Nutrition and Hydration

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Author:
Prittyrick
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304379
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Nutrition and Hydration
Updated:
2015-06-24 14:39:39
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elders
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healthy living
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  1. Nutrition
    • The key element is preventing the health of older adults
    • the quality and quantity of the diet will help prevent, delay the onset of, and manage chronic processes
    • 80% of older americans have HTN, DM, and hyperlipdemia
    • Always keep the pt in mind- find out what they like. you don't know their resources
    • what are the resources- enough money
    • realistic goals- make sure it works for the pt
    • diet teaching= low in fat, in sodium chole
    • U can bring in a local flyer and talk about their food choices- what they like
  2. balance diet and nutrient needs
    • biggest change- our calorie needs go down esp for women
    • elders appetite decre but what food choices are good for them
  3. My plate older adults
    • half the plate should be fruits and veggies
    • 1/3 of the plate grains and the other protein
    • fork on plate to remind to put other devices down
    • water
    • Active: focus on eating, using it as a social event, staying active decre CV, obesity, depression
    • elders should have lots of colors on their plate
    • Make realistic plan- arthritis can they cut veggies, pt who are SOB.
    • decre oils and fats no added sugar
  4. Reccommendation
    • 1. fewer calories: activity level reduced and metabolic rate reduce
    • 2. limit saturated and trans fats: reduce the risk of heart disease and cancer
    • 3. Increase Protein 20-25%: prevent fraility strengthen muscle and bones
    • 4. incre fiber: control weight, improve glucose tolerance, gi function, protection against heart disease and cancer (greens, veggies, lentils, whole grain)
    • 5 Vita and minerals: balance, prevent cobalamin defiency (vita b12)- find in poultry, egg yolk, grains
    • 6. calicium and vita d: prevent osteoporosis
    • 7. increase fluids: prevent dehydration
  5. Cobalamin defiency
    • defiency of instrinisic factor in the gastric mucosa- lack of absorption of vita b12
    • Insidious onset- slow onset
    • S/S
    • - anemia
    • - GI- beefy red tongue, N/V, thrush bc immune system is impaired
    • - neuromuscula- numbness and tingling in fingers and toes
    • - impaired though process
    • Intervention
    • - assess risk factor
    • - food choices
    • - medications: b12 injection, intranasal
    • two classes of drugs that decre acid- PPI, Antacid, H2 blocker (so think about meds pt is on bc the decrease in acid makes u vita b12 defiency)
  6. Osteoporosis
    • loss of bone mineral density
    • normal part of aging
    • silent disorder until fracture occurs
    • interventions:
    • - assessing those are risk: alcohol use, sedentary life, steriods, low ca diet, low estrogen post meno, smoking, thin causacian women, high soda intake- bc of high phosphate interact with ca, FH
    • - prevent
    • - diet: incre Ca and vitamin D
    • - medication: ca supplement which cause constipation
    • food: diary, cheeses, yogurt, cottage cheese, salmon, greens
  7. Factor affecting nutrition and hydration
    • age associated changes
    • life long eating habits
    • socialization
    • acute and chronic illness- physical and emotional/dementia
    • financial
    • transportation
    • hospitalization
    • long term care residence
  8. Age related changes
    • Taste: decline in and sensitivity by age of 70 1/6 taste buds loss- u loss sweet taste first
    • Smell
    • digestive system: everything decre
    • Buccal: teeth (condition, gums, relationship between gum disease and CV disorder), dry mouth (affects taste, decre appetite)
    • what causes dry mouth= antichol, antidepressant
  9. Appetities of older adults
    • appetites are influenced by physical activity, functional limitations, smell, taste mood, socialization and comfort
    • healthy older people are less hungry and more full before meals
    • older adults:
    • - consume smaller meals at a slower pace
    • - eat fewer snacks
    • - become satisfy more rapidly
  10. Life long eating habits
    • Are developed out of tradition, ethnicity and religion
    • the older adult may be isolated from social events during which food is provided
    • effects of medications and or disease process may cause disinterest in food- ie antibiotics flagyl cause a metallic taste
    • excessive drinking decreases eating habits
  11. Influences on nutrition
    • chronic conditions such as heart disease and COPD- energy, functional impairment
    • side effects of medications
    • poverty- can afford food
    • limited transporation to the grocery store- unable to walk due to arthritis
