Week 9: Nutrition, Hydration And Oral Care Flashcards
(36 cards)
Changes in caloric requirements for older adults
- Generally need less calories because Activity decreases and metabolic rate slows down.
- Still require the same or higher amounts of nutrients
Dietary Recommendations: Fats
- 20-35% of total calories.
- Limit saturated fat and trans fatty acids.
Dietary Recommendations: Protein
-Increase to 20-25% total calories for older adults who tends to experience protein deficiency when ill (minimizes fragility)
Dietary Recommendations: Fiber
25 grams daily
Dietary Recommendations: Vitamins and minerals
- Consumption of five servings of fruits/vegetables provides adequate A,C,E and K.
- Changes of aging contribute to decreased absorption of Vit B12
Malnutrition can increase the risk for
- Infection
- PU
- Anemia
- Hip fractures
- Hypotension
- Impaired cognition
- Increased morbidity and mortality
Malnutrition can be related to
Inadequate consumption of micro and macro nutrients or a consequence of inflammation
Factors Affecting Fulfillment of Nutritional Needs
- Age-related changes in taste and smell
- Lifelong eating habits
- Socialization
- Chronic diseases and conditions
- GI disorders
- Socioeconomic deprivation
- Transportation
Nutrition screening and assessment includes
- 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
Approaches to enhancing intake in LTC
- 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
Risk factors for dysphagia
- 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
Signs and Symptoms of Dysphagia include
- 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
Feeding Tubes
- Do not prevent aspiration or risk of aspiration.
- Interfere with basic psychological, biological and cultural needs associated with eating.
Feeding tubes are not associated with
- Improved survival
- Reduced incidence of pneumonia
- Improved function
- Fewer PU
Feeding tubes are associated with complications including
- Cellulitis
- Diarrhea
- Aspiration pneumonia
- Metabolic problems
Before enteral feedings, what factors should be assessed
-Poor nutritional uptake including meal environment, feeding techniques, food preferences, medications and depression.
Water is important for
- Thermoregulation
- Dilution of water-soluble medications
- Facilitation of bowel and renal function
- Maintaining metabolic processes
What are age related changes that affect hydration?
- 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.
Dehydration
-Complex problem that results in reduction of total body water.
Significant issues associated with dehydration include:
- Thromboembolic complications
- Kidney Stones
- Constipation
- Falls
- Medication toxicity
- Renal failure
- Seizure
- Electrolyte imbalance
- Hyperthermia
- Delayed wound healing
Risk factors for dehydration include
- Emotional illness
- Surgery
- Trauma
- Higher physiological demands
Signs and Symptoms of Dehydration include
- 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
Dehydration: Lab Tests
- 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
Dehydration Interventions
- Monitor closely and implantation of intake and output is essential
- Oral hydration is the first treatment approach
- Water is the best fluid to offer
