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VN057 Gerontology 10

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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  1. VN057 Gerontology 10 Ch 17 cont’d; 18

  2. 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

  4. 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

  5. Periodontal Disease (cont.) • Gingivitis-the beginning of periodontal disease • gum swelling, tenderness, and bleeding • eventually recession of gum tissue away from the tooth

  6. Healthy gums

  7. Gingivitis

  8. Gingivitis with some recession

  9. 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

  10. 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

  11. 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

  12. 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

  13. Leukoplakia (cont.)

  14. A disease that is suspected to play a role in thromboembolic disorders, bacterial endocarditis, and myocardial infarction is: • dental caries. • halitosis. • gingivitis. • periodontal disease.

  15. 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

  16. 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

  17. 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

  18. 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

  19. 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

  20. 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]

  21. 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

  22. 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

  23. 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

  24. 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

  25. Chapter 18 Elimination

  26. 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.

  27. Normal Elimination Patterns

  28. 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

  29. 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

  30. Elimination and Aging

  31. 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]

  32. 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

  33. 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

  34. 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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