NUTRITION DISORDERS OF ELDERLY
DEFINITIONNutrition is a whole range of processes in the living body to receive materials from their environment and use of these materials in order to produce a variety of important activities in his own body. Nutritional disorders occur when a diet containing one or more nutrients in the right amount.
EpidemiologyResults of the survey conducted by the United States and the DHSS published in 1979 shows that 3% of the studied subjects had clinical malnutrition. If this number does not include cases of obesity in the overall elderly population there will be 300,000 seniors with inadequate diet that can not be avoided and can have a negative impact on health. A common nutritional disorder in the survey were obese, low consumption on folic acid, vit. C, vit. D, vit. B, iron, and calcium.
FACTORS CAUSELiving aloneA person living alone often do not even bother to provide food cooking tasks.
Physical weaknessFor example arthritis or injury cerebrovascular (CVA) which causes difficulty to shop and cook. They are not able to plan and provide their own food.
LossMainly seen in older men who never cook for themselves. They usually do not understand the value of a balanced nutritional foods.
DepressionCause loss of appetite. They did not bother to go shopping, or to feed emmasak.
Low incomeInability to buy food carefully to increase the consumption of nutritious foods.
Gastrointestinal diseasesIncluding toothache, ulcers
Abuse of alcoholReduce calorie intake and calorie intake as energy with little other nutritional factors
DrugIn the elderly who received more drugs than any other age group younger adverse effects on elderly nutrition. Treatment will result in the further deterioration of nutrients.
SIGNS AND SYMPTOMSIncomplete and missing teethDecreased appetiteLethargicNot spiritBB less / more than normalStomach feels bloatedHard to swallowNausea vomitingPathophysiology→ decreased saliva production process changes affect the complex carbohydrates into disakorida→ decreased salivary function is hard to swallow→ pencenaan gland function decreases stomach feels uncomfortable / bloatedMany teeth are loose (toothless) → decreased appetiteWith the aging process occurs esophageal smooth muscle motility disorders.
Of process changes on the aging process in the elderly cause reduced food intake in the elderly that would affect the nutritional status of the elderly.
IMPACT NUTRITION DISORDERSMuscle weakness and fatigue because energy is decreased. Elderly with nutritional disorders are at high risk for falls or disability in the mobilization that caused pressure sores or injuries. Be easily damaged bone and wound healing process will go a long press and his condition will deteriorate. Elderly nutrition mistakes that drive can be divided into 3 groups:General malnutritionDiet does contain some nutrients in adequate amounts.
Specific nutrient deficienciesOccurs when a particular food or group of foods in the diet does not exist. Example: iron deficiency in the elderly is a state of bad teeth so the teeth do not eat meat because of difficulty chewing and consumption of vit. C lower in the elderly are continuous in the long term having stomach diet.
ObesityCaused by bad eating habits from a young age. Movement that obese seniors will be more difficult.
COMPLICATIONSDiabetes mellitus
Hypertension
Heart disease
Gastritis
Peptic ulcer
EXAMINATION SUPPORTLaboratoryRadiography with contrast barrem.
MANAGEMENTAttention to the nutritional needs of the elderly. Yan recommended daily energy sufficiency for older men or equal to 60 years with a weight about 62 kg is 2200 kcal, while for women is 1850 kcal
Attention to form interesting and varied diet so as not boring (liquid, slurry filter, porridge, rice team, plain rice)
Adding other liquid food / milk if the elderly are not biased spend their food
If there is a metabolic disease such as diabetes, avoid simple sugars, if there is kidney disease instead selected essential amino acids.
Simple changes to improve diet for seniors are: Drink one glass of pure fruit juice (not to be mixed with water or sugar), breakfast with whole grains (such as oatmeal, brown rice) and eggs every morning, Pursue eat meat or fish at least once in a day, drink a glass of milk at bedtime, eat at least one serving of vegetables every day.
Nursing care
ASSESSMENTWeightAssociated with height, BMI sample (body mass index) orproper records
Changes in body weightFocused on loss or weight gain at this time
DentitionAre seniors wear dentures or false teeth if they require? Is there a false teeth lost or damaged?
Eating habitsPersonal aspects, cultures, and religions recognize nutrition
Ability to eatCan the elderly move food from plate to mult and swallow properly
PharmacologyIs the client a lot of taking medications (including medications do themselves) that can adversely impact the nutrition.
Nursing DiagnosisKetidaseimbangan nutrition less than body requirements b / d are not able to incorporate, digest, absorb food
Imbalance nutrition more than body requirements b / d of excess intake
Lack of self-care to eat b / d weakness or fatigue
Constipation b / d poor eating habits.
