esophagus becomes more dilated, reduced intestinal blood flow , decreased stomach motility, emptying time and hunger contractions

15

Why do older adults have a reduced need for nutrients ?

Metabolic activities slow down and their BMR decreases... not as much is going on as in the younger adult.

16

Pulmonary Aspiration

Food gets into the lungs- this is an increasing concern in older adults

17

What are we worried about when there is reduced intestinal blood flow ?

Constipation, not getting adequate nutrient intake

18

Nursing interventions for constipation

High Fiber diet - helps to increase peristalsis and bulk up stool. Foods with good fiber -
Suppository - pill inserted into the rectum...

19

Nursing interventions for diarrhea

Low fiber diet

20

Why might someone be on a high fiber diet?

When stool is stuck or needs to be bulked to be excreted

21

What factors might cause lower adults to consume less fluids?

Decreased thirst sensation, decreased mobility, mood changes, more sedentary lifestyle,

22

What are effects of fluid restriction ?

Dehydration, increased infection risk, delirium (imbalance of fluid vs electrolytes)

23

Effects of fluid overhydration ?

Kidney overload, increased blood pressure (which means heart is pumping faster and more), Renal and Cardiac dysfunction

24

Men older than 50 need how much water ?
How much do women older than 50 need ?

3.7 L a day
2.7 L a day

25

What are components of a nutritional assessment ?

History taking - any aspect of obtaining, preparing, eating and enjoying food
Physical Assessments - BMI and clinical data
Laboratory data - protein status, body vitamin, mineral and trace element status

26

Components of Mini Nutritional Assessment Screening Tool

Physical: decreased food intake, weight loss, mobility
Mental - neuro problems /psychological stressors in past 3 months
Social - what they can afford
Cultural Variables

This all helps us to determine nursing interventions

27

Interventions and services to enhance nutritional status

Supplemental nutrition assistance programs: food stamps
Meals on wheels
Shopping and meal prep. assistance
Home health aides for feeding assistance
Congregate eating programs
Nutritional and psychological counseling
Consider ethnic and religious factors
Promote oral health

28

What are different types of diets ?

Consistent Carbohydrate (ex: those with diabetes)
High or low Fiber diet
Sodium Restriction: for those with hypertension
Renal Diet: diets that are tailored toward preserving the kidneys. Low fluid intake

29

What is "Advance as Tolerated"

Diet gradually becomes more regular from fluids only to solids. If a patient is coming out of surgery, they would gradually get back to eating regular foods

30

Name some special diets

Clear Liquid
Full Liquid
Pureed
Mechanical soft
Thickened Liquids (Dysphagia patients)

31

What does a clear liquid diet entail?

Only clear fluids and foods that become fluid at body temperature

32

Full liquid diet ?

Fluids and foods that are normally liquid and foods that turn to liquid when they are room temperature.

33

Pureed diet

Blenderized diet made up of liquid and foods blenderized to a liquid. All foods are allowed

34

Mechanical Soft Diet

Regular diet with modifications for texture (chopped, ground, mashed, or soft). Excludes most raw fruits, veggies, and foods w/ seeds, nuts, and dried fruits.

35

Short term Nutritional Assistance Measures

NG and NI tube

36

Long term nutritional assistance measures

Percutaneous endoscopic gastrostomy (PEG-tube)
Percutaneous endoscopic jejunum (PEJ-tube

37

What does TPN stand for?

Total Parenteral Nutrition - all nutrition is going directly into GI system.

38

What does PPN stand for ?

Peripheral parenteral nutrition (PPN)

39

What is micturation

Also known as urination or voiding

40

What is normal urinary function dependent upon?

Adequate renal blood flow
Nervous system control
Filtering activities within the kidney
Performance of the urinary tract musculature

41

What are the phases of micturation ?

Phase I: Filling and Storage
Urine stored in the bladder until pressure stimulates special stretch sensory nerve endings in bladder wall (adults 250-450 ml)

Phase II: Bladder emptying
Stretch receptors transmit impulses to the spinal cord voiding reflex center
Internal sphincter relaxes stimulating the urge to void
Conscious portion of brain relaxes the external urethral sphincter muscle
Urine is eliminated through urethra

42

What factors can affect frequency of urine elimination ?

