GERONTOLOGICAL NURSING|UPDATED EDITION
EXAM REVIEW
Chapter 11 – Nutrition and Hydration
• Anorexia loss of appetite
• Dysphagia: difficulty swallowing due to difficulty moving food
o Transfer dysphagia: from the mouth to the esophagus
o Transport dysphagia: down the esophagus
o Delivery dysphagia: from the esophagus into the stomach
• Nutrition status influences one’s ability to defend the body against
disease, maintain anatomic and structural normality, think clearly, and
possess the energy and desire to engage in social activity
• Cause/contributing factors to nutritional status decline
o Teeth erosion/tooth loss
▪ Nursing diagnosis: Nutritional deficiecy related to limited
ability to chew foods, acute pain related to poor condition
of teeth
o Reduction in saliva to approximately 1/3 previous volume
▪ Nursing diagnosis: Nutritional deficiency related to less
efficient mixing of foods
o Inefficient digestion of starch due to decreased salivary ptyalin
▪ Nursing diagnosis: Nutritional deficiency related to reduced
breakdown of starches
o Atrophy or epithelial covering in oral mucosa
▪ Nursing diagnosis: Violation of integrity of oral mucosa
o Increased taste threshhold/approximately 1/3 the number of
functioning taste buds
▪ Nursing diagnosis: Risk of nutritional excess related to
increased intake of salts and sweets to copensation for
taste alterations
o Decreased thirst sensation
▪ Nursing diagnosis: Fluid volume deficit related to
decreased thirst
o Reduced hunger contractions
▪ Nursing diagnosis: Nutritional deficiency related to reduced
ability to sense hunger sensations
o Weaker gag reflex, reduced stomach motility
▪ Risk of aspiration, Nutritional deficiency related to self-
imposed restrictions to avoid discomfort
o Less hydrochloric acid, pepsin, and pancreatic acid
▪ Nursing diagnosis: Nutritional deficiency related to
ineffective breakdown of food
o Lower fat tolerance
, ▪ Nursing diagnosis: Acute pain related to indigestion
o Decreased colonic peristalsis: reduced sensation for signal to
defecate
▪ Nursing diagnosis: Nutritional deficiency related to reduced
appetite and self-imposed restrictions related to
constipation
o Less efficient cholesterol stabilization and absorption
▪ Nursing diagnosis: Risk of infection related to risk of
gallstone formation
o Increased fat content of pancreas; decreased pancreatic
enzymes
▪ Nursing diagnosis: Nutritional deficiency related to
problems in normal digestion
• Basal metabolic rate declines 2% for each decade of life after age 25,
which contributes to weight increase when the same caloric intake of
younger years is consumed.
o Reduction in calories is recommended beginning in the fourth
decade of life
o Limiting dietary fat intake to less than 30% of total calories
consumed is a good practice for older adults
• Niacin, riboflavin, thiamine, and vitamins B6, C, and D are the most
common nutrients found to be deficient in older adults, but caution
must be exercised to avoid overdose/adverse effects
o Vitamin D: calcium deposits in kidneys and arteries
o Vitamin K: blood clots
o Folic acid: masking of vitamin B12 deficiency (a cause of
dementia)
o Calcium: renal calculi; impaired ability to absorb other minerals
o Potassium: cardiac arrest
• From 64 to 74 years of age, the rate of heart disease among women
equals that of men. The reduction of fat intake to 30% kcal or less (70
g in a 1,800-cal diet) can be beneficial in reducing the risk of heart
disease in older women.
• Water is 50% or less of total body weight in older adults
• Factors that cause older adults to consume less fluid:
o Age-related reductions in thirst sensation
o Fear of incontinence (physical condition and lack of toileting
opportunities
o Lack of accessible fluids
o Inability to obtain or drink fluids independently
o Lack of motivation
o Altered mood or cognition
, o Nausea, vomiting, and gastrointestinal distress
• Fluid volume deficit: a state of dehydration in which intracellular,
extracellular, or vascular fluid is less than that required by the body
• Dehydration: a life-threatening condition to older persons because of
their already reduced amount of body fluid, is demonstrated by dry,
inelastic skin; dry, brown tongue; sunken cheeks; concentrated urine;
blood urea value elevated above 60 mg/dL; and, in some cases,
confusion.
• Signs of periodontal disease:
o Bleeding gums, particularly when teeth are brushed
o Red, swollen, painful gums
o Pus at gum line when pressure is exerted
o Chronic bad breath
o Loosening of teeth from gum line
• Threats to good nutrition
o Indigestion and food intolerance are common among older
people because of decreased stomach motility, less gastric
secretion, and a slower gastric emptying time.
▪ Recommend several small meals vs. three large ones, or
identify specific foods to avoid
▪ Sitting in a high Fowler position while eating and for 30
minutes after meals is helpful as it increases the size of the
abdominal and thoracic cavities, provides more room for
the stomach, and facilitates swallowing and digestion.
