Digestion and Nutrition

An adult child caring for an older adult parent calls the nurse, stating concern about the parent's chronic bad breath and stubborn plaque on the teeth. Which teeth-cleaning measure should the nurse recommend for this older adult?

"An manual toothbrush is most effective when giving oral hygiene."

An older adult reports that the dentures are rubbing against the gums and causing discomfort. The client is not wearing the dentures at all now and states it will be too expensive to buy another set. What is the nurse's best response?

"Sometimes dentures can be lined to ensure a proper fit."

A 78-year-old client states eating 3 full servings of fruits and vegetables per day. What is the nurse's best response?

"You should incorporate at least 2 more servings into your diet."

Age-Related Changes Affecting Digestion and Eating Patterns • Decreased sense of smell & taste

- Affect food enjoyment - Affected by medications and medical conditions

Risk Factors Affecting Digestion and Nutrition • Lifestyle

- Alcohol and Smoking

Age-Related Changes Affecting Digestion and Eating Patterns • Liver

- Becomes smaller, more fibrous, blood flow decreased by 1/3

Risk Factors Affecting Digestion and Nutrition • Medication effects

- Broad-spectrum antibiotics - Diuretics

An older adult client with a history of renal failure is admitted with dehydration and hyponatremia. The nurse identifies which assessment finding(s) as being consistent with the client's diagnosis of dehydration? Select all that apply.

- Confusion - Decreased skin elasticity - Increased blood urea nitrogen (BUN)

Age-Related Changes Affecting Digestion and Eating Patterns • Gallbladder

- Decreased bile acid synthesis - Increase secretion of cholecystokinin leads to cholelithiasis (gallstones)

Age-Related Changes Affecting Digestion and Eating Patterns • Stomach

- Decreased gastric acid secretions - Slow gastric emptying

Evidence-based Practice for Dysphagia • Dysphagia as a risk for Aspiration, Aspiration Pneumonia, Malnutrition, & Dehydration

- Diminished muscle strength and function - Reduced tissue elasticity - Impaired dental status - Neurological conditions, Frailty, Altered mental status, Medications

Risk Factors Affecting Digestion and Nutrition • Functional impairment

- Dysphagia

Risk Factors Affecting Digestion and Nutrition • Oral health

- Edentulous, lack of teeth may gradually increase with age - Poor oral care

The nurse is preparing to feed a dependent older adult client. Which action(s) will the nurse take? Select all the apply.

- Elevate the head of the bed. - Ensure the client is alert. - Position with head slightly flexed and chin down. - Observe for signs of swallowing difficulty. - Describe food as presented.

Risk Factors Affecting Digestion and Nutrition • Socioeconomic influences

- Food insecurity

Risk Factors Affecting Digestion and Nutrition • Medical problems

- Gingival bleeding

Age-Related Changes Affecting Digestion and Eating Patterns • Pancreas

- Increase susceptibility to Type 2 DM

Evidence-based Practice for Dysphagia • Recommendations for Nursing Interventions

- Interdisciplinary team - Rest for 30 minutes before eating, sit upright, allow at least 30 minutes for eating or assisted feeding - Alternate small amounts of solid and liquid foods - Minimize distraction - Good oral care

Risk Factors Affecting Digestion and Nutrition • Psychosocial:

- Loneliness, stress, anxiety, memory issues, and depression

Nutritional Requirements for Healthy Aging • Nutrients

- Protein - Fiber - Folate - Vitamin D - Calcium - Magnesium - Potassium - Zinc - Sodium - Saturated fat

An older adult client resides in a long-term care setting. The dental exam reveals bad breath; a few teeth that are loose; use of a partial appliance; and swollen, red, and painful gums. Which action(s) will the nurse take? Select all that apply.

- Provide routine oral care. - Stress importance of adequate nutrition. - Instruct the client to rinse mouth with warm saline regularly.

