Dental Caries • Tooth decay, loose teeth, and lost teeth are ongoing problems in the population • Poor nutrition and decreased appetite can often be attributed to dental problems • Decay, or caries-caused by bacteria that penetrate through the enamel shield of the tooth and cause destruction
Periodontal Disease • A less obvious but potentially more serious complication of poor oral care • Food debris & plaque build up in the mouth and on the teeth when oral hygiene is inadequate • Activity of bacteria on debris cause bad breath, or halitosis. • often disturbing to the older person and to anyone in close contact
Periodontal Disease (cont.) • Gingivitis causes gum swelling, tenderness, and bleeding and eventually leads to recession of the gum tissue away from the tooth
Pain • Dental caries and periodontal disease • most common reasons for oral pain • oral lesions such as stomatitis or altered sensations in the mouth are also reported • Pain may be limited to the oral cavity or may affect the face and jaw • Oral pain can cause loss of appetite, decreased food intake, a negative effect on the overall quality of an older person’s life
Dentures • Partial plates tend to catch particles of food and may 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 • Xerostomia, or dry mouth is common • may result from normal age-related reduction in saliva secretion, medication side effects inadequate hydration, or diseases such as diabetes • Makes chewing and swallowing more difficult, promotes tooth decay, and alters the sense of taste
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
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 • 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 • Certain 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 of the mouth are relatively common in older individuals who receive broad-spectrum antibiotic therapy for some other infection • Antibiotics destroy the normal mouth flora and allow opportunist bacteria or yeast colonies to become established and grow
Superinfections (cont.) • A hairy tongue is the result of enlargement of the papillae on the tongue; this 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, even in small amounts, can harm the mucous membranes • Alcohol- chemically irritating and drying to the mucous membranes • Tobacco, whether smoked, chewed, or taken as snuff, increases the risk for oral cancer
Problems Caused by Neurologic Conditions • Neuro conditions such as stroke, multiple sclerosis, or Parkinson’s disease decrease coordination and strength • difficult for the person to manipulate the equipment needed for oral hygiene • Can be difficult to open mouth
Problems Caused by Neurologic Conditions (cont.) • severe arthritis may find equipment difficult to manipulate • May be difficult to open the mouth adequately for good, thorough cleaning • medication for seizure or other neuro disorders need to use special precautions • medications often cause gum problems
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.) • Promote adequate intake of nutrients and fluids • Provide lozenges or topical analgesics as prescribed • Communicate suspected oral side effects of medication therapy to the physician and dentist
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 Elimination
Objectives • Describe the normal elimination processes. • Identify the older adults who are most at risk for problems with elimination. • Describe age-related changes in bladder and bowel elimination.
Bowel Elimination • typical adult: moderate amount formed brown stool passed without difficulty • Usual adult: bowel movements every 1- 2 days • urge usually occurs 30 to 45 minutes p meal • gastrocolicand defecation reflexes stimulate peristalsis
Urinary Elimination • Usual adult: urge when bladder contains approximately 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
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] • 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.) • Dietary fiber-important role in promoting normal elimination • indigestible substance traps moisture & providsbulk • Repeatedly ignoring the urge to defecate can lead to suppression or even extinction of the defecation reflex
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
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.
Assessment • How often do bowel movements occur? Is there any pattern? • Is the person continent or incontinent? • consistency? • amount ? • color ? • Are blood, mucus, undigested food, or other unusual substances evident in the stool?
Assessment (cont.) • Has it been checked for occult blood? • Do they have to strain? • Is the stool expelled with excessive force, or does it ooze from the body? • Does the person report or has the nurse observed any particular foods that affect bowel movements? • Do these foods cause diarrhea or constipation?
Assessment (cont.) • Does the person rely on aids for elimination (suppositories, laxatives, enemas)? • How long has the person been using this aid? • Is the abdomen distended? • If the person cannot speak, does he or she rub the abdomen? • Has the person’s appetite decreased? • Are they nausiated?
Assessment (cont.) • If they don’t feel like they have to have a b.m.- what do you feel with digital examination? • Does the diet have adequate bulk? • Does the person take any bulk enhancers? • Do they take adequate fluid with them • What does the person say about his or her bowel habits? • Has the bowel pattern changed recently? • Does the person report any concerns related to bowel elimination?
Nursing Diagnosis • Altered elimination pattern-Constipation
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 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 • Position to facilitate ease of elimination • Provide privacy for elimination
Nursing Interventions for Constipation (cont.) • Administer stool softeners or bulk-forming laxatives as prescribed by the physician • Administer prescribed suppositories or enemas if other methods have not been effective • Perform digital rectal examination and impaction removal as ordered or according to agency policy
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