Question

1. Discuss a minimum of 3 teaching methods to promote nutrition in the elderly.

2. Discuss documentation of patient dietary intake

3. Describe a community agency for the elderly.

4. Discuss a nursing care plan for bladder/bowel training and for impaired communication.

Answer 1

Ans) Methods to promote nutrition in the elderly:

- Make Meals and Snacks Nutrient-dense.
- Add Extra Calories Without Extra Volume.
- Use Herbs and Spices When Preparing Foods.
- Make Meals Colorful and Appealing.
- Serve Several Small Meals and Snacks.
- Do Not Fill Up on Non-nutritious Items.
- Make Mealtime Enjoyable and Social.
- Use Nutrition Supplements When Necessary.

Documentation of patient dietary intake:

A food record chart aims to record quantitatively all food and drinks consumed as accurately as possible. Reliability of the information is another potential problem, owing to the inclusion of foods not actually consumed or omission of foods that were.

Community Services for elderly:
- Adult Day Care.
- Medicaid-Covered Dental Care.
- Free dentures
- State Pharmaceutical Assistance Programs (SPAPs)
- Low-Cost Prescription Drugs.
- National Family Caregiver Support Program (NFCSP)
- Discounted Phone or Internet Services.

Nursing Interventions & Rationales

Begin bladder retraining per protocol when appropriate (fluids between certain hours, digital stimulation of trigger area, contraction of abdominal muscles, Credé’s maneuver)- Timing and type of bladder program depend on type of injury (upper or lower neuron involvement). Note: Credé’s maneuver should be used with caution because it may precipitate autonomic dysreflexia.

Encourage adequate fluid intake (2–4 L per day), avoiding caffeine and use of aspartame, and limiting intake during late evening and at bedtime. Recommend use of cranberry juice/vitamin C. Sufficient hydration promotes urinary output and aids in preventing infection. Note: When patient is taking sulfa drugs, sufficient fluids are necessary to ensure adequate excretion of drug, reducing risk of cumulative effects. Note: Aspartame, a sugar substitute (e.g., Nutrasweet), may cause bladder irritation leading to bladder dysfunction.

Observe for cloudy or bloody urine, foul odor- Dipstick urine as indicated. Signs of urinary tract or kidney infection that can potentiate sepsis. Multistrip dipsticks can provide a quick determination of pH, nitrite, and leukocyte esterase suggesting presence of infection.

Promote continued mobility- This decreases risk of developing UTI.

Cleanse perineal area and keep dry- Provide catheter care as appropriate. Proper perineal hygiene decreases risk of skin irritation or breakdown and development of ascending infection.

Recommend good hand washing and proper perineal care- Handwashing and perineal care reduce skin irritation and risk of ascending infection.

Refer to urinary continence specialist as indicated- Collaboration with specialists is helpful for developing individual plan of care to meet patient’s specific needs using the latest techniques, continence products.

Teach Kegel exercises- These exercises improve pelvic floor muscle tone and urethrovesical junction sphincter tone.

Limiting intake of alcohol and caffeine- These chemicals are known to be bladder irritants. They can increase detrusor overactivity.

Bowel elimation:

- Daily practice/time for bowel elimation

- Stool softerners

- Encourage intake of dietary fibre

- Drinking warm water.