Nutritional Requirements for Healthy Aging • Nutritional Deficiency/Problem

- Sarcopenia and Frailty - DM, colorectal cancers, obesity - Neurologic deterioration - Osteoporosis, CVD, neurologic condition - Osteoporosis, CVD, neurologic condition - BP problems, DM - CVD - Anorexia, impaired immune function - Hypertension - CVD

Age-Related Changes Affecting Digestion and Eating Patterns • Intestinal tract

- Structural changes may affect immune function & absorption of some nutrients

The long-term care nurse is assessing the nutritional status of a group of clients. Which client(s) does the nurse determine as being at risk for impaired gustatory function? Select all that apply.

- The client who has recently completed radiation therapy. - The client with rapidly progressing Alzheimer disease. - The client with a history of head trauma.

Age-Related Changes Affecting Digestion and Eating Patterns • Oral cavity

- Tooth enamel becomes harder/more brittle - Dentin becomes more fibrous - Nerve chambers are shorter & narrower - Teeth loosen and may fall out (periodontal disease)

Evidence-based Practice for Dysphagia • Recommendations for Assessment

- Use EAT-10 screening tool (done by Speech-Language Therapist) - Questions r/t chewing, swallowing problems, foods or beverages to avoid, sensation of food getting stuck in throat, voice changes, inability to handle secretions - Observations: LOC, voluntary coughing, voice quality, control of secretions - Signs/symptoms: drooling, coughing during meals, voice changes following meals, gurgling sounds in the throat, upper respiratory tract infection, pocketing food in the cheeks

Functional Consequences Affecting Digestion & Nutrition

-Ability to procure, prepare food, and enjoy food -Mastication and digestion of food -Nutritional status and weight changes -Psychosocial function

EAT-10 Swallowing Assessment Tool

-An evidence-based screening tool -Helps to measure swallowing difficulties -Score of >3 out of 40 points need further evaluation and reporting

Guidelines for Daily Food Intake for Older Adults

1. Select a variety of high-quality foods 2. Avoid saturated fats 3. Drink plenty of liquids without added sugars. 4. Use a variety of herbs and spices

Diminished taste sensation is common in older adults, with increased prevalence in those who are age

80 or older and those who have chronic conditions

An 80-year-old client who has just spent 2 days at the beach with the family is demonstrating confusion and has concentrated urine. Which action will the nurse take?

Administer fluids.

After reviewing a client's list of medications the nurse asks if the client ever experiences a dry mouth. Which medication on the list caused the nurse to ask the client this question?

Diuretic

xerostomia

Dryness of the mouth caused by reduction of saliva

An older adult client experiences frequent episodes of constipation. Which recommendation(s) will the nurse include in the teaching plan for this client? Select all that apply.

Eat prunes daily. Include oatmeal for breakfast 3 days per week.

A 78-year-old client reports heartburn on a regular basis after eating. Which topic will the nurse include in the teaching plan?

Eat smaller meals.

The nurse is assessing an older adult client's food journal after receiving education to help the client to gain weight. When reviewing the client's entries, what information demonstrates the client has implemented the teaching provided?

Five to six small meals per day noted.

Evidence-based Practice for Dysphagia - Observations:

LOC, voluntary coughing, voice quality, control of secretions

The Mini Nutritional Assessment (MNA) tool

Mini Nutritional Assessment - Short Form (MNA®-SF) The MNA®-SF provides a simple and quick method of identifying elderly persons who are at risk for malnutrition, or who are already malnourished. It identifies the risk of malnutrition before severe changes in weight or serum protein levels occur.

During a physical examination, the nurse notes that the older adult client has a smooth red tongue. Which follow-up intervention would the nurse anticipate?

Nutritional screening

The nurse notes that an older adult client experiencing weight loss has several missing teeth and the remaining teeth have evidence of gum erosion. Which intervention will the nurse include in the plan of care?

Order a soft diet. The nurse will order a soft diet so the client can eat nutritious food that is easily on the mouth.

The nurse is caring for an unresponsive client who wears partial dentures. Which action will the nurse take to provide oral care for this client?

Remove dentures, brush teeth and dentures daily.

An older adult client reports having a dry mouth after being diagnosed with thrush. Which recommendation will the nurse make to this client?

Rinse your mouth with warm saltwater.

The nurse observes the unlicensed assistive personnel provide mouth care to an older client. For which observation should the nurse intervene?