o Anorexia
o Dysphagia
o Constipation
o Malnutrition
▪ decreased taste and smell sensations, reduced mastication
capability, slower peristalsis, decreased hunger
contractions, reduced gastric acid secretion, less
absorption of nutrients because of reduced intestinal blood
flow, and a decrease in cells of the intestinal absorbing
surface
▪ Signs of malnutrition
• Weight loss greater than 5% in the past month or
10% in the past 6 months
• Weight 10% below or 20% above ideal range
• Serum albumin level lower than 3.5 g/100 mL
• Hemoglobin level below 12 g/dL
• Hematocrit value below 35%
EXAM REVIEW
Chapter 11 – Nutrition and Hydration
• Anorexia loss of appetite
• Dysphagia: difficulty swallowing due to difficulty moving food
o Transfer dysphagia: from the mouth to the esophagus
o Transport dysphagia: down the esophagus
o Delivery dysphagia: from the esophagus into the stomach
• Nutrition status influences one’s ability to defend the body against
disease, maintain anatomic and structural normality, think clearly, and
possess the energy and desire to engage in social activity
• Cause/contributing factors to nutritional status decline
o Teeth erosion/tooth loss
▪ Nursing diagnosis: Nutritional deficiecy related to limited
ability to chew foods, acute pain related to poor condition
of teeth
o Reduction in saliva to approximately 1/3 previous volume
▪ Nursing diagnosis: Nutritional deficiency related to less
efficient mixing of foods
o Inefficient digestion of starch due to decreased salivary ptyalin
▪ Nursing diagnosis: Nutritional deficiency related to reduced
breakdown of starches
o Atrophy or epithelial covering in oral mucosa
▪ Nursing diagnosis: Violation of integrity of oral mucosa
o Increased taste threshhold/approximately 1/3 the number of
functioning taste buds
▪ Nursing diagnosis: Risk of nutritional excess related to
increased intake of salts and sweets to copensation for
taste alterations
o Decreased thirst sensation
▪ Nursing diagnosis: Fluid volume deficit related to
decreased thirst
o Reduced hunger contractions
▪ Nursing diagnosis: Nutritional deficiency related to reduced
ability to sense hunger sensations
o Weaker gag reflex, reduced stomach motility
▪ Risk of aspiration, Nutritional deficiency related to self-
imposed restrictions to avoid discomfort
o Less hydrochloric acid, pepsin, and pancreatic acid
▪ Nursing diagnosis: Nutritional deficiency related to
ineffective breakdown of food
o Lower fat tolerance
, ▪ Nursing diagnosis: Acute pain related to indigestion
o Decreased colonic peristalsis: reduced sensation for signal to
defecate
▪ Nursing diagnosis: Nutritional deficiency related to reduced
appetite and self-imposed restrictions related to
constipation
o Less efficient cholesterol stabilization and absorption
▪ Nursing diagnosis: Risk of infection related to risk of
gallstone formation
o Increased fat content of pancreas; decreased pancreatic
enzymes
▪ Nursing diagnosis: Nutritional deficiency related to
problems in normal digestion
• Basal metabolic rate declines 2% for each decade of life after age 25,
which contributes to weight increase when the same caloric intake of
younger years is consumed.
o Reduction in calories is recommended beginning in the fourth
decade of life
o Limiting dietary fat intake to less than 30% of total calories
consumed is a good practice for older adults
• Niacin, riboflavin, thiamine, and vitamins B6, C, and D are the most
common nutrients found to be deficient in older adults, but caution
must be exercised to avoid overdose/adverse effects
o Vitamin D: calcium deposits in kidneys and arteries
o Vitamin K: blood clots
o Folic acid: masking of vitamin B12 deficiency (a cause of
dementia)
o Calcium: renal calculi; impaired ability to absorb other minerals
o Potassium: cardiac arrest
• From 64 to 74 years of age, the rate of heart disease among women
equals that of men. The reduction of fat intake to 30% kcal or less (70
g in a 1,800-cal diet) can be beneficial in reducing the risk of heart
disease in older women.
• Water is 50% or less of total body weight in older adults
• Factors that cause older adults to consume less fluid:
o Age-related reductions in thirst sensation
o Fear of incontinence (physical condition and lack of toileting
opportunities
o Lack of accessible fluids
o Inability to obtain or drink fluids independently
o Lack of motivation
o Altered mood or cognition
, o Nausea, vomiting, and gastrointestinal distress
• Fluid volume deficit: a state of dehydration in which intracellular,
extracellular, or vascular fluid is less than that required by the body
• Dehydration: a life-threatening condition to older persons because of
their already reduced amount of body fluid, is demonstrated by dry,
inelastic skin; dry, brown tongue; sunken cheeks; concentrated urine;
blood urea value elevated above 60 mg/dL; and, in some cases,
confusion.
• Signs of periodontal disease:
o Bleeding gums, particularly when teeth are brushed
o Red, swollen, painful gums
o Pus at gum line when pressure is exerted
o Chronic bad breath
o Loosening of teeth from gum line
• Threats to good nutrition
o Indigestion and food intolerance are common among older
people because of decreased stomach motility, less gastric
secretion, and a slower gastric emptying time.
▪ Recommend several small meals vs. three large ones, or
identify specific foods to avoid
▪ Sitting in a high Fowler position while eating and for 30
minutes after meals is helpful as it increases the size of the
abdominal and thoracic cavities, provides more room for
the stomach, and facilitates swallowing and digestion.
o Anorexia
o Dysphagia
o Constipation
o Malnutrition
▪ decreased taste and smell sensations, reduced mastication
capability, slower peristalsis, decreased hunger
contractions, reduced gastric acid secretion, less
absorption of nutrients because of reduced intestinal blood
flow, and a decrease in cells of the intestinal absorbing
surface
▪ Signs of malnutrition
• Weight loss greater than 5% in the past month or
10% in the past 6 months
• Weight 10% below or 20% above ideal range
• Serum albumin level lower than 3.5 g/100 mL
• Hemoglobin level below 12 g/dL
• Hematocrit value below 35%
