Case Study

NSG360CH15HYDRATIONANDORALCARE.pptx

Chapter 15

Hydration and Oral Care

Hydration Management

Water is important for thermoregulation and dilution of water-soluble medications, facilitates bowel and renal function, and maintains metabolic processes

A significant number of older adults drink less than 1 L of fluid/day, less than the recommended amount of 1500 mL/day

Adequate fluid consumption and maintenance of fluid balance is essential to health

Hydration Management

Age-related changes affecting hydration

Thirst sensation diminishes

Creatinine clearance declines

Total body water decreases

Loss of muscle mass and increase in fat cells

See Box 15-1 for more changes

Other contributing factors include medications, functional impairment, and other comorbid conditions like diabetes

Dehydration

Complex problem that results in reduction of total body water

Often related to changes of aging in older adults

Considered a geriatric syndrome

Significant issues associated with dehydration:

thromboembolic complications

kidney stones

constipation

falls

medication toxicity

renal failure

Seizure

electrolyte imbalance

hyperthermia

delayed wound healing

Dehydration

Majority of older people develop dehydration from increase fluid losses combined with decreased fluid intake, related to decreased thirst

Risk factors for dehydration include emotional illness, surgery, trauma, higher physiological demands (see Box 15-4)

Dehydration

Signs and symptoms

Often atypical in the older adult

Skin turgor is not a reliable indicator in older adults

Look for

dry mucous membranes in mouth and nose

furrows on the tongue

Orthostasis

speech incoherence

rapid pulse

decreased urine output

extremity weakness

dry axilla

sunken eyes.

Dehydration

Laboratory tests and urine

Labs: serum sodium, serum and urine osmolarity, and specific gravity (less fluid/more sodium and solute in relation to fluid in bloodstream)

Most cases of dehydration have an elevated blood urea nitrogen (BUN); however, there are many other causes for elevation of BUN/creatinine ratio

Observe urine patterns for changes

Dehydration

Interventions

Based on comprehensive assessment, risk identification, and hydration management

Monitor closely and implementation of intake and output is essential

Oral hydration is the first treatment approach

Water is the best fluid to offer

See Box 15-5

Dehydration

Rehydration

Depends on severity and type of dehydration

Intravenous

Replace 50% of loss within first 12 hours or sufficient quantity to relieve tachycardia and hypotension

Hypodermoclysis

Infusion of isotonic fluids into the subcutaneous space

Not for severe dehydration

Oral Health

Dental health increasingly neglected with advanced age, debilitation, and limited mobility

Poor oral health associated with dehydration, malnutrition, and other systemic diseases

Tips for best practice: Promoting Oral Health (Box 15-6)

Healthy People 2020 (Box Healthy People 2020)

Common Oral problems

Xerostomia (mouth dryness) and hyposalivation

30% of older adults affected

Affects eating, swallowing, speaking

More than 400 medications cause hyposalivation

Treatment:

review medications,

good oral hygiene,

adequate water,

avoid alcohol and caffeine,

over-the-counter oral saliva substitutes

Oral Cancers

Occur more frequently later in life

Occur more frequently in men than women

Early detection essential as 60% of cases aren’t diagnosed until Stage 4

Risk factors (Box 15-7)

Tobacco use

Alcohol use

HPV (human papillomavirus) infection

Genetic susceptibility

Promoting Healthy Aging: Implications for Gerontological Nursing

Assessment of oral health

Physical examination of oral cavity and oral health

Federal regulations mandate annual examination for LTC residents

Oral health instrument: The Kayser-Jones Brief Oral Health Status Examination (BOHSE)

Interventions for oral health

Promote oral health through teaching persons and caregivers recommended interventions, screening for oral disease, making dental referrals

Provide supervision and evaluation of oral care in hospitals and LTC facilities

Box 15-10

Promoting Healthy Aging: Implications for Gerontological Nursing

Dentures

Patient and/or caregiver education of proper cleaning techniques

Tips for best practices: Denture Care (Box 15-12)

Damaged and ill-fitting dentures are a common problem

Only 13% of persons with dentures get an annual dental examination

Box 15-11

Promoting Healthy Aging: Implications for Gerontological Nursing

Oral hygiene in hospitals and LTC

Lack of attention to oral hygiene contributes to poor nutrition and negative outcomes

Cleaning teeth with a toothbrush after meals lowers risk of aspiration pneumonia

Crucial in prevention ventilator-associated pneumonia

LTC residents vulnerable secondary to cognitive impairment and dependency on staff to provide good oral care

Promoting Healthy Aging: Implications for Gerontological Nursing

Tube feedings and oral hygiene

Tube feedings are associated with significant pathological colonization in the mouth

Provide oral care twice a day for persons with gastrostomy tubes and brush teeth after each feeding

Only toothbrushes assist in the removal of plaque; use foam swabs to clean mouth of endentulous

Which is NOT an age-related change that affects hydration?

Thirst sensation diminishes

Creatinine clearance declines

Total body water decreases

Loss of fat cells and increase in muscle mass

Question 1

ANS: D

Signs and symptoms of dehydration in an older adult include all of the following except:

dry mucous membranes in mouth and nose.

decreased skin turgor.

dry axilla.

speech incoherence.

Question 2

ANS: B