INTERVENTION
"Ketidaseimbangan nutrition less than body requirements b / d are not able to incorporate, digest, absorb food"
Increase intake of food by reducing interference from the environment
Serve foods that are easily digested in warm, enclosed and berkan a little but often
Avoid foods that contain lots of gas
Give penkes Hg proper diet program
"The imbalance of nutrition more than body requirements b / d intake of excess"Perform patient assessment diet
Create a workout program for sports
Avoid foods that contain lots of fat
Give penkes Hg: the right diet program that may result in excess BB
"Lack of self-care to eat b / d weakness or tiredness"
Reduce interference from the environment at mealtime
Assess the need for assistance to be provided
Assist in the selection of the right foods from the menu
Assist patients in food intake
"Constipation b / d bad eating habits"Record and review the color, consistency, amount and timing of BAB
Assess and record pergerakanusus
Provide adequate fluids and foods high in fiber
Give penkes Hg: dietary habits, activities and foods containing liquid gas and bowel habits
Digestive System DiseaseGastroinstestinal digestive system or systems (ranging from mouth to anus) is the human organ system that functions to receive food, digest it into nutrients and energy, absorb nutrients into the bloodstream as well as get rid of the food can not be digested or is the remainder of the process of the body. Digestive tract consists of the mouth, throat (pharynx), esophagus, stomach, small intestine, colon, rectum and anus. The digestive system also covers the organs that lie outside the digestive tract, the pancreas, liver and gallbladder.
Aging is characterized by the loss of many cells of the body and decrease the metabolism in the cell lainnya.Proses causes a decrease in body function and body composition changes. Changes in the digestive system:
Tooth loss, the main cause of periodontal desease which is common after age 30 tahun.Penyebab others include poor oral hygiene and poor nutrition.
Sense of taste menurun.Adanya chronic irritation of the lining of lendir.atropi sense of taste (± 80%), loss of sensitivity of taste buds on the tongue nerve teritama sweet, salty, sour, pahit.Selain the secretion of saliva is reduced to approximately 75% thus resulting in a dry mouth and can reduce taste.Usofagus melebar.Penuaan usofagus be pengerasansfringfar the bottom so that it becomes slack (relaxation) and resulted in widening usofagus (presbyusofagus). Situation slows the emptying usofagus and not infrequently continue sebagaiher nianhiatal.Gangguan swallow normally originate in the region in the area presofagus tepatnta osofaring hidden in the system causes central nerve or due to neuromuscular disorders such as shrinking while the number of ganglion muscle layer thickened with manometer shall appear the sign of slowdown usofagus emptying.
Stomach, decreased hunger (hunger decreased sensitivity). Layer thinned hull over 60 years, HCL and pepsin secretion is reduced, decreased gastric acid, gastric emptying time decreased the impact of vitamin B12 and iron decreased.
Peristaltic weakness and constipation arising biaanya
The absorption function impairment (impaired absorption power). Reduced total weight of the small intestine over the age of 40 years, although the absorption of nutrients in general is still in the normal range, except for calcium (above 60 years) and iron.
Liver (liver). Decrease liver enzymes involved in the oxidation and reduction, which led to drug metabolism and detoxification is less efficient.
Decreased saliva production thereby affecting the complex change process krbohidrat a disaccharide. Salivary function as pelican swallows the food is reduced so that the process became difficult.
Keluahn-complaints such as bloating, a feeling of discomfort in the stomach and so on, often due to lack of food dicernaakibat reduced digestive gland function. Can also be caused due to reduced tolerance to foods that contain fat especially.
Another common complaint is constipation, which is caused by the lack of cellulose content, lack of appetite can be caused by so many teeth that are loose. With the aging process problems can occur motilits esophageal smooth muscle, can also occur reflux disease (caused by reflux of gastric contents into the esophagus), this incident reached the peak at age 60-70 years.Disease commonly occurs in the digestive system.
Anemia (iron deficiency)Anemia is quite common in the elderly population, which may be due to an underlying predisposing conditions, such as malnutrition, anemia and infection kronis.Prognosis better after iron replacement therapy.
EtiologyDietary iron intake is inadequate or unbalanced diet is bad
Iron malabsorption, such as chronic diarrhea, partial or total gastrectomy, and malabsorption syndromes such as celiac disease
Blood loss secondary to medication-induced GI bleeding (due to anticoagulant, aspirin, steroids) or due to bleeding due to trauma, GI ulcers, malignant tumors, and varicose veins.
Intravascular hemolysis caused hemoglobulinuria hemoglobulinuria or nocturia, aroksimal
Erythrocyte trauma caused by a mechanical prosthetic heart valve or vena cava filter.
Signs and symptomsCan be asymptomatic for many years.
Fatigue
Headache
Can not concentrate
Shortness of breath (especially on the physical work)
Improvements frequency of infection
On chronic anemia, dysphagia neuromuscular effects (vasomotor disturbances, paresthesias, and pain neuralgik), glosistis (red tongue, swelling, soft, shiny and tenderness), stomatitis and brittle nails.
