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

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Periodontal Disease (cont.)

Gingivitis-the beginning of periodontal disease

gum swelling, tenderness, and bleeding

eventually recession of gum tissue away from the tooth

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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

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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

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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 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

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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

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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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