Eating and Feeding Problems in the Older Adult
A 78-year-old widow comes to her physician's office for a follow-up visit related to her renal failure and recent dietary restrictions. Which statement describes the reason behind the nurse's decision to perform a nutritional screening? Altered diets can place patients nutritionally at risk. Nutritional screening is required for patients in renal failure. Nutritional screenings are considered best practice for all patients. Elderly patients are mandated by Medicare for nutritional screenings.
Altered diets can place patients nutritionally at risk. Alterations in prescribed diets or diet schedules place patients at risk for nutritional problems. Nutritional screening is required for patients in renal failure. Nutritional screenings are not required for patients in renal failure, but could be important with changes in body weight, altered diets, or inadequate nutritional intake. Nutritional screenings are considered best practice for all patients. Nutritional screenings are not considered best practice for all patients, but are recommended for those considered to be at risk. Elderly patients are mandated by Medicare for nutritional screenings. Medicare does not mandate nutritional screenings for elderly patients.
Which population of patients might benefit from a nutritional screening using the Malnutrition Screening Tool (MST)? Select all that apply. Cancer patients Nursing home patients General medical patients Non-institutionalized patients Patients who have had surgery
Cancer patients Oncology patients often benefit from a nutritional screening with the Malnutrition Screening Tool. Nursing home patients Nursing home patients are better served by the Malnutrition Universal Screening Tool. General medical patients The MST has been validated for use in the general medical population. Non-institutionalized patients Determine Your Nutritional Health is a recommended tool for use in the non-institutionalized older adult. Patients who have had surgery The MST is appropriate for use in the surgical patient.
Which age-related sensory changes in olfaction and taste are related to decreased intake in the older adult? Select all that apply. Decrease in salivary production Age-related decrease in the sense of smell and taste Stomach upset due to increased sensitivity to smells Increase in eating discomfort due to dental problems Decrease in eating enjoyment due to a diminished sense of taste and smell
Decrease in salivary production Age-related decrease in salivary production can affect the smell and taste of food. Age-related decrease in the sense of smell and taste As adults age, the sense of smell and taste decreases. Stomach upset due to increased sensitivity to smells The sense of smell decreases with age. An increase in sensitivity to smells is not typically seen in the older adult. Increase in eating discomfort due to dental problems Although dental problems can make eating uncomfortable, this is not related to olfactory and taste sensations. Decrease in eating enjoyment due to a diminished sense of taste and smell Without the satisfaction of smelling and tasting food, the enjoyment of a meal is decreased.
Which complications are associated with malnutrition in the older adult? Select all that apply. Delayed healing Prolonged hospitalizations Accelerated immune response Increased incidence of pneumonia Increased rate of institutionalization
Delayed healing Malnutrition often delays the healing process. Prolonged hospitalizations Hospitalized patients suffering from malnutrition are hospitalized longer than those with healthy nutritional status. Accelerated immune response Malnutrition leads to the suppression of the immune response, not the acceleration of it. Increased incidence of pneumonia As muscle protein is catabolized and the respiratory muscles are affected, this can increase the risk of pneumonia. Increased rate of institutionalization Due to the effect that malnutrition has on the older adult, these patients have a higher rate of institutionalization than their nutritionally stable counterparts.
A patient recently admitted to a nursing home had numerous concerns that arose during the nutritional screening. Which elements of a nutritional assessment would be appropriate to consider? Select all that apply. Diet history Urinary output Serum albumin levels Total lymphocyte count Measurement of height and weight
Diet history Diet history, including the number of meals and snacks, chewing or swallowing difficulties, GI problems, medical history, and appetite (along with other parameters) is an important component of the nutritional assessment. Urinary output Urinary output is an important factor to consider in the older adult, but it is not a part of a nutritional assessment. Serum albumin levels The serum albumin level is the serum protein most frequently assessed in suspected malnutrition; therefore, it is an important component of the nutritional assessment. Total lymphocyte count The total lymphocyte count may be used as a nutritional marker and may be decreased in a severe case of prolonged malnutrition. Measurement of height and weight Anthropometrics include the measurement of height and weight and are important components of the nutritional assessment.
Which potential team members might be needed to address individualized risk factors contributing to malnutrition? Select all that apply. Dietitians Social workers Radiology technicians Physicians/nurse practitioners Rehabilitation therapists (OT, PT, speech)
Dietitians Dietitians are an important resource needed to address risk factors that contribute to malnutrition. Social workers Social workers are part of the interprofessional team necessary to address risk factors that contribute to malnutrition. Radiology technicians Radiology technicians typically are not involved in addressing risk factors of malnutrition. Physicians/nurse practitioners Assessing for risk factors that contribute to malnutrition requires the expertise of the patient's primary medical caregiver, such as the physician or nurse practitioner. Rehabilitation therapists (OT, PT, speech) Occupational, physical, and speech therapists are often part of the interprofessional team charged with addressing risk factors that contribute to malnutrition.
How might functional impairment impact nutritional status in the older adult? Digestive problems can be caused by impaired functioning. Functional impairment can result in changes to taste and smell. Functional impairments can limit the ability to grocery shop, prepare food, or eat unassisted. Functional impairments can decrease enzymatic functioning and increase protein requirements.
