vn057 gerontology 10
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VN057 Gerontology 10Ch 17 cont’d; 18
Dental Caries
Tooth decay, loose teeth, and lost teeth-ongoing problem Poor nutrition & decreased appetite-often caused by
dental problems Decay [caries/cavites]-caused by bacteria
penetrates through enamel that protects tooth Destruction of inner structures of tooth
infection
3
caries
Periodontal Disease
less obvious than caries potentially more serious
complication of poor oral care Food debris & plaque build up in mouth & on teeth
Bacteria multiply-lots of “food “ for them Disrupts “seal” between gum and tooth Infection; bone loss
bacteria cause bad breath, or halitosis. disturbing to the older person and anyone in close contact
8
Periodontal Disease (cont.)
Gingivitis-the beginning of periodontal disease gum swelling, tenderness, and bleeding eventually recession of gum tissue away from the tooth
11
Healthy gums
Gingivitis
Gingivitis with some recession
Pain
caries & periodontal disease most common reason for oral pain Sometimes oral lesions, stomatitis
may be limited to mouth or may affect the face and jaw can cause loss of appetite, decreased food/fluid intake negative effect on the overall quality of life
17
Dentures
Partial plates-tend to catch particles of food-can weaken healthy teeth
Complete dentures-difficult to fit Dentures may not fit properly if a significant amount of
weight is gained or lost Dentures can cause irritation, inflammation, and
ulceration of gums and oral mucous membranes
18
Dry Mouth
Xerostomia, or dry mouth is common normal age-related reduction in saliva medication side effects inadequate hydration diseases such as diabetes
Makes chewing and swallowing more difficult, promotes tooth decay, and alters the sense of taste
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Leukoplakia
White patches in the mouth Often are precancerous and require prompt medical
attention Can also be med s/e or thrush Lesions on the posterior third or sides of the tongue
often are abnormal and should be brought to the attention of the physician
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Leukoplakia (cont.)
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A disease that is suspected to play a role in thromboembolic disorders, bacterial endocarditis, and myocardial infarction is:A. dental caries.B. halitosis.C. gingivitis.D. periodontal disease.
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Cancer
Oral or pharyngeal cancer have poor prognosis Early recognition and treatment before mets to other
tissues offer the best hope Symptoms- include leukoplakia or erythroleukoplakia,
sores in the mouth that do not heal, oral bleeding, pain or difficulty swallowing, difficulty wearing dentures, swollen lymph nodes in the neck, earache
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Disorders Caused by Vitamin Deficiencies
deficiencies of riboflavin, niacin, and vitamin C can affect oral mucous membranes
A smooth purplish sore tongue may be related to riboflavin deficiency
Complaint of a burning sensation or soreness of the mouth may indicate niacin deficiency
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Superinfections
relatively common Caused by broad-spectrum antibiotic therapy for some
other infection Antibiotics destroy the normal mouth flora allow opportunist bacteria or yeast colonies to become
established and grow
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Superinfections (cont.)
A hairy tongue result of enlargement of the papillae on the tongue often follows antibiotic therapy
Black or brown discoloration on the tongue may be caused by tobacco use or by a chromogenic (color-producing) bacterium
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Alcohol- and Tobacco-Related Problems
Alcohol and tobacco, even in small amounts, can harm the mucous membranes
Alcohol- chemically irritating and drying to the mucous membranes
Tobacco- smoked, chewed, or snuff, increases risk for oral cancer
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Problems Caused by Neurologic Conditions
Neuro conditions such as stroke, multiple sclerosis, or Parkinson’s disease decrease coordination and strength difficult to manipulate toothbrush & floss Can be difficult to open mouth Difficult to raise arm[s]
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Problems Caused by Neurologic Conditions (cont.)
severe arthritis-equipment difficult to manipulate difficult to open the mouth Can’t hold toothbrush or floss Raise arms to be able to get to mouth
medication for seizure or other neuro disorders need to use special precautions medications often cause gum problems
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Nursing Interventions for Impaired Oral Mucous Membranes
Complete a thorough assessment of the oral mucous membranes
Initiate referral to a dentist or dental hygienist Provide oral hygiene
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Nursing Interventions for Impaired Oral Mucous Membranes (cont.)
Promote adequate intake of nutrients and fluids lozenges or topical analgesics as prescribed Report suspected side effects of medication therapy to
the physician and dentist
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Dental care
Access to dental care is often an issue for people with impaired mobility Getting to the office Ability to tolerate time in wheel chair/use walker Getting on to the chair Ability to cooperate with personnel Ability to open their mouth
Chapter 18Elimination
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Objectives
Describe normal elimination processes. Identify people who are most at risk for problems with
elimination. Describe age-related changes in bladder and bowel
elimination.
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Normal Elimination Patterns
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Bowel Elimination
typical adult: moderate amount formed brown stool passed without
difficulty every 1- 2 days urge usually occurs 30 to 45 minutes p meal
gastrocolic and defecation reflexes stimulate peristalsis
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Urinary Elimination
Usual adult: urge when bladder has about 300 mL of urine
This varies greatly Voluntary control of external sphincter
allows healthy adults to hold larger amounts until it’s convenient
Most adults void between 6 and 10 times per day
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Elimination and Aging
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Constipation
Hard, dry stools- difficult to passIncreased risk associated with aging
decreased abdominal muscle toneInactivity &/or immobilityinadequate fluid intake
Especially combined with bulk forming agents [metamucil]
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Constipation
inadequate dietary bulkdisease conditions [parkinsons, gastroparisis +
more]Medicationsdependence on laxatives or enemasvarious environmental conditions
Inability to get to toiletholding too long, lack of privacy
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Constipation (cont.)