    • financial factos that influence the choice of foods
    • social isolation- alone u don't want to eat
  12. Hospitalization and ling term residency
    • compromised ability to feed self
    • lack of interest eating
    • inadequate staffing members who do not allow enough time for feeding the slower eating
    • restrictive diets or complaints of taste of food
    • environment in which the pt eats- alone in dinner room
    • dementia- confusion, aspiration
  13. Nutritional screening
    • Assessment is key
    • tools to evaluate nutrition
    • 1. Mini nutritional assessment- look at malnutrition- screening tool
    • 2. minium data set (MDS)- long term care- screening tool nutritional decifit
    • 3. 24 hour diet recall- what did you eat in the last 24 hours- may not remember, not accurate, may not tell u everything so it may depend on the relationship between u and pt
    • 4. three day dietary history- everything you eat- what is? how much, volume
  14. Physical examination data related to nutrition
    • nutritional data consists of:
    • height and weight (BMI) what is the trends for weight- no weight change but not eating. could be fluid- albumin- keeps fluid in the vascular space, binds protein binding drugs
    • VS
    • condition of tongue lips and gums
    • skin turgor, texture, and color
    • functional abilities
    • overall appearance
    • Anthropometrical measurements
    • height and weight
    • midarm circumstance and triceps skinfold
  15. Biomedical measurements
    • CBC- looking for anemia, rbc, H&H
    • Total lymphocytes count- tells us infection, immune deficient
    • thyroid level- metabolism incre and decr
    • CMP- lytes, BUN/Cr, BS (elev BUN creatin normal tells dehydration) creatinin comes from muscles- and they loss muscle mass so creatinine can be low
    • liver function- metabolizing drug
    • urinalysis- infection- increase WBC 100,000, protein (changes in permability related to infection, nitrates (tells us nitrate bateria)
    • serum albumin, total protein
    • cholesterol- cononary ateries
    • serum trasferrin- iron stores
    • stool occult blood
    • labs, physical with pt hx tells us the story
  16. Dysphagia in the older adult
    • difficulty swallowing
    • 16-22% in adults over age 50y and up to 60% in long term care pts
    • cause: motor, sensory, neurological or behavioral
    • goal: maintain nutritional status through the functional ability to swallow safely
    • aspiration is the most dangerous complication
    • nursing dx- impaired swallowing
  17. What to do with Dysphagia in older adult
    • NPO
    • dysphagia screening tool
    • - screen done by the nursing
    • - refer to handout- have to answer yes to all questions in order to progress to a diet
    • speech and swallowing
    • can manage secretions not pocketing food, speech clear, face symmerical, follow commands, swallow 30 ml of water (medicine cup)- clear voice
    • speech and swallowing evaluation by SLP (if any problems)
    • Modified barium swallow- different texture of food and monitor with fluroscope
    • if fail: options
  18. s/s of dysphagia and aspiration
    • Assess s/s of dysphagia
    • - coughing
    • - pooling of secretions or food
    • - food retained for long period of time
    • - nasal regurtation
    • - excessive throat clearing
    • - gurgling wet voice
    • - c/o food caught in throat
    • Assess s/s of aspiration
    • - coughing
    • - changes in lungs sounds and o2 stat- cracking (fluid in small spaces) wheezing- occulusion
    • - temperature
    • - incre WBC
  19. Initial diet management for dysphagia
    • thick liquid/puree diet to start and advance as tolerate
    • OOB in char, HOB elevated
    • - reduce distraction, take time
    • chin tuck swallow- closes epiglottis
    • educate family
    • types liquid (thick it)
    • - thin- nothing added
    • - nectar- mix pours in drop
    • - honey- stays inside
    • - pudding- keeps original shape
  20. initial diet management- other key points
    • assess fatigue, allow rest before meals
    • assess meds; change LOC, fatigue- sedatives, hypothics
    • have suction set up
    • assess mouth pocketing
    • allow HOB elevated for a least an hour after- decre aspiration
  21. Enteral feedings
    • pt not able to take food in
    • promote positive nitrogen balance
    • meet the nutritional requirements when oral intake is inadequate or not possible, and the GI tract is fuctioning (keep Gi functioning best options)
    • feedings can be delivered to stomach, distal duodenum or proximal jejunum
  22. tube feeding adminstration method
    • tubes:
    • - Nasogastric tube- goes thru nasal passagway. small so can get occulded
    • Gastrostomy or jejunostomy tubes for long term feeding- G tube goes thru the stomach
    • Methods
    • - intermittent bolus feedings
    • - intermittent gravity drip
    • - continous infusion
    • - cyclic feeding
  23. types of feedings
