week 6 FAMILY NURSING

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Chapter_011.pptNursingandagingfamily.ppt

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Chapter 11

Hydration and Oral Care

The promotion of an adequate fluid balance, which prevents complications resulting from abnormal or undesirable fluid levels
Daily needs for water can usually be met by functionally independent older adults through intake of fluids with meals and social drinks
A significant number of older adults drink less than 1 L/day of fluid

Hydration Management

A complex condition resulting in a reduction in total body water
In older people, it most often develops as a result of disease, age-related changes, or the effects of medication
Considered a geriatric syndrome
A significant risk factor for a number of conditions

Dehydration

Assessment is complex in older people because clinical signs may not appear until dehydration is advanced
Provide education to older people and their caregivers on the need for fluids and the signs and symptoms of dehydration
Identify and quickly treat acute situations such as vomiting, diarrhea, and febrile episodes

Implications for Gerontological Nursing and Healthy Aging

Signs and Symptoms of Dehydration

Weight loss
Orthostasis
Dry mucous membranes in the mouth and nose
Dysphagia
Decreased urine output with dark urine
Longitudinal furrows on the tongue
Incoherent speech
Rapid pulse rate
Extremity weakness
Dry axilla
Sunken eyes

Hydration Management

Interventions consist of risk identification and hydration management
Any individual who develops fever, diarrhea, vomiting, or a nonfebrile infection should be monitored closely by implementing intake and output records and providing additional fluids
Keep NPO requirements as short as possible for older adults

Oral hydration used for
Mild to moderate dehydration
Those who can drink
Those who do not have mental or physical compromise
Water is the best fluid to offer
Other clear fluids may also be useful

Oral Hydration

Depends on the severity and the type of dehydration
Includes IV therapy or hypodermoclysis (HDC)
Replace 50% of the loss within the first 12 hours (or 1 L/day in afebrile elders)
Monitor for hyponatremia and symptoms of overhydration in those with heart failure or renal disease

Rehydration

When assessing a long-term care resident who has been experiencing diarrhea, which of the following findings would lead the nurse to suspect the person is dehydrated?

Heart rate of 48 beats/min

Blood pressure 170/90 mm Hg

Urine output of 100 mL/4 hours

Hyperactive bowel sounds in all quadrants

Question

C—The urine output is low, consistent with dehydration. The blood pressure would be low and the heart rate elevated. Bowel sounds are not affected.

Answer

A basic need that is increasingly neglected with advanced age, debilitation, and limited mobility
Age-related changes in the oral cavity, medical conditions, poor dental hygiene, and lack of dental care contribute to poor oral health
Poor oral health is a risk factor for dehydration, malnutrition, and a number of systemic diseases
Pain from infected teeth, ill-fitting dentures, or oral candidiasis can limit eating ability and compromise comfort and quality of life

Oral Health

Dry mouth
Affects eating, swallowing, and speaking
Contributes to dental caries and periodontal disease
If medication side effects are contributing to dry mouth, medications may be changed or altered
Affected persons should practice good oral hygiene practices, regular dental care, adequate water intake, and avoid alcohol
Saliva substitutes and salivary stimulants may help

Xerostomia

More than 60% of oral cancers are not diagnosed until an advanced stage
Early signs and symptoms may be subtle and not recognized by the individual or health care provider
Therapy options include surgery, radiation, and chemotherapy
If detected early, these cancers can almost always be treated successfully

Oral Cancer

Access to dental care for older people may be limited and cost prohibitive
Those with the poorest oral health are economically disadvantaged, lack insurance, disabled, homebound, or institutionalized
If a seriously ill or institutionalized individual needs dental care, it can be challenging to have him or her transferred to a dental office
Medicare does not provide any coverage for oral health care services; Medicaid coverage varies

Oral Care

Assessment of the mouth, teeth, and oral cavity can identify oral health problems and serve as an early warning for some diseases
The MDS 3.0 requires information obtained from an oral assessment
Federal regulations mandate an annual examination for residents of long-term care facilities

Assessing Oral Health

Nurses are involved in promoting oral health through teaching recommended interventions; screening for oral disease; making dental referrals; and providing, supervising, and evaluating oral care
Older adults and providers need to know the proper care of dentures and oral tissue

Interventions for Oral Health

An often neglected part of daily nursing care
It is the responsibility of the caregiver to provide oral care
Poor oral hygiene contributes to poor nutrition and other negative outcomes such as aspiration or ventilator-associated pneumonias
Implement comprehensive protocols, such as the MOUTH (Managing Oral Hygiene Using Threat Reduction Strategies) intervention

Oral Hygiene in Hospitals

After teaching an older adult about oral hygiene, which statement reflects a need for further teaching?

“I will use toothpaste to clean my dentures.”

“It would be best to visit the dentist twice a year.”

“Dentures should be kept in cleaning solution overnight.”

“Petroleum jelly will help keep my lips from cracking.”

Question

A—Persons should not use toothpaste on dentures because it abrades denture surfaces.

Answer