Fluid intake, physical location, kidney function, mobility issues, pregnancy, prostate issues,

43

What is polyuria ?

Excessive output of urine.

44

What is oliguria ?

A low output of urine (24 hour output < 400 ml)

45

What is anuria ?

Complete kidney shutdown, renal failure; 24-hour output < 50ml

46

Nocturia ?

Voiding 2 or more times a night

47

What is urgency ?

Feeling that the person must void

48

Frequency

Increased incidence of voiding

49

Dysuria

Voiding that is painful or difficult

50

Urinary retention

Emptying of the bladder is impaired, the bladder becomes over distended

51

Neurogenic Bladder

person does not perceive bladder fullness and is unable to control the urinary sphincters due to dysfunctional neurological function

52

Incontinence

Involuntary loss of urine

53

What are some decreased GU changes that occur with aging?

Decreased bladder capacity, decrease in nephrons, weaker bladder muscles,decreased tubular function, decreased size of renal mass,
between ages 20 and 90, renal blood flow decreases 53% and glomerular filtration rate decreases 50%

54

What are ways to collect and measure urine output ?

Bedpan, urinal, catheter

55

What are you assessing for urine?

Color - clear, hazy, cloudy
Clarity- straw, yellow, red-orange, red, orange, brown
Odor - no odor, foul, sweet

56

What is hematuria?

Blood in the urine

57

What is proteinuria?

Protein in the urine

58

What is pyuria ?

Pus in the urine

59

What are reasons for urinary catheterization ?

Relieving urinary retention
Obtaining a sterile urine specimen
Obtaining a urine specimen (when usual methods can’t be used)
Emptying bladder before, during, or after surgery
Monitoring critically ill patients
Increasing comfort for terminally ill patients

60

What are CAUTIS?

Catheter Associated Urinary Tract Infections
35 – 40% of all nosocomial infections are CAUTI’s.
50% of patients develop bacteriuria (bacteria in the urine) within the first 24 hours of being catheterized

61

What is urinary incontinence ?

The complaint of any involuntary leakage of urine

62

Different types of incontinence

Urge Incontinence
Stress Incontinence
High Post-Void Residual Incontinence (overflow incontinence)
Transient Incontinence
Mixed Incontinence
Functional Incontinence
Reflex Incontinence
Total Incontinence

63

Transient Incontinence

D = delirium or acute confusion
I = infections (UTI)
A = atrophic vaginitis
P = pharmocologic agents
P = psychiatric disorders (depression; sedative and antianxiety agents)
E = endocrine disorders
R = restricted mobility
S = stool impaction

Transient incontinence appears suddenly and lasts for 6 months or less- usually caused by treatable factors, such as confusion secondary to acute illness, infection, and as a result of medical treatment such as the use of diuretics or intravenous fluid administration.

64

Urge Incontinence

Sudden need to urinate
Caused by bladder contractions
Bladder may not be full
Over active Bladder
Causes
Inflammation, infection, neurological disease
BPH, “Overactive bladder”
Treated with anticholinergic medicines
May increase symptoms of dementia

65

Stress incontinence

Involuntary loss of urine (coughing, laughing, standing, exercising)
Cause
Childbirth, Menopause, Chronic Constipation
Not a complication of normal aging
Treatment
Kegal Exercises
Surgery

66

Overflow Incontinence

Overflow Incontinence (High Post-Void Residual)
Excessive accumulation of urine in the bladder
Causes urine leakage
Cause
BPH, neurologic disease, tumors, spinal cord injury
Treatment
Alpha-1-adrenergic blocking agents: relax striated and smooth muscle (Cardura, Flomax)
Side Effects: Orthostatic hypotension, bradycardia, arrhythmia

67

What is the only type of incontinence for which a urinary catheter may be used ?

Overflow Incontinence

Patient may require indwelling catheterization or
Intermittent urethral catheterization

68

Functional Incontinence

Inability to reach toilet or adjust clothing
Cause
Mobility deficits, visual loss, dexterity, dementia, severe depression, medications (sedatives)
Caregiver inattention
Toilet inaccessible
Treatment
Treat underlying cause
Assist with mobility

Can't reach the toilet in time because of limitations

69

What are some quality of life issues associated with incontinence ?