Digestive problems can be caused by impaired functioning. Digestive problems result from a decline in organ function, which is a physiologic factor resulting from aging. Functional impairment can result in changes to taste and smell. Changes to the sense of taste and smell are physiologic factors that result from aging or from certain medications. They are not functional impairments. Functional impairments can limit the ability to grocery shop, prepare food, or eat unassisted. Functional impairments lead to difficulty moving around and can limit the ability to shop grocery, prepare food, or eat unassisted. Functional impairments can decrease enzymatic functioning and increase protein requirements. Issues with enzymatic functioning are physiologic factors that can result in malnutrition.
A 65-year-old male is admitted to the hospital with the diagnosis of a severe cerebrovascular accident. He is unconscious and unresponsive. Which form of nutritional support will be required for this patient? Enteral Parenteral Oral feedings with clear liquids Simple intravenous fluid replacement
Enteral An unconscious, unresponsive patient post cerebrovascular accident will need enteral nutritional support initially. Should the patient begin to recover, progression to oral feedings would be appropriate when the patient can safely swallow. Parenteral Parenteral feedings are typically used when the GI tract cannot be used for enteral feedings or is unable to absorb nutrients. Oral feedings with clear liquids Unconscious patients should not be given any sort of oral feedings because it may lead to aspiration. Simple intravenous fluid replacement Simple intravenous fluid replacement will not provide the nutrients needed for recovery or proper nutrition.
Which factors are considered to be causes of malnutrition? Select all that apply. Increase in water intake Decrease in water intake A deficiency of calorie intake Suppressed immune response An oversupply in calorie intake
Increase in water intake An increase in water intake can lead to overhydration, but does not impact calorie intake. Decrease in water intake A decrease in water intake can lead to dehydration, but it does not impact calorie intake or malnutrition. A deficiency of calorie intake A deficiency or decrease in calorie intake can result in undernutrition and malnutrition. Suppressed immune response A suppressed immune response is a result of malnutrition. It does not lead to malnutrition. An oversupply in calorie intake Overnutrition, that is an oversupply of calorie intake, can lead to malnutrition.
A postoperative patient is admitted to the ICU after extensive surgery to the throat and esophagus due to cancer. How might the nurse anticipate providing this patient nutritional support? Select all that apply. Oral feedings Enteral feedings via peg tube Intravenous fluids via a peripheral line Enteral feedings via a nasogastric tube Parenteral feedings via an implanted port
Oral feedings Oral feedings are not appropriate due to the nature of the surgery on the throat and esophagus. Enteral feedings via peg tube Enteral feedings via peg tube may be appropriate, as the feeding would bypass the throat and esophagus and deliver nutrients directly into the stomach. Intravenous fluids via a peripheral line Intravenous fluids through a peripheral line will not provide the nutritional support needed for this patient. Enteral feedings via a nasogastric tube Enteral feedings via a nasogastric tube would not be appropriate due to the extensive surgery to the throat and esophagus. Parenteral feedings via an implanted port Parenteral feedings are appropriate for this patient. Given the cancer diagnosis, it is likely that the patient has an implanted port which would provide necessary access.
Which psychosocial factors might negatively impact the older adult's nutritional status? Select all that apply. Poverty Isolation Confusion Large social network Family meal gatherings
Poverty Poverty can impact the older adult's nutritional status due to limited ability to buy food; but it is a socio-economic factor, not a psychosocial factor. Isolation Isolation can lead to malnutrition because older adults may skip meals or simply not want to bother with meal preparation. Confusion Confusion is a psychosocial factor that can lead to missed meals or forgetting to eat altogether. Large social network A large social network would not have a negative effect on the older adult's nutritional status. Meals are often the central component of social functions and could increase food intake. Family meal gatherings Older adults are more likely to eat when they are not alone. Family support can increase nutritional intake.
How do cachexia and sarcopenia differ? Sarcopenia is more severe than cachexia. Cachexia is involuntary, while sarcopenia is voluntary. Sarcopenia results from protein catabolism due to disease, while cachexia results from the normal aging process. Cachexia results in a loss of body weight, fat, and muscle, while sarcopenia results in a loss of strength and function.
Sarcopenia is more severe than cachexia. Cachexia is an involuntary and severe loss of body weight, fat, and muscle. sarcopenia results in an involuntary loss of muscle mass, strength, and function. Cachexia is involuntary, while sarcopenia is voluntary. Both cachexia and sarcopenia are involuntary. Sarcopenia results from protein catabolism due to disease, while cachexia results from the normal aging process. Sarcopenia may be related to the normal aging process, while cachexia results from protein catabolism caused by underlying disease. Cachexia results in a loss of body weight, fat, and muscle, while sarcopenia results in a loss of strength and function. Cachexia results in a severe loss of body weight, fat, and muscle; while sarcopenia results in the loss of muscle mass, strength, and function.
An 80-year-old female has been admitted to the neurological unit diagnosed with a stroke. She is suffering from dysphagia. Which intervention would be beneficial for this patient? Select all that apply. Thickened liquids Altered food textures Education regarding hydration Concentrated oral supplements Elevation of the head of the bed
Thickened liquids Thickened liquids would be easier to swallow and would be beneficial for the patient suffering from dysphagia. Altered food textures Altered food textures would ease chewing and swallowing and would be helpful to the patient with dysphagia. Education regarding hydration Education related to the importance of hydration is a general intervention and is not focused on the needs of the patient with dysphagia. Concentrated oral supplements Concentrated oral supplements are for patients who cannot ingest adequate protein or calories. This is not the current situation with the patient with dysphagia. Elevation of the head of the bed Elevating the head of the bed can help prevent aspiration, which would be beneficial for the dysphagic patient.
