Chapter 9: Nutrition and Hydration

The nurse is feeding an older adult patient with hemiparesis as a result of a stroke. Which intervention by the nurse is most important when feeding this patient? a. Allow time to empty the mouth between bites. b. Provide foods that require chewing. c. Offer small sips of fluids with each bite. d. Serve pureed foods only.

ANS: A Allowing time to empty the mouth between bites decreases food buildup in the mouth and gives the patient time to swallow without being rushed. Providing foods that require chewing may be unsafe; the patient may have a decreased ability to chew foods. Pureed foods may not be necessary. The patient may only need extra time to manage each bite.

Which of the following is a true statement about fluid intake for older adults? a. Daily total volume should be 1500 ml to 2000 ml. b. Coffee is a suitable beverage for maintaining hydration. c. Caffeinated beverages are sometimes preferable to water. d. Total daily fluid intake should be approximately 10 ml per kg of body weight.

ANS: A Daily total volume of fluid should be 1500 ml to 2000 ml. Caffeine increases urine production and therefore aggravates dehydration rather than relieving it. Total daily fluid intake should be 30 ml per kg of body weight, not 10 ml.

To avoid trauma to the mouth from hot food being served to a patient diagnosed with dementia, the nurse should: a. Set hot food aside to allow it to cool slightly. b. Mix the hot food item with a cold food item. c. Touch the food to check the temperature before serving. d. Request a patient menu that includes several cold foods.

ANS: A Waiting for hot foods to cool slightly is the safest method. Foods should not be mixed so that each maintains its individual flavor. Touching contaminates the food that will be ingested by the patient. Patients have the right to choose any type of food, whether it is cold or hot.

Which medication(s) affect appetite and nutrition in the older adult? (Select all that apply.) a. Digoxin b. Theophylline c. Iron supplements d. Aspirin e. Phenergan

ANS: A, B, C, D Many medications affect appetite and nutrition, including digoxin, theophylline, nonsteroidal antiinflammatory drugs (NSAIDs), iron supplements, antidepressants, and psychotropic medications. Clinically significant drug-nutrients interactions can result in nutrient loss, and evidence is accumulating that shows the use of nutritional supplements may counteract these possible drug-induced nutrient depletions. A thorough medication review is an essential component of nutritional assessment, and individuals should receive education about the effects of prescription medications, as well as herbals and supplements, on their nutritional status.

Which intervention should the nurse use to decrease the risk of burns during mealtime in patients with mental and physical impairments? a. Wait until the drink has cooled. b. Assist patients with warm drinks. c. Use plastic mugs instead of ceramic. d. Serve only cold beverages to patients at risk.

ANS: B Assist patients who have deficits with warm drinks. This intervention prevents oral trauma and burns from possible spills. The use of plastic mugs does not prevent the spilling of hot liquids. All patients have the right to foods and drinks served at different temperatures. Serving only cold drinks violates a patients rights.

Which is a common age-related physical change that may affect digestion and food intake? a. Loss of the majority of taste buds b. Decreased motility in the esophagus c. Decreased cholecystokinin secretion d. Loss of smell

ANS: B Decreased motility in the esophagus is a common age-related change and can affect the ease of swallowing. A loss of the majority of taste buds is not a common age-related physical change. A small number of taste buds are lost beginning around 60 years of age, but it does not affect all flavors equally. Decreased cholecystokinin secretion is not common; however, increased cholecystokinin secretion is. A loss of smell is not a common age-related physical change.

Which of the following is a true statement about nutrition for older adults? a. The older person should be encouraged to practice strict controls on cholesterol intake to ensure protection against heart disease. b. Transportation can be a critical factor in nutritional insufficiency in older adults. c. Soul food is a concern primarily for the African-American culture. d. No government programs promote congregate dining among older adults.

ANS: B Older persons often have difficulty in obtaining adequate transportation to remote supermarkets and may choose light-weight but less nutritious food items rather than heavy fresh fruits and vegetables. Cholesterol phobia, or the excessive concern over cholesterol control, can contribute to malnutrition in older adults. Every culture has some particular foods and ways of preparing food that can bring great comfort for a person raised in that culture. Title VII of the Older Americans Act provides funding for outreach centers that serve social meals open to all older adults, regardless of their ability to pay.

A nurse is educating a patient who has been recently diagnosed with osteoporosis on foods high in calcium. The nurse should include which food choice? a. Okra b. Plain yogurt c. Turnip greens d. Whole wheat bread

ANS: B Plain yogurt has 452 mg of calcium per 8 ounces. Okra has 30 mg of calcium per serving. Turnip greens have 14 mg of calcium per serving. Whole wheat bread has 26 mg of calcium per serving.