Changed social patterns
Isolation
depression
altered lifestyles
impaired sexual function

70

What is the problem with using absorbent products for incontinence ?

This builds a perception that incontinence cannot be treated
Increased risk for Skin breakdown
and Increased risk for UTI

Long-term use not recommended until a full assessment has been completed with a health care provider.

71

What are some nursing interventions to manage urinary incontinence in the older adult ?

Maintain fluid intake
Provide easy access to the bathroom
Assess factors that influence voiding
Use assistive devices when necessary (examples?)
Use collection devices when necessary (examples?)
Encourage safety when ambulating (how?)
Encourage performance of kegel exercises several times daily
Encourage participation in a bladder retraining program

72

Nocturia Interventions

Nocturia is having to urinate frequently at night

Ensure easy access to the bathroom or commode.
Use night light.
Discourage fluid intake at bedtime.
Discourage alcohol use before bedtime.
Evaluate med. Regimen.
Use clothing that is easily removed for voiding
Keep assistive devices readily available
Evaluate gait and ability to ambulate safely
Asses for urinary tract infection

73

Primary purpose of peristalsis

These contractions of the circular and longitudinal muscles of the intestine move waste products along the length of the intestine continuously.

74

What body system controls peristalsis?

The autonomic nervous - parasympathetic nervous system stimulates movement while the sympathetic system inhibits movement

75

How much of our ingested food waste is excreted in the stool within 24 hours?

one third to one half of ingested food waste is normally excreted in the stool within 24 hours, and the remainder within the next 24 - 48 hours

76

How often does mass peristalsis sweeps occur every 24 hours?

Occur one to four times each 24 hour period in most people, propelling the fecal mass forward.

This often occurs after food has been ingested, accounting for the urge to defecate that often occurs after meals.

77

Age related changes affecting defecation

Slowing of GI motility with increased stomach emptying time
Decreased colonic peristalsis
Decreased muscle tone/incontinence
Weakening of intestinal walls
Reduced sensation for signal to defecated

78

Factors influencing elimination

Daily patterns
Food and fluid
Activity and muscle tone
Lifestyle
Psychological variables
Pathologic conditions
Medications
Diagnostic studies
Surgery and anesthesia

79

Elimination pathologies affecting the older adult

Constipation
Common chronic problem for older adults

Diarrhea

Fecal impaction
Prolonged retention or
Accumulation of fecal material that forms a hardened mass in the rectum

Fecal incontinence
Involuntary passing of stool or flatus
Can result from physiologic or lifestyle changes

80

What are foods affecting bowel elimination?

Constipating foods: Cheese, lean meat, eggs, pasta

Foods with laxative effect: Fruits and vegetables, bran, chocolate, alcohol, coffee

Gas-producing foods: Onions, cabbage, beans, cauliflower

81

Primary prevention strategies for Constipation

Maintenance of regular bowel routines
Respond to urge to defecate
25-38 grams of fiber/day
Increase fluid intake:
1500-2000ml of fluid/day
Adjust diet – add fiber

82

What are laxatives ?

Drugs that induce emptying of the intestinal tract

83

What are enemas ?

Inserting a solution into the large intestine to remove feces

Tap water enema
Normal saline enema
Hypertonic solution enema (Fleet enema most common)
Soapsuds enema

84

What are suppositories ?

Solid substance that melts at body temperature - inserted into rectum

85

Laxatives/enemas/suppositories all do what ?

Empty the colon of feces


Use laxatives/enemas/suppositories cautiously

86

What is a digital removal of fecal impaction

Inserting a gloved finger into the rectum to dig out feces

87

What are different bowel diversions?

Ostomy
Surgically formed opening from the inside of an organ to the outside

Ileostomy
Liquid fecal content from the ileum of the small intestine

Colostomy
Permits formed feces in the colon to exit through the stoma

88

Feces Color , Texture, and OdorNormal versus Abnormal

Soft
Hard
Formed
Loose
Liquid
Brown, green, red, black
Foul
Soft
Hard
Formed
Loose
Liquid
Brown, green, red, black
Foul

89

What type of stool are you likely to see from an ileostomy ?

Liquid fecal content