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Chapter 16 Nutrition and Hydration

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Chapter 16 Nutrition and Hydration Components of the Nutritional Assessment History Physical Examination Biochemical Evaluation Cognition and Mood Anthropometric ... – PowerPoint PPT presentation

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Title: Chapter 16 Nutrition and Hydration


1
Chapter 16 Nutrition and Hydration
2
Components of the Nutritional Assessment
  • History
  • Physical Examination
  • Biochemical Evaluation
  • Cognition and Mood
  • Anthropometric Measurement

3
History
  • Review health history and medical record for
    evidence of diagnoses or conditions altering the
    purchase, preparation, ingestion, digestion,
    absorption, or excretion of foods.
  • Review medications for those that can affect
    appetite and nutritional state.
  • Assess patients description of diet, meal
    pattern, food preferences, and restrictions.
  • Keep a diary of all food intake for a week.

4
Physical Assessment
  • Inspect hair.
  • Inspect skin.
  • Test skin turgor.
  • Note muscle tone, strength, and movement.
  • Inspect eyes.
  • Inspect oral cavity.
  • Observe person drinking or eating for
    difficulties.

5
Biochemical Evaluation
  • Obtain blood sample for screening of
  • Total iron binding capacity
  • Transferrin saturation
  • Protein albumin
  • Hemoglobin hematocrit
  • Electrolytes vitamins
  • Prothrombin time
  • Obtain urine sample for screening of specific
    gravity.

6
Cognition and Mood
  • Test cognitive function.
  • Note alterations in mood, behavior, cognition,
    level of consciousness.
  • Be alert to signs of depression.
  • Ask about changes in mood or cognition.

7
Anthropometric Measurement
  • Measure and ask about changes in height and
    weight.
  • Determine triceps skinfold measurement (TSM).
  • Measure the midarm circumference (MC) with a tape
    measure (using centimeters).
  • Use this to calculate midarm muscle circumference
    (MMC) with formula
  • MMC in cm MAC in cm (0.314 x TSM in mm)

8
Factors Contributing to Reduced Need for Calories
of the Elderly
  • The older body has less body mass and a relative
    increase in adipose tissue.
  • Adipose tissue metabolizes more slowly than lean
    tissue and does not burn calories as quickly.
  • Basal metabolic rate declines 2 for each decade
    of life.
  • The activity level for most older adults is
    usually lower than it was during younger years.

9
Harris-Benedict Equation (REE)
  • Males
  • 66 13.7 x weight (kg) 5 x height (cm)
    6.8 x age kcal/day
  • Females
  • 655 9.7 x weight (kg) 1.8 x height (cm)
    4.7 x age kcal/day

10
Recommended Diet for Elderly
  • Should contain calories of a high quality
    including
  • Fibers
  • lt30 total calories from dietary fat.
  • At least 1 g protein per kg body weight daily
    approximately 15 daily calories from proteins.

11
Examples of at Risk Nutrition-related Conditions
for Women
  • Heart disease
  • Cancer
  • Osteoporosis

12
Hydration
  • Total body fluids are reduced with age, thereby
    contributing to the risk for dehydration.
  • Older adults require approximately 1500 ml fluid
    daily.
  • Factors that may cause elders to consume less
    fluid
  • Reduction in thirst sensation
  • Fear of incontinence
  • Lack of accessible fluids

13
Signs of Periodontal Disease
  • Bleeding gums, particularly when teeth are
    brushed
  • Red, swollen, painful gums
  • Pus at gumline when pressure is exerted
  • Chronic bad breath
  • Loosening of teeth from gumline

14
Nutritional Supplements
  • Inquire about supplement use during the
    assessment.
  • Increasing numbers of people are using
    nutritional supplements on a daily basis.
  • Supplements can compensate for inadequate intake
    of nutrients.
  • Supplements can interact with medications.

15
Reasons for Increased Ingestion in the Elderly
  • Decreased stomach motility
  • Less gastric secretion
  • Slower gastric emptying time

16
Non-Pharmacologic Measures for Managing
Indigestion
  • Eat several small meals rather than three large
    ones.
  • Avoid or limit fried foods.
  • Identify and eliminate specific foods from the
    diet to which an intolerance exists.
  • Sit in a high Fowler position while eating and
    for half an hour after meals.
  • Ensure adequate fluid intake and activity.

17
Forms of Dysphagia
  • Transfer Dysphagia
  • Difficulty moving food from the mouth to the
    esophagus.
  • Transport Dysphagia
  • Difficulty moving food down the esophagus.
  • Delivery Dysphagia
  • Difficulty moving food from the esophagus into
    the stomach.

18
Causes of Dysphagia
  • Neurological conditions, such as a stroke
  • Most cases are due to gastroesophageal reflux
    disease (GERD).

19
Factors to Consider When Assessing Swallowing
Problems
  • Onset
  • Types of foods that present the most problems
  • Solids or liquids
  • Occurrence
  • Consistent or periodical
  • Other symptoms and related complications
  • Aspiration
  • Weight loss 

20
Nursing Measures for Swallowing Difficulties
  • Have the person sit upright whenever food or
    fluid is being consumed.
  • Allow sufficient time for eating.
  • Assure there is no residual food in the mouth
    before feeding additional food.
  • Place small portions in the mouth.
  • Discourage the person from talking while eating.

21
Nursing Measures for Swallowing Difficulties
(cont.)
  • Keep a suction machine readily available.
  • Monitor intake, output, and weight.
  • Tilt the head to a side and placing food on a
    particular part of the tongue.
  • Correct underlying problems.

22
Causes of Constipation in the Elderly
  • Slower peristalsis
  • Inactivity
  • Side effects of drugs
  • A tendency toward less bulk and fluid in the
    diet.

23
Measures to Prevent Constipation
  • Drink plenty of fluids.
  • Eat plenty of fruits and vegetables.
  • Exercise regularly.
  • Allow adequate time for a bowel movement.

24
Factors That Increase the Risk for Malnutrition
  • Reduced taste and smell sensations
  • Slower peristalsis
  • Decreased hunger contractions
  • Reduced gastric acid secretion
  • Less cells on intestinal surface

25
Clinical Signs of Malnutrition
  • Weight loss greater than 5 in the past month or
    10 in the past 6 months.
  • Weight 10 below or 20 above ideal range.
  • Serum albumin level lower than 3.5 g/100 mL
  • Hemoglobin level below 12 g/Dl.
  • Hematocrit value below 35.

26
Source
  • Eliopoulos, C. (2005).  Gerontological Nursing,
    (6th ed.).  Philadelphia Lippincott, Williams
    Wilkins (ISBN 0-7817-4428-8).
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