Nursing Process for Impaired Oral Mucous Membranes ch 17 contd
2
Slide 3
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 3
Slide 4
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
4
Slide 5
Periodontal Disease (cont.) Gingivitis causes gum swelling,
tenderness, and bleeding and eventually leads to recession of the
gum tissue away from the tooth 5
Slide 6
Slide 7
Slide 8
Slide 9
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 persons life 9
Slide 10
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 10
Slide 11
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 11
Slide 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
12
Slide 13
Leukoplakia (cont.) 13
Slide 14
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.
14
Slide 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 15
Slide 16
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 16
Slide 17
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 17
Slide 18
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 18
Slide 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, whether
smoked, chewed, or taken as snuff, increases the risk for oral
cancer 19
Slide 20
Problems Caused by Neurologic Conditions Neuro conditions such
as stroke, multiple sclerosis, or Parkinsons disease decrease
coordination and strength difficult for the person to manipulate
the equipment needed for oral hygiene Can be difficult to open
mouth 20
Slide 21
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 21
Slide 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 22
Slide 23
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 23
Slide 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
Slide 25
Chapter 18 Elimination 25
Slide 26
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. 26
Slide 27
Normal Elimination Patterns 27
Slide 28
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 gastrocolic
and defecation reflexes stimulate peristalsis 28
Slide 29
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 its convenient Most adults void between 6 and 10 times per
day 29
Slide 30
Elimination and Aging 30
Slide 31
Slide 32
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
32
Slide 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
suppression or even extinction of the defecation reflex 33
Slide 34
Slide 35
Fecal Impaction mass of hardened feces trapped in the rectum
& cant 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
35
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Slide 37
Slide 38
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. 38
Slide 39
Nursing Process for Constipation 39
Slide 40
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? 40
Slide 41
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? 41
Slide 42
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 persons appetite
decreased? Are they nausiated? 42
Slide 43
Assessment (cont.) If they dont 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? 43
Nursing Goals/Outcomes Exhibit regular patterns of bowel
elimination Identify behaviors that promote normal bowel
functioning Modify behaviors to enhance regular bowel elimination
45
Slide 46
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 persons defecation urge is strongest
Position to facilitate ease of elimination Provide privacy for
elimination 46
Slide 47
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 47
Slide 48
Nursing Process for Diarrhea 48
Slide 49
Slide 50
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 50
Nursing Goals/Outcomes Exhibit regular patterns of bowel
elimination Identify behaviors that promote normal bowel
functioning Modify behaviors to enhance regular bowel elimination
54
Slide 55
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 physicians
orders regarding medications that decrease intestinal motility
Stool testing as ordered 55
Slide 56
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 56
Slide 57
Which nursing diagnosis is most important for the patient with
diarrhea? A.Disturbed body image B.Fluid volume deficit C.Knowledge
deficit D.Impaired gas exchange 57
Slide 58
Nursing Process for Bowel Incontinence 58
Slide 59
Assessment Same as for constipation 59
Slide 60
Nursing Diagnosis Bowel incontinence 60
Slide 61
Nursing Goals/Outcomes Exhibit regular patterns of bowel
elimination Identify behaviors that promote normal bowel
functioning Modify behaviors to enhance regular bowel elimination
61
Slide 62
Nursing Interventions Assess patterns of elimination and
causative factors Establish a toileting schedule Take measures to
prevent or reduce episodes of constipation Use appropriate aids or
garments Clean the person promptly after each episode of
incontinence 62
Slide 63
Nursing Process for Impaired Urinary Elimination 63
Slide 64
Slide 65
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 65
Slide 66
Urinary Retention (cont.) Symptoms feeling of fullness,
discomfort, or tenderness Small frequent voids Frequent bladder
infections Restlessness diaphoresis 66
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Slide 71
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 71
Slide 72
Urinary Incontinence The involuntary loss of urine social or
hygiene problem In some cases, incontinence is curable using
surgery,medications, or other treatments In others- better managed,
thus allowing the older person a more normal lifestyle 72
Slide 73
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 73
Slide 74
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 74
Slide 75
Assessment Is the person continent or incontinent? any specific
time of day or under any special conditions? history of any medical
conditions that would interfere with urine elimination (neurogenic
bladder)? history of any medical condition that would decrease
awareness of the need to void? 75
Slide 76
Assessment (cont.) difficulty in starting to urinate? any
involuntary loss of urine when he or she coughs, laughs, or
sneezes? pain or burning with urination? What is the persons
pattern of fluid intake? 76
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 Establish a
routine to reduce or prevent the occurrence of bladder elimination
problems 78
Slide 79
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 79
Slide 80
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 80
Slide 81
Nursing Interventions (cont.) Administer medications as
prescribed by the physician Insert catheter as prescribed by the
physician 81