Dietary fiber-important role in promoting normal eliminationindigestible substance traps moisture & provids
bulk Repeatedly ignoring the urge to defecate can lead to problems with defecation reflex
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Fecal Impaction
mass of hardened feces trapped in the rectum & can’t be passed result of unrelieved constipation
Symptoms longer-than-usual delay in defecation Passage of small amounts of liquid stool without any formed
fecal material Digital examination of the rectum may reveal presence
of a hardened mass of feces
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Objectives
Discuss methods for assessing elimination practices. Identify selected nursing diagnoses related to elimination
problems. Describe interventions used to prevent or reduce
problems related to elimination.
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Nursing Interventions for Constipation
Assess bowel elimination patterns and contributing factors
Increase physical activity Increase intake of dietary fiber and fluids Schedule or encourage toileting at times when the
person’s defecation urge is strongest r/t meals Cup of warm liquid in am
Position to facilitate ease of elimination Provide privacy for elimination
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Nursing Process for Diarrhea
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Diarrhea
Frequent passage of liquid, unformed stools Stools are liquid because they pass through the large intestine too
rapidly and are expelled before sufficient water can be absorbed in the large intestine
Symptom of another problem many causes
malabsorption syndromes Obstruction- tumors of the GI tract or stool lactose intolerance Diverticulosis pathogenic organisms medications
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Nursing Interventions for Diarrhea
Assess the elimination pattern and suspected causative factors
Maintain adequate fluid intake Institute measures to maintain skin integrity Promptly report observations to the physician, and follow
up on physician’s orders regarding medications that decrease intestinal motility
Stool testing as ordered
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Bowel Incontinence
common for those who are unable to recognize &/or respond to normal sensation mental impairment Mobility Delayed assistance
Less frequently disorders of color or rectum Cancer inflammatory bowel disease Diverticulitis weak rectal muscles diarrhea
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Nursing Goals/Outcomes
Exhibit regular patterns of bowel elimination Identify behaviors that promote normal bowel
functioning Modify behaviors to enhance regular bowel elimination
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Nursing Interventions
Assess patterns of elimination and causative factors Establish a toileting schedule
Bowel training program Take measures to prevent or reduce episodes of
constipation Use appropriate aids or garments Clean the person promptly after each episode of
incontinence
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Nursing Process for Impaired Urinary Elimination
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Urinary Retention
Abnormal accumulation of urine in the bladder; bladder unable to empty completely Normally, no more than 50 mL of urine remains in the bladder after voiding
decreased muscle tone in the bladder wall medications prostate gland enlargement/uterine prolapse trauma to the muscles of the perineum neurologic problems anxiety Decreased fluid intake
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Urinary Retention (cont.)
Symptoms feeling of fullness, discomfort, or tenderness Small frequent voids Frequent bladder infections Restlessness diaphoresis
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Urinary Retention Treatment
If caused by perineal trauma or anxiety noninvasive tx such as medications, peppermint oil [inhaled scent] or a
sitz bath may be enough to stimulate effective voiding If severe retention is caused by an obstruction such as an
enlarged prostate, catheterization or surgery may be necessary prevent serious bladder damage that could result from persistent or
excessive bladder distention Pessarys were once commonly used with uterine prolapse, now
usual tx is surgery
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Urinary Incontinence
The involuntary loss of urine social or hygiene problem
In some cases, incontinence is curable using surgery ,medications, or other treatments
Kegel exercises In others- better managed, thus allowing the older
person a more normal lifestyle
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Types of Urinary Incontinence
Stress incontinence Leakage of urine
conditions that increase intra-abdominal pressure exercise, lifting heavy objects, laughing, coughing, or sneezing
Urge incontinence Caused by involuntary contraction of the detrusor muscle of
the bladder Overflow incontinence
Leakage of small amounts of urine from an overly full bladder
Common with retention problems
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Types of Urinary Incontinence (cont.)
Functional incontinence normal urethral and bladder function cognitive or physical in nature
Total incontinence A condition in which older adults experience continuous and
unpredictable loss of urine
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Nursing Goals/Outcomes
Exhibit a reduction in episodes of urinary incontinence or retention
Urinate at acceptable times in acceptable places Identify measures that reduce episodes of urinary
incontinence or retention Ie-toilet every 2 hours Bladder training program
Establish a routine to reduce or prevent the occurrence of bladder elimination problems
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Nursing Interventions
Assess elimination and fluid intake patterns Explain measures that help improve tone of the
sphincter muscles Kegel exercises
Modify clothing to make toileting easier Reduce environmental barriers
grab bars in the bathroom, installing toilet risers, keeping the urinal or bedpan readily available, and providing a call signal for assistance
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Nursing Interventions (cont.)
Answer call signals promptly Develop a toileting schedule Familiarize older adults with the locations of bathrooms
throughout the facility Provide support and encouragement Initiate actions to maintain skin integrity Provide incontinence pads or garments when appropriate
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Disposable and Reusable Incontinence Garments
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