Hydration and Oral Care Elimination
Hydration and Oral Care Elimination
Students are required to post a minimum of three times per week (1 main post answering the question 100% before Wednesday and 2 peer responses by Sunday. The three posts in each individual discussion must be on separate days (same day postings / replies will not be accepted). Hydration and Oral Care Elimination
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Chapter 11 – Hydration and Oral Care.
Chapter 12 – Elimination.
Questions:
Choose a condition, disease, disorder affecting the elderly discussed in chapter 11 and 12 of your textbook.
1. Discuss signs and symptoms of the chosen condition, disease, disorder.
2. Explain possible treatments.
Guidelines: The answer should be based on the knowledge obtained from reading the book, no just your opinion.
Grading Criteria: Student mentioned a condition, disease, disorder discussed in chapter 11 or 12 of the textbook (25%). Student mentioned at least 3 signs and symptoms of the chosen condition, disease, disorder (45%). Student explained possible treatment(s) of the chosen condition, disease, disorder (30%).
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Chapter_011.pptChapter 11
Hydration and Oral Care
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- The promotion of an adequate fluid balance, which prevents complications resulting from abnormal or undesirable fluid levels
- Daily needs for water can usually be met by functionally independent older adults through intake of fluids with meals and social drinks
- A significant number of older adults drink less than 1 L/day of fluid
Hydration Management
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- A complex condition resulting in a reduction in total body water
- In older people, it most often develops as a result of disease, age-related changes, or the effects of medication
- Considered a geriatric syndrome
- A significant risk factor for a number of conditions
Dehydration
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- Assessment is complex in older people because clinical signs may not appear until dehydration is advanced
- Provide education to older people and their caregivers on the need for fluids and the signs and symptoms of dehydration
- Identify and quickly treat acute situations such as vomiting, diarrhea, and febrile episodes
Implications for Gerontological Nursing and Healthy Aging
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Signs and Symptoms of Dehydration
- Weight loss
- Orthostasis
- Dry mucous membranes in the mouth and nose
- Dysphagia
- Decreased urine output with dark urine
- Longitudinal furrows on the tongue
- Incoherent speech
- Rapid pulse rate
- Extremity weakness
- Dry axilla
- Sunken eyes
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Hydration Management
- Interventions consist of risk identification and hydration management
- Any individual who develops fever, diarrhea, vomiting, or a nonfebrile infection should be monitored closely by implementing intake and output records and providing additional fluids
- Keep NPO requirements as short as possible for older adults
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- Oral hydration used for
- Mild to moderate dehydration
- Those who can drink
- Those who do not have mental or physical compromise
- Water is the best fluid to offer
- Other clear fluids may also be useful
Oral Hydration
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- Depends on the severity and the type of dehydration
- Includes IV therapy or hypodermoclysis (HDC)
- Replace 50% of the loss within the first 12 hours (or 1 L/day in afebrile elders)
- Monitor for hyponatremia and symptoms of overhydration in those with heart failure or renal disease
Rehydration
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When assessing a long-term care resident who has been experiencing diarrhea, which of the following findings would lead the nurse to suspect the person is dehydrated?
Heart rate of 48 beats/min
Blood pressure 170/90 mm Hg
Urine output of 100 mL/4 hours
Hyperactive bowel sounds in all quadrants
Question
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- C—The urine output is low, consistent with dehydration. The blood pressure would be low and the heart rate elevated. Bowel sounds are not affected.