Swabbed the lower back molars with lemon-glycerin swabs Lemon-glycerin swabs dry the oral mucosa and contribute to tooth enamel erosion.

Slowing of gastric emptying is an

age-related change that can lead to anorexia and inadequate energy intake.

The nurse suspects that an older adult's diarrhea is related to medications. Which medication should the nurse consider as causing this client's problem?

ampicillin

Propranolol is identified as having the potential to cause

anorexia

Alcohol can interfere with the absorption with

b-complex vitamins and vitamin C

During a home visit, the nurse observes an older client place prepared food on a plate for dinner. Which observation indicates that additional teaching is required?

beef steak 50% of the plate, green beans 25%, potato 25%

A clinical sign of malnutrition is a serum albumin level below

below 3.5 g/dL (35 g/L).

The liver assists digestion by producing and secreting

bile which is essential for utilizing fats. It also plays an important role in metabolizing and storing medications and nutrients. With increasing age, the liver becomes smaller and more fibrous, and blood flow to the liver decreases by approximately one-third.

Decreased calcium contributes to

bone loss in older adult female clients. The client must be encouraged to bear weight.

The action of eating certain foods does not increase salivation. It is the action of

chewing or sucking on foods such as a popsicle that causes salivation to increase.

Oral health influences nutritional status because it affects

chewing, eating, swallowing, speaking, and social interaction.

Saliva is essential for

chewing, swallowing, and maintenance of a moist oral mucosa. Saliva facilitates digestion by supplying digestive enzymes, regulating oral flora, cleansing the taste buds, lubricating the soft tissue, and preparing food for chewing. Although significant hyposalivation (i.e., decreased salivary flow) is not an inherent age-related change, about one-third of older adults experience xerostomia

Medications and vitamins that are similar in chemical structure may

compete at sites of action, thus altering their excretion pattern.

Codeine is identified as having the potential to cause

constipation

The partial dentures of an unresponsive client should be removed and brushed at least

daily. The nurse should also dry brush the teeth and return the partial appliance to the mouth to maintain form.

A lack of muscular stress on bones, as well as lack of weight-bearing stimuli will lead to

decreased bone density.

Food insecurity,

defined as the state of being without reliable access to a sufficient quantity of affordable and nutritious food, affects about 9% of older adults in the United States, with higher prevalence among those who are non-white, living alone, and with less than a high school education. Food insecurity increases the risk for frailty, chronic conditions, and nutritional deficiencies

Drinking coffee can lead to

dehydration and a lack of moisture in the mouth.

Antacids can contribute to the

development of constipation

Ampicillin is identified as having the potential to cause

diarrhea

dysphagia

difficulty swallowing

Evidence-based Practice for Dysphagia - Signs/symptoms:

drooling, coughing during meals, voice changes following meals, gurgling sounds in the throat, upper respiratory tract infection, pocketing food in the cheeks

It is recommended that older adults eat at least

five servings of fruit and vegetables daily.

Prednisone is identified as having the potential to cause

fluid and electrolyte distrubances

The clients who underwent radiation therapy, with rapidly progressing Alzheimer disease, and with a history of head trauma respectively are at risk for

for impaired gustatory function, which is defined as an impaired ability to taste.

A nurse is assisting an older adult client who is being treated for pancreatitis to create a menu. Which food selection by the client would lead the nurse to develop a teaching plan for the client?

fried chicken with collard greens

The nurse is caring for a client 1 month after a cerebrovascular accident. Which assessment will the nurse perform first?

gag reflex

Regular heat burn can be a sign of

gastrointestinal reflux

Older adults are likely to experience disorders of the

gastrointestinal tract because of commonly occurring conditions.

The ability to taste is called

gustatory function

when using the modified MyPlate for older adults, fruits and vegetables should take up

half of the plate

EAT-10 (Swallowing Assessment Tool)

he Eating Assessment Tool (EAT-10) is increasingly used to screen for self-perceived oropharyngeal dysphagia (OD) in community-dwelling elders. A summated EAT-10 total score ranges from 0 to 40, with a score ≥ 3 indicative of OD.

