Vn057 gerontology 10
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VN057 Gerontology 10. Ch 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

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VN057 Gerontology 10

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Vn057 gerontology 10

VN057 Gerontology 10

Ch 17 cont’d; 18


Dental caries

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


Caries

caries


Periodontal disease

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


Periodontal disease cont

Periodontal Disease (cont.)

  • Gingivitis-the beginning of periodontal disease

  • gum swelling, tenderness, and bleeding

  • eventually recession of gum tissue away from the tooth


Healthy gums

Healthy gums


Gingivitis

Gingivitis


Gingivitis with some recession

Gingivitis with some recession


Vn057 gerontology 10

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


Dentures

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


Dry mouth

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


Leukoplakia

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


Leukoplakia cont

Leukoplakia (cont.)


Vn057 gerontology 10

A disease that is suspected to play a role in thromboembolic disorders, bacterial endocarditis, and myocardial infarction is:

  • dental caries.

  • halitosis.

  • gingivitis.

  • periodontal disease.


Cancer

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


Disorders caused by vitamin deficiencies

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


Superinfections

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


Superinfections cont

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


Alcohol and tobacco related problems

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


Problems caused by neurologic conditions

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]


Problems caused by neurologic conditions cont

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


Nursing interventions for impaired oral mucous membranes

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


Nursing interventions for impaired oral mucous membranes cont

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


Dental care

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 18

Chapter 18

Elimination


Objectives

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.


Normal elimination patterns

Normal Elimination Patterns


Bowel elimination

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


Urinary elimination

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


Elimination and aging

Elimination and Aging


Constipation

Constipation

  • Hard, dry stools- difficult to pass

  • Increased risk associated with aging

    • decreased abdominal muscle tone

    • Inactivity &/or immobility

    • inadequate fluid intake

      • Especially combined with bulk forming agents [metamucil]


Constipation1

Constipation

  • inadequate dietary bulk

  • disease conditions [parkinsons, gastroparisis + more]

  • Medications

  • dependence on laxatives or enemas

  • various environmental conditions

    • Inability to get to toilet

    • holding too long, lack of privacy


Constipation cont

Constipation (cont.)

  • Dietary fiber-important role in promoting normal elimination

    • indigestible substance traps moisture & provids bulk

  • Repeatedly ignoring the urge to defecate

  • can lead to problems with defecation reflex


Fecal impaction

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


Objectives1

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.


Nursing interventions for constipation

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


Nursing process for diarrhea

Nursing Process for Diarrhea


Diarrhea

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


Nursing interventions for diarrhea

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


Bowel incontinence

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


Nursing goals outcomes

Nursing Goals/Outcomes

  • Exhibit regular patterns of bowel elimination

  • Identify behaviors that promote normal bowel functioning

  • Modify behaviors to enhance regular bowel elimination


Nursing interventions

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


Nursing process for impaired urinary elimination

Nursing Process for Impaired Urinary Elimination


Urinary retention

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


Urinary retention cont

Urinary Retention (cont.)

  • Symptoms

    • feeling of fullness, discomfort, or tenderness

    • Small frequent voids

    • Frequent bladder infections

    • Restlessness

    • diaphoresis


Urinary retention treatment

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


Urinary incontinence

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


Types of urinary incontinence

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


Types of urinary incontinence cont

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


Nursing goals outcomes1

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


Nursing interventions1

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


Nursing interventions cont

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


Disposable and reusable incontinence garments

Disposable and Reusable Incontinence Garments


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