Answer
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- A basic need that is increasingly neglected with advanced age, debilitation, and limited mobility
- Age-related changes in the oral cavity, medical conditions, poor dental hygiene, and lack of dental care contribute to poor oral health
- Poor oral health is a risk factor for dehydration, malnutrition, and a number of systemic diseases
- Pain from infected teeth, ill-fitting dentures, or oral candidiasis can limit eating ability and compromise comfort and quality of life
Oral Health
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- Dry mouth
- Affects eating, swallowing, and speaking
- Contributes to dental caries and periodontal disease
- If medication side effects are contributing to dry mouth, medications may be changed or altered
- Affected persons should practice good oral hygiene practices, regular dental care, adequate water intake, and avoid alcohol
- Saliva substitutes and salivary stimulants may help
Xerostomia
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- More than 60% of oral cancers are not diagnosed until an advanced stage
- Early signs and symptoms may be subtle and not recognized by the individual or health care provider
- Therapy options include surgery, radiation, and chemotherapy
- If detected early, these cancers can almost always be treated successfully
Oral Cancer
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- Access to dental care for older people may be limited and cost prohibitive
- Those with the poorest oral health are economically disadvantaged, lack insurance, disabled, homebound, or institutionalized
- If a seriously ill or institutionalized individual needs dental care, it can be challenging to have him or her transferred to a dental office
- Medicare does not provide any coverage for oral health care services; Medicaid coverage varies
Oral Care
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- Assessment of the mouth, teeth, and oral cavity can identify oral health problems and serve as an early warning for some diseases
- The MDS 3.0 requires information obtained from an oral assessment
- Federal regulations mandate an annual examination for residents of long-term care facilities
Assessing Oral Health
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- Nurses are involved in promoting oral health through teaching recommended interventions; screening for oral disease; making dental referrals; and providing, supervising, and evaluating oral care
- Older adults and providers need to know the proper care of dentures and oral tissue
Interventions for Oral Health
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- An often neglected part of daily nursing care
- It is the responsibility of the caregiver to provide oral care
- Poor oral hygiene contributes to poor nutrition and other negative outcomes such as aspiration or ventilator-associated pneumonias
- Implement comprehensive protocols, such as the MOUTH (Managing Oral Hygiene Using Threat Reduction Strategies) intervention
Oral Hygiene in Hospitals
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After teaching an older adult about oral hygiene, which statement reflects a need for further teaching?
“I will use toothpaste to clean my dentures.”
“It would be best to visit the dentist twice a year.”
“Dentures should be kept in cleaning solution overnight.”
“Petroleum jelly will help keep my lips from cracking.”
Question
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- A—Persons should not use toothpaste on dentures because it abrades denture surfaces.
Answer
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Chapter_012.ppt
Chapter 12
Elimination
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The body must remove waste products of metabolism to sustain healthy function
Bowel and bladder functions later in life contribute to the independence of older adults
Nurses are in a key position to implement evidence-based assessment and interventions to enhance continence and improve function, independence, and quality of life for older people. Hydration and Oral Care Elimination
Concepts of Elimination
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- The involuntary loss of urine sufficient to be a problem
- Is an underdiagnosed, underreported, and undertreated condition, especially in older adults
- Treatment is not sought because of embarrassment, normal aging, or the older adult is uneducated about treatment. Hydration and Oral Care Elimination
Urinary Incontinence
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- Thought to be related to
- Cognitive impairment
- Limitations in daily activities
- Institutionalization
- Stroke, diabetes, obesity, poor general health, certain medications, and comorbidities are associated with urinary incontinence (UI)
Risk Factors for Urinary Incontinence
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- Increased risk of falls, fractures, hospitalization, and skin breakdown
- Loss of dignity and autonomy
- Increased feelings of depression, anxiety, shame, and embarrassment
- Increased social isolation
- Sexual activity is avoided
- Loss of independence and self-confidence
Consequences of Urinary Incontinence
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- Incontinence is classified as
- Transient (acute) or
Sudden onset
Present for 6 months or less
Usually caused by treatable factors such as urinary tract infections (UTIs) or delirium
- Established (chronic)
Sudden or gradual onset
Includes stress; urge; urge, mixed, or stress UI with high postvoid residual (PVR); functional UI; and mixed UI
Types of Urinary Incontinence
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- Continence must be routinely addressed in the initial assessment of every older person
- Nurses are expected to be able to collect and organize data about urine control, report findings, and implement evidence-based interventions
Implications for Gerontological Nursing and Healthy Aging
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- Multidimensional
- Determine if UI is transient or established, determine type of UI, and identify possible causes
- Continence care is a quality of care indicator for nursing homes; residents should be assessed on admission and whenever there is a change in cognition, physical ability, or urinary tract function. Hydration and Oral Care Elimination
Assessment
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- Behavioral
- Scheduled voiding
- Bladder training
- Prompted voiding
- Pelvic floor muscle exercises
- Lifestyle modifications
- Absorbent products
- Nonsurgical devices
Interventions
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- Pharmacologic treatment
- Anticholinergic, antimuscarinic agents may be indicated for urge UI and overactive bladder (OAB)
Have similar efficacy
Choice depends on drug effects, drug–drug and drug–disease interactions, dosing frequency, titration range, and cost
- Beta3-agonists (mirabegron) are a new class of medications for urge UI and OAB
- Surgical treatment
- Colposuspension (Burch operation)
- Slings
Interventions (Cont.)