Common causes of taste disorders are

head trauma, radiation, upper respiratory tract infections, medical conditions (e.g., diabetes or hypothyroidism).

Broad-spectrum antibiotics can alter

intestinal flora and impair nutrient synthesis.

A smooth red tongue can be an indication of an

iron, vitamin B12, or niacin deficiency.

Dysphagia (i.e., difficulty during any phase of the swallowing process)

is a functional impairment that can significantly affect chewing, digestion, nutritional status, and safe and effective swallowing.

What is the recommendation of caloric intake for older adults?

less calories but better quality

Age-related changes of the oral mucosa include

loss of elasticity, atrophy of epithelial cells, and diminished blood supply to the connective tissue. These changes can be exacerbated by conditions common in older adults (e.g., chronic disease, vitamin deficiencies), making the oral mucosa more friable and susceptible to infection and ulceration.

Consequences of reduced gastric acid include

malabsorption of increased bacterial overgrowth in the intestinal tract and malabsorption of iron, calcium, and vitamin B12

What time tends to be the best tie for older adults to have a bowel movement?

mornings

Digestion begins when food enters the

mouth and is acted on by the teeth, saliva, and neuromuscular structures responsible for mastication.

Rinsing the mouth with warm saltwater will soothe the

mouth and stimulate saliva production

The nurse should elevate the head of the bed before feeding the client to decrease the risk

of aspiration

when using the modified MyPlate for older adults, grains should take up

one-quarter of the plate

When using the modified MyPlate for older adults, protein should be

one-quarter of the plate.

An imbalance of calcium in the body can lead to

orthostatic hypotension.

Adventitious lung sounds and shortness of breath are associated with

overhydration

An older adult client with controlled chronic illnesses has no interest in eating and is losing weight. What should the nurse assess first?

reason for no interest in eating

Gustatory function depends primarily on

receptor cells in the taste buds, which are located on the tongue, palate, and tonsils.

A nurse is assessing an older adult client who has been admitted to the long-term care facility. Which finding would the nurse interpret as a potential pathological process rather than a normal age-related change?

red and swollen gums

Prolonged use of proton pump inhibitors casues

reduced gastric acid secretions

A primary digestive function of the pancreas is the

secretion of enzymes essential for metabolizing glucose, neutralizing acids in the chyme, and breaking down fats, proteins, and carbohydrates in the small intestine. Degenerative age-related changes in the pancreas increase the susceptibility of older adults to the development of type 2 diabetes.

The nurse is concerned that an older adult client is experiencing undiagnosed malnutrition. What information may cause the nurse to make this clinical determination?

serum albumin level 2.8 g/dL (28 g/L)

Once the nurse assures the client is alert, the nurse positions the client's head

slightly flexed with the chin pointing down.

Presbyphagia

slowed swallowing

Smoking diminished the ability to

smell and taste food and it also interfere with absorption of Vitamin C and folic acid.

Conditions that can lead to impaired olfaction include

smoking or chewing tobacco, viruses, poor oral health, periodontal disease, nasal sinus disease, trauma, and medications (e.g., diuretics and antidepressants).

Olfaction

the ability to smell odors

Diuretics can interfere with

the transport of water, sodium, glucose, and amino acids

Lemon-glycerin swabs should not be used because

they dry the oral mucosa and erode tooth enamel.

With age, teeth experience

wear on the surfaces, a decrease in the size and volume of pulp, an increase in brittleness, varying degrees of root absorption, and a loss of enamel.

Confusion, decreased skin elasticity, and increased BUN are all associated

with dehydration.

Risk Factors Affecting Digestion and Nutrition • Cultural influences

• Cultural influences

Risk Factors Affecting Digestion and Nutrition • Environmental • Myths/Misunderstandings

• Environmental • Myths/Misunderstandings

Nutrition Assessment

• Interviewing about digestion and nutrition • Using physical assessment and laboratory information • Observing cues to digestion and nutrition • Using assessment tools - The Mini Nutritional Assessment (MNA) tool • https://www.mna-elderly.com/user_guide.html - EAT-10 (Swallowing Assessment Tool)