Geriatrics exam 2 study. LATEST UPDATE.

Geriatrics exam 2 study Chapter 6 Calories are units of heat that are used to measure available energy in consumed food. Factors that influence calories used are: • Activity pattern • Gender • Body size • Age • Body temperature • Emotional status • The temperature of climate in which the person lives. Various nutrients provide amounts of calories. Fats which can come from either can come from either plants sources (oleomargarine) or animal sources butter. Alcohol yields 7/calories to grams and no nutritional value. If sick, need to intake more calories. Fats- A certain amount of fat is necessary and desirable in the diet to aid in the absorption of fat-soluble vitamins and to provide adequate amounts of essential fatty acids. Fat is desirable because it adds flavor to food and provides a sense of fullness with a meal. Foods with no fat would be unappealing, poor tasting, and not very satisfying. Fat-soluble vitamins- Vitamin A- Found in milk, butter, cheese, fortified margarine, liver, green and yellow vegetables and Fruits. Promote healthy epithelium ability to see in dim light, normal mucus formation. Vitamin D- Promotes absorption of calcium Vitamin E- Promotes integrity of red blood cells Vitamin K- Essential for formation of prothrombin, which is necessary for blood clotting. Vitamin C- ascorbic acid- promotes healing and elasticity of capillary walls. Absorbs iron give them orange juice. May turn stool colors. Sodium- is one of the most important elements in the body. Sodium is mostly fond in extracellular fluid. Sodium levels are regulated by kidneys, which retain or eliminate sodium according to the body needs. Potassium- is the major intracellular ion in the body. Many diuretic and antihypertensive medications deplete the body of potassium as can prolonged or frequent diarrhea. Water- Approximately 60% of the average adult body is composed of water. Most adults require 2000 to 3000 mL of fluid each day. Most of this is consumed as beverages such as water, tea, coffee, and juice. Solid foods are practically fruits and vegetables contain significant amount of water. Malnutrition- is defined as a disorder of nutrition resulting from unbalanced insufficient or excessive diet or form impaired absorption, assimilation or use of food. Factors affecting nutrition in older adults • Chronic health factors • Chronic obstruction pulmonary disease • Chronic heart failure • Arthritis • Dementia • And many others can interfere with obtaining and preparing adequate nutritional food Pain- Whether it is chronic or acute can interfere with an older persons appetite and desire to procure, prepare and consume food Cost of food is a concern for many older adults with limited income. Food rich in protein, such as meats and dairy products, tend to be more expensive than starchy carbohydrates Depression- is a common reason for decreased appetite in older adults. Grief failing, health, loss of independence. Hemoglobin- is a complex protein-iron molecule responsible for the transport of oxygen and carbon dioxide with the blood stream. Low hemoglobin levels may result from anemia or blood loss More common in subtle blood loss form bleeding gastric or duodenal ulcers, diverticulitis tumors, or pathologic lower gastrointestinal tract conditions. Risk factors for deficient fluid volume in older adults: • Altered swallow reflex (patients with stroke) • Nausea and an unwillingness to eat or drink • Acute emotional distress and decreased interest in personal needs • Inability to obtain adequate fluids without assistance (bedridden patients) • Altered cognition( Alzheimer disease or dementia) and lack of awareness of the needs fluids • Draining wounds, open sores, or ulcers • Diuretic medications • Kidney disease • Tube feedings of low-sodium preparations • Diaphoresis • Intermittent or persistent vomiting • Intermittent of persistent diarrhea Risk for Excess fluid Volume in Older adults • Increased fluid intake secondary to excess sodium intake, hyperglycemia, or medications • Compulsive water drinking • Decreased urine output secondary to kidney dysfunction • Heart failure • Insufficient protein intake or excessive protein loss • Steroid therapy • History of alcoholism or liver disease • Kidney disease Maintain adequate fluid intake: • Offer smaller amounts of fluids at more frequent intervals. Encourage the individual every 30 to 60 minutes throughout the day. • Keep preferred beverages at the bedsides • Use smaller containers such as medication cups or small juice glasses when offering beverages. Small beverages are less intimidating than large containers. • Keep beverages easily available for individuals who are not in their rooms. Low sodium, low sugar beverages are ideal because individuals on restricted diets can consume them. • Encourage the intake of foods with a high fluid content, such as fruit, vegetables, soups, and cooked cereals. • Administer nasogastric, gastric, or parenteral fluids as ordered by the physicians. Patients that cannot swallow may need supplemental fluids administered by other routes. Implement the following measures to decrease intake: • Avoid keeping fluids at the bedside. If fluids are easily available, older adults are likely to consume them too freely. • Offer frequent oral hygiene. When fluids are restricted, saliva production decreases and the mucous membrane feel dry and uncomfortable. Thick, tenacious secretions can build up in the mouth if not removed regularly. • Provide lozenges or hard candy- sucking on a hard lozenge stimulates the release saliva. Offer candy and lozenges only to those who are alert enough not to swallow or choke on them. Verify that there is no dietary prohibition. • Plan a schedule to distribute limited fluids throughout the day. Plan the total volume fluid volume intake for the day with the prescribed limitations. Then divide the total into appropriate amounts spaced throughout the day. • Limit the quantity of foods that are high in fluid content. Fluids contained in solid foods can contribute to excess fluid volume and edema. Foods such fresh fruits and vegetables have high fluid content, whereas foods such as breads, dried fruits, and cooked meats have lower fluid content. Nursing interventions that should take place in hospitals or extended care facilities: • asses the individual carefully to determine the cause of the problem • schedule weekly weight checks • keep a dietary record of the amount, type, and frequency of food intake • explain the importance of nutrition to overall health or disease control • determine foods likes and dislikes • monitor lab values • assess the condition of the skin, hair, nails, and mucous membranes • consult w/ the dietitian • institute measures to increase or decrease nutritional intake • complete a thorough documentation of nutritional status, including assessment, interventions, referrals, and patient response Chapter 7 Adverse drug reactions- common in older adults. Studies have revealed that 15% or more of hospitalizations of older persons were related to ADR's, & about half are potentially preventable. Geropharmacolgy- the study of how older adults respond to medication, a new but growing area. Drug distribution- b/c there is less b