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- Urinary catheters
- Intermittent catheterization
- Indwelling catheters
Not appropriate for long-term management (more than 30 days) except in certain clinical conditions
- External catheters
Interventions (Cont.)
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- Most common cause of bacterial sepsis in older adults
- 10 times more common in women than in men
- May be difficult to detect
- Older individuals do not report classic symptoms
- Cognitively impaired residents may not recall or report symptoms
Urinary Tract Infection
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- UTIs that occur in a patient with an indwelling catheter or within 48 hours of catheter removal
- Most common hospital-acquired infection worldwide
- Incidence decreased by implementing evidence-based guidelines, catheter reminders, stop orders, nurse-initiated removal protocols, and a urinary catheter bundle
Catheter-Associated Urinary Tract Infections (CAUTIs)
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During a visit to the emergency department, a 92-year-old man discloses that he dribbles when he urinates. Which of the following would be a reason for this incontinence?
Diet
Old age
Laziness when urinating
Underlying cause, such as an infection
Question
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- D—Dribbling is a symptom of a UTI.
Answer
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- Can be a source of concern and a potentially serious problem, especially for older persons who are functionally impaired
- Normal elimination should be an easy passage of feces, without undue straining or a feeling of incomplete evacuation or defecation, Hydration and Oral Care Elimination
Bowel Elimination
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- A reduction in the frequency of stool or difficulty in formation or passage of stool
- One of the most common gastrointestinal complaints encountered in clinical practice
- Associated with impaired quality of life, significant health care costs, fecal impaction, bowel obstruction, cognitive dysfunction, delirium, falls, and increased morbidity and mortality
Constipation
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- Common in incapacitated and institutionalized older people
- Symptoms include malaise, urinary retention, elevated temperature, incontinence of bladder or bowel, alteration in cognitive status, fissures, hemorrhoids, and intestinal blockage
- Treat with oil-retention enemas and digital removal
Fecal Impaction
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- Assess
- Precipitants and causes of constipation
- Thorough bowel history
- Physical assessment rules out systemic causes
- Food and fluid intake
- Abdomen is examined for masses, distention, tenderness, and bowel sounds
- Rectal examination is performed for painful anal disorders. Hydration and Oral Care Elimination
Implications for Gerontological Nursing and Healthy Aging
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- Examine medications for constipation-producing effects
- Increase fluid and fiber intake
- Promote exercise
- Environmental manipulation
- Establish regularity of bowel evacuation
- Cautiously use laxatives
- Use enemas
Interventions
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- The involuntary loss of liquid or solid stool that is a social and hygienic problem
- Often associated with UI
- Can be transient or persistent
- Devastating social affects
- Contributing factors include damage to the pelvic floor, neurologic disorder, functional impairment, immobility, and dementia
Fecal Incontinence
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- Assessment
- Obtain a complete history of UI; investigate stool incontinence, surgical and obstetric history, and medications
- Use of laxatives and enemas
- Digital examination is performed to determine the presence of a mass
- Effect on quality of life
Implications for Gerontological Nursing and Healthy Aging
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- Environmental manipulation (access to toilet)
- Diet alterations
- Habit-training schedules
- Improved transfer and ambulation abilities
- Sphincter-training exercises
- Biofeedback
- Medications
- Surgery to correct underlying cause
Interventions
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Which of the following interventions would the nurse include in a bowel retraining program for a patient in an extended care facility?
Administering a daily oil-retention enema
Limiting fluid intake at breakfast and lunch
Reducing the intake of high residue foods
Toileting the patient at the same time daily
Question
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- D—A critical part of a bowel retraining program is to establish a regular time for bowel movements.
Answer
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