Which increases the risk for chronic dehydration in older adults? a. Overuse of diuretic agents c. Dry mucous membranes b. Poor cognitive function d. Fluid loss from vomiting

ANS: B Poor cognitive functioning, depending on others for ambulation, living in a residential facility, and having four chronic illnesses are factors that increase the risk of chronic dehydration. An overuse of diuretic agents is more likely to cause acute dehydration. Dry mucous membranes are reliable indicators of chronic dehydration. Fluid loss from vomiting leads to acute dehydration.

An older adult with a gastrostomy tube has difficulty using the dominant hand. Which of the following should the nurse provide to prevent complications of the gastrostomy tube? a. Use foam swabs to brush the teeth. b. Provide oral care every 4 hours. c. Supply a soft tooth brush and floss. d. Position the patient at 90 degrees for tube feedings.

ANS: B The nurse provides oral care every 4 hours and brushes the teeth after meals to decrease the microorganism count in the mouth of an older adult with a gastrostomy tube. Foam swabs are ineffective tools to remove plaque, regardless of the toothpaste. Because this older adult has difficulty with the dominant hand, providing oral care supplies can be a waste of time, unless the nurse assists the older adult to maintain oral health with the supplies. The nurse positions the older adult at a 30- to 45-degree angle during tube feedings to facilitate gastric emptying.

An older man dislikes the daily meal he receives from his family because it is always cold. He is underweight and has a hemoglobin of 11.2 g/100 ml. Which recommendation should the nurse implement? a. Assess the man for a potential transfer to an assisted living facility. b. Meet with the man and his family to solve the problem. c. Collaborate with a social worker for food stamps. d. Ask the family about providing hot meals for him.

ANS: B This man is underweight and has low hemoglobin and potential signs of malnutrition. The nurse uses education and a problem-solving approach for adults who have nutritional deficiencies and live in the community; thus meeting with the family and the older adult will manage the malnutrition and improve this mans nutritional status. Although assessing the man for transfer to an assisted living facility can be an option, implementing a transfer would be premature before other attempts are made to resolve the problem. Sources for food are not this mans problem unless the family-supplied meal is his only source of food, which is unknown. This can be a part of education and problem solving.

The nursing home staff needs assistance to feed properly the residents who need assistance with feeding. Which of the following should the nurse implement to ensure that the residents are properly fed? a. Instruct the feeding assistants to feed four people at a time. b. Draw on the availability of family members who are able to follow instructions. c. Ask some residents to self-feed for part of the mealtime. d. Assign a small group of nursing assistants to do the feeding.

ANS: B With adequate training and cooperation, the nurse allows family members to feed residents who need assistance with feeding. While the family is assisting with feeding, the nurse supervises the feeding, offers feedback to family members, if necessary, and evaluates the outcome. The nurse avoids assigning more than three residents to each assistant for feeding; four residents are too many to assist safely. If a resident needs assistance with feeding, then attempting to self-feed can be dangerous, humiliating, and frustrating for a resident. If a small group of assistants performs all of the feeding, then the residents will potentially have to wait for long periods before being fed. Since the time required to implement feeding assistance is 38 minutes, a lengthy delay can result in adverse effects or injury for the resident and increase the risk of errors for the assistants, leading to frustration with the residents.

Which intervention(s) can be used to improve intake for individuals with dementia? (Select all that apply.) a. Serve soup in a plastic bowl. b. Cut up foods before serving. c. Use clear cups to serve drinks. d. Provide one utensil at a time.

ANS: B, D Cutting food before serving decreases the risk for choking, as well as making it easier for patients to feed themselves. Soups should be served in a mug instead of a bowl to enable patients to hold the cup for ease of consuming. The use of red cups, not clear cups, has been shown to increase food intake. Providing one utensil at a time can often decrease confusion during meal time.

Which recommendations for daily food intake is correct for older adults according to the MyPlate for Older Adults from Tufts University? (Select all that apply.) a. Three 8-ounce glasses of water b. Two servings of deep-colored fruit c. Four or more servings of high-quality protein d. One or two servings of brightly colored vegetables e. Three or more servings of low-fat or nonfat dairy products f. Six or more servings of fortified, enriched, or whole grain foods

ANS: B, E, F The Tufts food pyramid recommends two or more servings of deep-colored fruit, three or more servings of low-fat or nonfat dairy products such as milk and yogurt, and six or more servings of whole, enriched, or fortified grain products such as brown rice and whole grain cereal and bread.

Which of the following is a true statement about dental health in older adults? a. Most people can expect to lose most of their teeth by old age. b. Excessive saliva production is a common problem among older adults. c. Dentures should be cleaned once a day by brushing and soaking in a cleaning solution. d. A little blood on the toothbrush is normal.

ANS: C Careful cleaning of dentures is necessary to prevent the buildup of residues that contribute to staining and odor, as well as to infection. Older adults can lose teeth, but more adults are retaining their teeth into older age. Tooth loss is most often a result of periodontal disease. Inadequate saliva production (xerostomia) is a common problem for older persons. Bleeding gums is a sign of periodontal disease.