In advanced stages, takhikardia (caused by decreased oxygen perfusion and increased cardiac output)
Diagnostic Examination
Blood tests can show the following:Low hemoglobin levels (<12gr/dl in men, <10gr/dl in women)
Low hematocrit (<47ml? Dl in men, <42ml/dl in women)
Low serum iron levels,
HR count low
Bone marrow examination showed no depletion or iron stores and hyperplasia normoblastik
Gi examination, such as stool test, barium swallow and enema, endoscopic, and sigmoidoscopy to rule out or confirm whether caused by iron deficiency bleeding.
HandlingBefore treatment can begin, the underlying cause of anemia should dipastikan.Selanjutnya iron replacement therapy consisting of oral preparations or a combination of iron and ascorbic acid (increase iron absorption) can be given.
Nursing diagnoses"The imbalance nutrition: less than body requirements related to iron deficiency in the diet"
InterventionProvide an iron supplement according to program
Monitor patient adherence to iron replacement therapy is prescribed.
Monitor whether patients had overdose of iron replacement.
Monitor the patient's complete blood count and serum iron with regular
Assess the dietary habits of the family for iron intake
Evaluate patient medication history.
"Ferpusi disorders associated with decreased hemoglobin network"
InterventionProvide oxygen therapy if necessary to helpprevent and reduce hypoxia
Provide frequent rest periods to reduce physical weakness
According to the program, give analgesics to relieve headache and other discomfort.
Monitor the patient if there are signs and symptoms of penururnan perfusion to vital organs
Monitor the patient's pulse rate with frequent
PenyluhanProvide a description of the patient's illness and treatment programs
Instruct patients not to stop treatment
Inform patients bawsa milk and antacids interfere with absorption, but vitamin C can increase absorption.
Tell the patient to report any adverse effects of iron therapy such as: nausea, vomiting, diarrhea, and constipation
Teach the patient to schedule an activity with periods of rest that can be adjusted to the condition of anemia.
Because iron deficiency can be repeated, explain the need for regular inspection and adherence to prescribed therapy.
Chronic GastritisGastritis is an inflammation of the gastric mucosa which can be acute or acute kronik.gastritis stomach is the most common disease, causing redness of the mucosa, edema, hemorrhage and erosion. Chronic Gastrits usually occurs in the elderly and patients with chronic anemia pernisiosa.gastritis usually involves an underlying pathological condition resulting from chronic lambung.gastritis chronic atrophic mucosa may undergo gastric ulcer and carcinoma.EtiologyEstimated by heliobacter pylori.
Signs and symptomsSigns and symptoms such as acute gastritis are: epigastric discomfort, pain because it is hard to digest food, anorexia, nausea and vomiting.Intolerance to spicy and fatty foodsMild epigastric pain is eased by eating
Diagnostic examinationGI endoscopy to ensure gastritis perdarahan.pemeriksaan performed within 24 hours is contraindicated after swallowing a corrosive agent.
Laboratory tests can detect faint bleeding in vomit or stool, if the patient is bleeding gastric
Blood tests showed that the levels of hemoglobin and hematocrit decreased when patients experience anemia due to bleeding.
Examination of H pylori and halitosis urea showed H pylori antibody
HandlingPriority for immediate treatment is to eliminate the cause of gastritis.sebagai example, gastritis caused by bacteria treated with antibiotics, ingestion of toxins neutralized with the proper antidote.For patients suffering from chronic gastritis, antacids given hour, which can reduce the frequency of patients requiring analgesics akut.Sebagaian gastritis until recovery occurs, oxygen, blood volume and fluid balance needs to be considered.
Nursing diagnosis
"Impaired nutritional needs less than body requirements related to inadequate intake, anorexia"
InterventionAssess food intake,
Weigh BB regularly,
Provide regular oral care, encourage clients to eat little but often,
Provide food in warm,
Auscultation of bowel sounds,
Assess the preferred food,
"Resti imbalance fluid volume and electrolyte less than body requirements related to inadequate intake, vomiting"
InterventionAssess signs and symptoms of dehydration,
TTV observations,
Measure intake and out
Encourage clients to drink 2500ml ± 1500,
Observation of skin and mucous membranes,
Collaboration with physicians in the delivery of intravenous fluids
"Impaired sense of comfort pain associated with inflammation of the gastric mucosa"InterventionAssess pain scale and location of pain,
TTV observations,
Provide a quiet and comfortable environment,
Encourage relaxation technique with deep breathing,
Perform collaboration in drug delivery according to the indication for reducing pain
PenyluhanTeach the patient to know the causes, diagnostic examinations and treatment programs
Give the patient a list of foods avoided, such as: pepper, or very spicy foods, alcohol, caffeine
If the fatherly advise smoking patients berhentibantu
Teach patients how to cope with stress, such as meditation, relaxation, deep breathing and guided imagination
Teach family members about the importance of supporting the patient when he made diet and lifestyle changes are necessary.