    • based on pt's needs fluid status
    • 1Kcal/ml of feeding
    • commercially available composed of proteins, CHO, fats with fiber, vitamins, minerals
    • Osmolarity of feedings usually matches body's osmolarity (300 mOs/kg) too much fluid with incr perstalis causing diarrehea then FVD- if u have a pt with tube feeding and having diarrehea it could mean osmolarity is off
    • different types of formulas available
  24. PEG tubes
    • assess site, soap and water,
    • with trach sponges
    • chronic may not have any dressing on it
  25. nursing management of tube feedings
    • keep HOB elevated- high fowlers position bc of aspiration- before and during feedings
    • assess tube placement- follow facility policy
    • assess residual volume- cont feedings q 4 hours
    • - measure this
  26. nx management of tube feedings 2
    • flushing with NS/water
    • reduce the risk of bacterial growth, crusting, occulusion and ensures patency, hydration needs
    • - 30-50mls
    • - when to flush? before/after meds, q 4 hrs, anytime u do something with it,
    • - is by gravity
    • assess pump function, tubing change, rate, temperature of feeding, volume, max time feeding can hang
    • assess intake/output, bowel sounds, abdomen, daily weights, tolerance of feedings, hydration status- room temp- cold will cause cramping
    • administer water flushes as prescribed
  27. Nursing management of tube feedings assess
    • assess NGT
    • - nares secure, mouth care, make sure open
    • Assess PEG
    • site care: soap and water, dsg, assess signs of infection, irritation, excoriation
    • - encourage self care
    • - mouth care- small amt of food for taste
    • administering meds via NGT, GT
    • assess coping and comfort of the pt
  28. Potential complications
    • obstruction
    • aspiration/regurgitation
    • diarrhea
    • constipation
    • hyperglycemia
    • infection
  29. Oral care of the older adult
    • orodental care in intergral to general health
    • healthy people 2020 adresses this
    • - reduce proportion of older adults with untreated cavies, tooth extraction, lost of all natural teeth, moderate to severe peridonitis
    • increase proportion of older adults: screening or oral cancers and early detection
    • poor oral health; risk factor for dehydration, malnutrition, infection, joint infections, pneumonia and poor glycemic control
    • big risk between gum disease and CV disease
  30. Interventions for oral care
    • regular examinations- screenings, BOHSE
    • brush, floss and fluoride mouthwash
    • toothbrush and floss; adaptions
    • foam swabs
    • oral care: g tube
    • caregiver: oral care
    • dentures
  31. Management of hydration in older adult
    • promotion of adequate fluid balance
    • consume: 1.5L of fluid/day
    • older adults are at greater risk for dehydration
    • dehydration: complex condition resulting in reduction in total body water
    • - often comorbid condition
    • - can worsen condition
    • - mortality can be as high as 50%
    • cause with other health problems
  32. Risk factors for dehydration
    • age related changes in thirst mechanism
    • decre kidney function
    • medications- lasix- looping diuretic
    • functional, communication and comprehension issues
    • dysphagia, GI problems, malnutrition
    • infections
    • diagnostic testing- cause NPO
  33. Key points of care
    • prevention
    • accurate assessment
    • teaching points
  34. Assessment of hydration
    • s/s of dehydration include:
    • volume deficit: hypotension, tachycardia, dizziness
    • weight loss weakness
    • dry mucous membranes
    • - delayed returned in skin turgor
    • - neuro s/s
    • - elevated Na >150
    • - increase BUN (blood urea nitrogen)
    • - dark urine0 specific gravity of urine > 1,020
    • at risk people > 85yrs old
    • functional impairment- ie not able to reach water or pour it
    • acute situtions- V/D or febrile episodes should be identified quickly and treated
  35. Interventions of dehydration
    • oral hydration
    • - mild to moderate dehydration
    • - individuals who can drink
    • - individuals who do not have mental or physical compromise
    • - water is the best fluid to offer
    • - other clear fluids maybe useful
    • IV therapy
    • - replace 50% of loss within the 1st 12 hrs to relieve tachycardia and hypotension
    • - further replacement is slow over longer period of time
    • why does heart rate incre- stimulates baro receptor- stimulates sympathe nervous system- stimulate beta receptor 1
    • dizziness with low bp- decre profusion
  36. nursing interventions for dehydration
    • assessment
    • accurate I&O, daily weight
    • encourage fluids at bedside
    • - offer variety, accessible
    • - set times to offer and prn
    • - fluid rounds
    • Patient and family teaching
    • prevention
    • - who is at risk
    • - teach pt family

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