The nurse is trying to improve the nutritional status of residents in the nursing home. Which recommendations should the nurse implement? a. Develop a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery. b. Replace the fluorescent lighting with candles at every table to create a cozy, restaurant-like atmosphere. c. Provide nutritious food according to the residents' expressed food preferences with a liberal use of seasonings that do not exceed any sodium restrictions. d. Distribute "med-pass" nutritional supplements.

ANS: C Only nutritious food that is actually eaten can enhance a persons nutritional status. Older adults are more likely to eat food they like, and seasonings can make food more palatable. Developing a seating chart for the main dining room based on the unit to facilitate a more organized and efficient meal delivery is not for the benefit of the residents but is an action for the benefit of management and degrades the dignity of the residents. Older adults require greater amounts of light to see; candlelight can be too dim to see adequately. Distributing med-pass nutritional supplements are costly and often are not dispensed or are not consumed as ordered.

The nurse instructs the unlicensed assistive personnel to feed an older adult. If the nurse is unable to observe feeding directly, then which action should the nurse use to assess the older adult's risk for aspiration immediately after feeding? a. Note food volume eaten. c. Inspect for pocketing. b. Observe skin color. d. Monitor for bradypnea.

ANS: C The nurse is able to assess the risk for aspiration by assessing the adult for pocketing, which is residual accumulations or pockets of food in the mouth that the older adult can aspirate after the meal is complete. If food is found in the mouth, then the nurse removes it and evaluates the current plan of care. The amount of food consumed by an older adult is unrelated to the risk of aspiration; therefore noting the amount of food that is eaten is unsuitable for detecting the risk for aspiration. An alteration in circulation as evidenced by a change in skin color can be a late indicator of aspiration. Thus a change in skin color can indicate the presence of aspiration, but the older adult with a change in skin color is not necessarily at risk for aspiration. The nurse monitors for tachypnea as an indicator of aspiration; however, tachypnea does not indicate a risk for aspiration.

An older adult who is on bed rest has tachycardia and dry mucous membranes after surgery. Which of the following is the nurse's priority for preventive care because of the patient's fluid volume status? a. Bowel obstruction b. Delirious behavior c.Thromboembolic events d. Delayed wound healing

ANS: C This older adult is at high risk for a thromboembolic event as a result of bed rest and dehydration. Because it is a potentially life-threatening situation, the nurses priority is to prevent a thromboembolic event, including deep venous thrombosis and pulmonary embolism. The patient is likely to have low circulating blood volume as evidenced by tachycardia, which is a compensatory mechanism when the tissues receive inadequate oxygenation. In addition, compensatory mechanisms that help restore fluid balance are limited in the older adult. This limitation results in poorer tissue perfusion and an increased risk for thrombus formation for a patient who is on bed rest; a lack of skeletal muscle action promotes pooling of blood in the extremities.

Which combination is suitable for the daily diet of older adults? a. Vitamin B12, 2.4 mcg; and fiber, 15 g b. Three 8-oz glasses of fluid; and 1600 calories c. Vitamin B12, 1.1 mcg; and 40% of daily calories from fat d. Calcium, 1200 mg; and vitamin D, 600 to 800 units

ANS: D Daily recommendation is 1200 mg of calcium, and 600 to 800 units of vitamin D are needed to enable the body to use the calcium. Daily vitamin B12 intake is correct, but older adults require 20 g to 35 g of fiber. Although 1600 calories per day is correct, fluid intake (preferably water) should be 1500 ml, approximately six to eight 8-oz glasses. Vitamin B12 intake should be 2.4 mcg per day, and calories from fat should be 20% to 25%.

Which of the following is a true statement? a. Urine flow gradually decreases in older age. b. Older adults generally need less fluid than younger people because of their lower body water content. c. Urine-specific gravity and skin turgor can be used to diagnose dehydration in older adults and in younger people. d. Multiple physiological changes of aging place older adults at a greater risk of dehydration than middle-aged persons or children.

ANS: D The loss of water-containing tissues, the loss of concentrating power in the kidneys, and a decreased sense of thirst all increase an older persons risk for dehydration. Urine flow does not diminish in old age. Specifically, it does not diminish in the presence of dehydration as it does in a younger patient. Lower body water content places an older patient at greater risk of dehydration, not a lower risk. These signs are less reliable in older age because of changes to the tissues.

The nurse notices that an older adult's urine is greenish-brown. Which step should the nurse implement next? a. Increase oral fluid intake. c. Evaluate the medication list. b. Review laboratory reports. d. Determine fluid volume status.

ANS: D The nurse assesses the older adults fluid status to develop a suitable plan of care. The nurse selects the correct nursing interventions, depending on the cause of the problem. Increasing oral fluid intake is implemented after the nurse completes the fluid assessment, if the intervention is determined to be suitable. The nurse reviews pertinent laboratory data as part of the fluid assessment. The nurse evaluates the medication list as part of the fluid assessment to eliminate a medication as the cause of the dark urine.