HA CH 11

Simple Screen for Dehydration

Drugs e.g diuretics End of life High fever Yellow urine turns dark Dizziness (orthostasis) Reduced oral intake Axilla dry Tachycardia Incontinence Oral problems/sippers Neurological impairment (confusion) Sunken Eyes

Promoting Oral Health

Encourage annual dental exams, including individuals with dentures. Brush and floss twice daily; use a fluoride dentrifice and mouthwash. Ensure dentures fit well and are cleaned regularly. Maintain adequate daily fluid intake (1500 mL). Avoid tobacco. Limit alcohol. Eat a well-balanced diet. Use an ultrasonic toothbrush (more effective in removing plaque). Use a commercial floss handle for easier flossing. Adapt toothbrush if manual dexterity impaired. Use a child's toothbrush or enlarge the handle of an adult-sized toothbrush by adding a foam grip or wrapping it with gauze or rubber bands to increase handle size. If medications cause a dry mouth, ask your health care provider if there are other drugs that can be substituted. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, avoid alcohol and tobacco.

The promotion of an adequate fluid balance which prevents medical complication defines which of the following terms?

Hydration Hydration is defined clinically as the taking in of water, which prevents complications resulting from abnormal or undesirable fluid levels. Dehydration is defined clinically as "a complex condition resulting in a reduction in total body water." Overhydration, according to Merriam-Webster Dictionary, is a condition in which the body contains an excessive amount of fluids. Hypernatremia is the presence of an abnormally high concentration of sodium in the blood.

Which of the following assessment(s) is/are considered reliable in the older adult? (Select all that apply.)

Orthostasis Decreased urine output Sunken eyes Orthostasis or orthostatic hypotension is a cause of dehydration which causes a lower pressure of blood against the arterial walls. Decreased urine output is a result of dehydration caused by not drinking enough fluids or a loss of fluids due to diarrhea or vomiting. Sunken eyes is the result of the skin losing its elasticity due to dehydration. Checking the skin turgor at the sternum is not considered reliable because of the loss of subcutaneous tissue.

Dental Health Goals for Older Adults

Prevent and control oral and craniofacial disease, conditions, and injuries, and improves access to preventive services and dental care reduce the proportion of adults with untreated dental decay reduce the proportion of adults with untreated caries reduce the proportion of adults who have ever had permanent tooth extracted bc of dental caries or perio disease reduce the proportion of adults 65-74 who have lost all their teeth reduce the proportion of adults 45-74 with moderate or severe perio disease inc the proportion of oral and pharyngeal cancers detected at earliest stages

When assessing an older male client, what are some issues that might put your client at risk for dehydration? (Select all that apply.)

Respiratory tract infection Heart failure Thromboembolic complications Longitudinal furrows on the tongue Dehydration is considered a geriatric syndrome that is frequently associated with common diseases (e.g., diabetes, respiratory illness) and frailty. Typical signs of dehydration may not always be present in older adults and symptoms are often atypical. However, the main reason for dehydration is reduced fluid intake. Heart failure, thromboembolic complications, longitudinal furrows on the tongue, and respiratory tract infections are risk factors for dehydration. Pulse rate in the 80s and nonfunctional impairments are not risk factors for dehydration. Dehydration is also a significant risk factor for orthostasis, delirium, delayed wound healing, infections, kidney stones, constipation and obstipation, falls, medication toxicity, renal failure, seizure, electrolyte imbalance, and hyperthermia.

The nurse is assessing an elder client for hydration. What is the best determination of hydration in this client?

Urine color Urine color is a very common and easy way to determine hydration, not necessarily dehydration. Although most cases of dehydration have an elevated BUN measurement, there are many other causes of an elevated BUN/creatinine ratio. The serum sodium levels measure the sodium in your blood system. Drinking too much fluid will decrease the level and dehydration will increase the levels. Urine osmolality is a determination of urine concentration.

Risk Factors for Dehydration in Older Adults

aging medications polypharmacy functional deficits communication and comprehension problems oral problems dysphagia dementia and delirium hospitalization low body weight diarrhea fasting inadequate assistance fever vomiting infections bleeding draining wounds artificial ventilation fluid restrictions hot temps multiple comorbidities

LO 1 identify factors that influence hydration management

meds illness disease preferences ability

signs and symptoms of oral and throat cancer

-swelling or thickening, lumps or bumps, or rough spots or eroded areas on lips, gums, or other areas inside mouth -velvety white, red, or speckled patches in mouth -persistent sores on face, neck, or mouth that bleed easily -unexplained bleeding in mouth -unexplained numbness or pain or tenderness in any area of face, mouth, neck, or tongue -soreness in back of throat; persistent feeling that something is caught in throat -difficulty chewing or swallowing, speaking, or moving jaw or tongue -hoarseness, chronic sore throat, or changes in voice -dramatic weight loss -lump or swelling in neck -severe pain in one ear-with a normal eardrum -pain around teeth; loosening of teeth -swelling or pain in jaw; difficulty moving jaw

Risk factors for Oral Cancer

-tobacco use of any kind -heavy alcohol use -excessive sun exposure -exposure to HPV -genetic susceptibility

LO 2 describe nursing actions for prevention and treatment of dehydration

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LO 3 demonstrate understanding of the relationship between oral health and disease

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LO 4 utilize cj to identify and evaluate nursing actions to maintain hydration and oral health in a variety of settings

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Older adults should consume how much fluid per day?

1500 mL/day All older adults should have an individualized fluid goal determined by a documented standard for daily fluid intake. At least 1500 mL of fluid/day should be provided. Those in-between and baby boomers should consume 1920 mL/day which amounts to the 8 by 8 "rule" of 8 cups each of 8 oz fluid per day. 2400 mL/day is the rule of thumb for pregnant women, or 10 8-oz cups/day. Healthy men will require 3000 mL per day of fluids.

An older adult client who has had several UTIs complains of constipation. What condition do you think this client might be suffering from?

Dehydration Dehydration is a significant risk factor for delirium, thromboembolic complication, infections, kidney stones, constipation, medication toxicity, and delayed wound healing. Malnutrition is a state in which a deficiency, an excess, or an imbalance of energy, protein, or other nutrients causes adverse effects on body form, function, and clinical outcome. Malnutrition does not necessarily cause constipation but could, however, be a factor in infections. A deficiency in vitamin B12 will not affect infections or constipation. Infections of the urinary tract are found in a separate system from the gastrointestinal system. Constipation, not a UTI, might be an issue.

Maintaining Hydration

calculate a daily fluid goal compare current intake to fluid goal to eval hydration status provide fluids consistently throughout the day plan for at risk pts perform fluid regulation and doc