Fecal incontinenceAlthough usually not a sign of major illness, incontinence can lead to serious disturbances on the physical and psychological well-being of the elderly. Fecal incontinence can occur gradually (such as dementia) or suddenly (such as spinal cord injury).
EtiologyFecal incontinence is usually the result of static and faecal impaction (as a hardened mass or collection) is accompanied by a decrease in activity,
Improper diet.
Chronic use of laxatives
Decrease in fluid intake
Neurological deficit
Complications of pelvic surgery, prostate or rectum
Drugs are like antihistamines, psychotropic and iron preparations
Signs and symptomsContinuous seepage of stool from the rectum
Inability to recognize the need for defecation
Abdominal cramping and distention
Examination dianostikDigital rectal examination to rule out fecal inpaksi
Colonoscopy may be needed to detect other intestinal disorders.
HandlingPatients who experience fecal incontinence should be assessed the underlying causes of problems with cermat.Pelatihan back bowel disease is a wise choice of therapy, for example, is a poor anal sphincter tone, pelvic muscle exercises can help mengoreksinya.lansia mengontrkasikan and can be taught to relax the anal sphincter in regular exercise program to strengthen the muscles. If incontinence is caused by impaction, blockage must be removed by enema or suppository manual.Enema or can be used repeatedly to get a complete evacuation of faeces
Nursing diagnosis"Fecal incontinence related to neuromuscular damage",
InterventionProvide adequate fluid intake
Start activity and sports programs
Set exercise habits, which include scheduled toileting such as after breakfast, raise awareness of defecation reflex,
If there is a severe neurological damage, induction of anti-diarrhea and constipation with a low-fiber diet, alternating
"Anxiety associated with fecal incontinence"InterventionSchedule extra time to encourage and support members of patients to reduce the shame
Provide support due to loss of control
Give praise for keberhasialn patients
"The risk of damage to the integrity of the skin associated with fecal incontinence"InterventionMaintain hygiene are effective treatments to improve patient comfort and to prevent skin damage and infection
Clean the perianal area as often as possible
Apply a moisturizing cream awar
Control bad odor
CounselingTeach the patient to gradually eliminate the use of laxatives
Involve the family to perform skin care to prevent irritation and infection
ConstipationWith age and the normal physiological changes, constipation is common in lansia.konstipasi exacerbated by poor nutrition, low fluid intake, and occurs because of a decrease peristaltic imobilisasi.konstipasi Koon and slowing nerve impulses that feel the need defekasi.Dengan age, internal anal sphincter and defecation tertunda.Jika lost tonusnya untreated constipation can lead to fecal impaction and megacolon.
Signs and symptomsLong periods of time between defecationCramps and bloating in the abdomenAbdomen hardStraining during defecationSmall stool dank erasBowel sounds distant or lessBack painHeadache
Diagnostic examinationDigital rectal examination can confirm or rule out physiological problems
HandlingShort-term treatment may consist of a strong laxative to empty the entire colon.
Long-term treatment includes high fiber diet, adequate caiaran asupana, reducing the use of laxatives and members sufficient time to evacuate the bowel completely transform according to normal routines.
For fecal impaction followed by manual removal of the feces that mengguanakan retention enema-warm oil and soap enemas are mengguanakan pembersih.Setelah 3 days the patient received stimulation of defecation and stool softeners.
Nursing diagnosis"Constipation related to neuromuscular damage, intestinal obstruction, megacolon, Immobilization, fluid and fiber intake is not adequate"
InterventionAsk the patient about his diet intake
Encourage increased fluid intake and a diet high in fiber
Give stool softeners as prescribed
Instruct the patient responds to the urge to defecate immediately
Encourage an increase in sporting activity
PenyluhanTeach the elderly to relieve constipation methods that include:High dietary intake of fluids seratPeningkatanMore physical activityMake adjustments to the physical limitations that may hinder the ability to go to the bathroom before the urge to defecate lost.
REFERENCESWatson, Roger. , 2003. Treatment In Elderly. Jakarta: EGCNugroho, Wahyudi. 2000. Gerontik nursing. Jakarta: EGCUI Faculty of Medicine. 2000. Guidelines for management of Geriatric Patient Health. For Doctors and Nurses. JakartaBeck, Mary E. 2000. Nutrition and Diet Relationship to Diseases for Nurses and Doctors. Jakarta: Yayasan Essentia MedicoTarwoto, Wartonah. , 2003. Basic Human Needs and Nursing Process. Jakarta: Salemba MedikaNANDA Nursing Diagnosis Guide 2005-2006. Prima Medika
