Chapter 16Nutrition and Hydration

Chapter 16Nutrition and Hydration

Components of the Nutritional AssessmentComponents of the Nutritional Assessment

• History

• Physical Examination

• Biochemical Evaluation

• Cognition and Mood

• Anthropometric Measurement

HistoryHistory

• Review health history and medical record for evidence of diagnoses or conditions altering the purchase, preparation, ingestion, digestion, absorption, or excretion of foods.

• Review medications for those that can affect appetite and nutritional state.

• Assess patient’s description of diet, meal pattern, food preferences, and restrictions.

• Keep a diary of all food intake for a week.

Physical AssessmentPhysical Assessment

• Inspect hair.

• Inspect skin.

• Test skin turgor.

• Note muscle tone, strength, and movement.

• Inspect eyes.

• Inspect oral cavity.

• Observe person drinking or eating for difficulties.

Biochemical EvaluationBiochemical Evaluation

• Obtain blood sample for screening of:

– Total iron binding capacity

– Transferrin saturation

– Protein; albumin

– Hemoglobin; hematocrit

– Electrolytes; vitamins

– Prothrombin time

• Obtain urine sample for screening of specific gravity.

Cognition and MoodCognition and Mood

• Test cognitive function.

– Note alterations in mood, behavior, cognition, level of consciousness.

– Be alert to signs of depression.

– Ask about changes in mood or cognition.

Anthropometric MeasurementAnthropometric Measurement

• Measure and ask about changes in height and weight.

• Determine triceps skinfold measurement (TSM).

• Measure the midarm circumference (MC) with a tape measure (using centimeters).

• Use this to calculate midarm muscle circumference (MMC) with formula:

– MMC in cm = MAC in cm – (0.314 x TSM in mm)

Factors Contributing to Reduced Need for Calories of the ElderlyFactors Contributing to Reduced Need for Calories of the Elderly

• The older body has less body mass and a relative increase in adipose tissue.

– Adipose tissue metabolizes more slowly than lean tissue and does not burn calories as quickly.

• Basal metabolic rate declines 2% for each decade of life.

• The activity level for most older adults is usually lower than it was during younger years.

Harris-Benedict Equation (REE)Harris-Benedict Equation (REE)

Males

66 + [13.7 x weight (kg)] + [5 x height (cm)] – [6.8 x age] = kcal/day

Females

655 + [9.7 x weight (kg)] + [1.8 x height (cm)] – [4.7 x age] = kcal/day

Recommended Diet for ElderlyRecommended Diet for Elderly

• Should contain calories of a high quality including:

– Fibers

– <30% total calories from dietary fat.

– At least 1 g protein per kg body weight daily; approximately 15% daily calories from proteins.

Examples of at Risk Nutrition-related Conditions for WomenExamples of at Risk Nutrition-related Conditions for Women

• Heart disease

• Cancer

• Osteoporosis

HydrationHydration

• Total body fluids are reduced with age, thereby contributing to the risk for dehydration.

• Older adults require approximately 1500 ml fluid daily.

• Factors that may cause elders to consume less fluid:

– Reduction in thirst sensation

– Fear of incontinence

– Lack of accessible fluids

Signs of Periodontal DiseaseSigns of Periodontal Disease

• Bleeding gums, particularly when teeth are brushed

• Red, swollen, painful gums

• Pus at gumline when pressure is exerted

• Chronic bad breath

• Loosening of teeth from gumline

Nutritional SupplementsNutritional Supplements

• Inquire about supplement use during the assessment.

• Increasing numbers of people are using nutritional supplements on a daily basis.

– Supplements can compensate for inadequate intake of nutrients.

– Supplements can interact with medications.

Reasons for Increased Ingestion in the ElderlyReasons for Increased Ingestion in the Elderly

• Decreased stomach motility

• Less gastric secretion

• Slower gastric emptying time

Non-Pharmacologic Measures for Managing IndigestionNon-Pharmacologic Measures for Managing Indigestion

• Eat several small meals rather than three large ones.

• Avoid or limit fried foods.

• Identify and eliminate specific foods from the diet to which an intolerance exists.

• Sit in a high Fowler position while eating and for half an hour after meals.

• Ensure adequate fluid intake and activity.

Forms of DysphagiaForms of Dysphagia

• Transfer Dysphagia

– Difficulty moving food from the mouth to the esophagus.

• Transport Dysphagia

– Difficulty moving food down the esophagus.

• Delivery Dysphagia

– Difficulty moving food from the esophagus into the stomach.

Causes of DysphagiaCauses of Dysphagia

• Neurological conditions, such as a stroke

• Most cases are due to gastroesophageal reflux disease (GERD).

Factors to Consider When Assessing Swallowing ProblemsFactors to Consider When Assessing Swallowing Problems

• Onset

• Types of foods that present the most problems

– Solids or liquids

• Occurrence

– Consistent or periodical

• Other symptoms and related complications

– Aspiration

– Weight loss 

Nursing Measures for Swallowing DifficultiesNursing Measures for Swallowing Difficulties

• Have the person sit upright whenever food or fluid is being consumed.

• Allow sufficient time for eating.

• Assure there is no residual food in the mouth before feeding additional food.

• Place small portions in the mouth.

• Discourage the person from talking while eating.

Nursing Measures for Swallowing Difficulties (cont.)Nursing Measures for Swallowing Difficulties (cont.)

• Keep a suction machine readily available.

• Monitor intake, output, and weight.

• Tilt the head to a side and placing food on a particular part of the tongue.

• Correct underlying problems.

Causes of Constipation in the ElderlyCauses of Constipation in the Elderly

• Slower peristalsis

• Inactivity

• Side effects of drugs

• A tendency toward less bulk and fluid in the diet.

Measures to Prevent ConstipationMeasures to Prevent Constipation

• Drink plenty of fluids.

• Eat plenty of fruits and vegetables.

• Exercise regularly.

• Allow adequate time for a bowel movement.

Factors That Increase the Risk for MalnutritionFactors That Increase the Risk for Malnutrition

• Reduced taste and smell sensations

• Slower peristalsis

• Decreased hunger contractions

• Reduced gastric acid secretion

• Less cells on intestinal surface

Clinical Signs of MalnutritionClinical Signs of Malnutrition

• Weight loss greater than 5% in the past month or 10% in the past 6 months.

• Weight 10% below or 20% above ideal range.

• Serum albumin level lower than 3.5 g/100 mL

• Hemoglobin level below 12 g/Dl.

• Hematocrit value below 35%.

SourceSource

• Eliopoulos, C. (2005).  Gerontological Nursing, (6th ed.).  Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).