Care of Older Adults: Dehydration, Failure to Thrive, Palliative Care PDF

CARE OF THE OLDER ADULT DEHYDRATIO N NURS 6121  TOPICS DEHYDRATION FAILURE TO PALLIATIVE THRIVE CARE/END OF LIFE CARE  DEHYDRATION Types MORE PREVALENT IN OLDER...

CARE OF THE OLDER ADULT DEHYDRATIO N NURS 6121  TOPICS DEHYDRATION FAILURE TO PALLIATIVE THRIVE CARE/END OF LIFE CARE  DEHYDRATION Types MORE PREVALENT IN OLDER Isotonic - balance loss ADULTS. of Na and water – vomiting, diarrhea DEFINED AS A STATE OF FLUID INTAKE DEPRIVATION OR EXCESS Hypertonic – FLUID LOSS. excessive water loss – renal disease, osmotic diuresis THE MOST SIGNIFICANT ELECTROLYTE ABNORMALITY IS Hypotonic – excessive SODIUM IMBALANCE. Na loss - diuretics  DEHYDRATION INTAKE ISSUE OUTPUT ISSUE ENVIRONMENTAL FACTORS ENVIRONMENTAL FACTORS RESTRICTED AMBULATION HOT WEATHER INCREASED METABOLIC DEMANDS INCREASED METABOLIC DEMANDS INFECTIONS INFECTIONS, DIARRHEA PHARMACOLOGIC FACTORS ENDOCRINE DISORDERS NARCOTICS, SEDATIVES DIABETES INSIPIDIS NORMAL AGING CHANGES HYPERGLYCEMIA POOR APPETITE PHARMACOLOGIC FACTORS FLUID LIMITATIONS NORMAL AGING CHANGES PREVENT URINARY INCONTINENCE MANAGEMENT OF HEART FAILURE  DEHYDRATION CLINICAL PRESENTATION HISTORY CONFUSION ASSESSMENT OF LETHARGY FLUID INTAKE FUNCTIONAL STATUS RAPID WEIGHT LOSS WEIGHT FUNCTIONAL DECLINE COGNITION BOWEL HABIT (CONSTIPATION, DIARRHEA. MEDICATIONS  DEHYDRATION PHYSICAL EXAM DIAGNOSTICS CARDIOVASCULAR ASSESSMENT – MAY SERUM ELECTROLYTES (NA> REVEAL A DROP IN BLOOD PRESSURE AND A RISE IN PULSE (VOLUME 148 MEQ/L, OR HYPO NA DEPLETION) BUN/CREATININE RATIO - TEMP MAY BE ELEVATED (DEHYDRATION, INFLAMMATORY RESPONSE) 25>1 (SUGGESTS CONCENTRATED URINE DEHYDRATION) TONGUE, MUCOUS MEMBRANE OSMOLALITY BECAUSE OF CHANGES IN SKIN COLLAGEN, POOR SKIN TURGOR IS H&H UNRELIABLE IN OLDER ADULTS GLUCOSE CONCENTRATION  DEHYDRATION DIFFERENTIAL DX MANAGEMENT ORTHOSTATIC HYPOTENSION ORAL HYDRATION (>1600 ML/24 HRS) DELIRIUM IV/ HYPODERMOCLYSIS UTI REPLACEMENT HOSPITALIZATION IF PATIENT IS UNSTABLE – ALTERED MENTAL STATUS, HEMODYNAMICALLY UNSTABLE, UNABLE TO TOLERATE ORAL INTAKE DEHYDRATION PREVENTION DRINK SIX TO EIGHT 8 OZ. GLASSES OF WATER OR JUICE DAILY TAKE A FULL GLASS OF WATER OR JUICE WITH MEDICATIONS DRINK MORE THAN USUAL IN HOT WEATHER OR WHEN YOU HAVE A FEVER KEEP A FLUID INTAKE RECORD FOR 2 DAYS POOR DENTAL HYGIENE, MENTAL HEALTH, MISSING TEETH, OR POORLY FITTING DENTURES WILL INTERFERE WITH FOOD AND FLUID INTAKE PEOPLE WITH MEMORY PROBLEMS NEED FLUID MONITORING FAILURE TO THRIVE  PROGRESSIVE LOSS OF ENERGY, STRENGTH, AND STAMINA LEADING TO A DECEASED FUNCTION AND GENERAL PHYSICAL AND FAILURE COGNITIVE DETERIORATION. TO STRONGLY ASSOCIATED WITH AGE AND IS SEEN IN THE LATE STAGES OF DECLINE THRIVE RESULTS IN DECREASED STRENGTH AND (FRAILTY) ENDURANCE, WEAKNESS, AND FATIGUE. NOT SYNONYMOUS WITH COMORBIDITY OR DISABILITY  CAUSES OF FAILURE TO THRIVE DISEASE PSYCHIATRIC CAUSES ORGAN FAILURE DEPRESSION METASTASES DEMENTIA INFECTION PSYCHOSIS STROKE DELIRIUM THYROID DISEASE FRACTURES GASTROINTESTINAL CAUSES MEDICATION MALABSORPTION COGNITIVE CHANGES DYSPHAGIA ANOREXIA DENTAL PROBLEMS DEHYDRATION DIARRHEA ENVIRONMENTAL CAUSES VITAMIN DEFICIENCY ISOLATION NEGLECT POVERTY  FAILURE TO THRIVE HEALTH HISTORY SIGNS OF ORGAN FAILURE GI MALABSORPTION COMPLETE PHYSICAL EXAM CANCER RISK FACTORS MAY HAVE NO GROSS ABNORMALITY INFECTION THYROID ABNORMALITIES DEPRESSION CHANGES IN MEMORY SCREENING TESTS CBC, ELECTROLYTES, KIDNEY AND CLINICAL PRESENTATION THYROID STUDIES, FASTING BLOOD WEAKNESS GLUCOSE, LIVER FUNCTION TESTS, CALCIUM LEVELS, UA, STOOL FOR INABILITY TO CARE FOR SELF OCCULT BLOOD X 3, CHEST X-RAY DIZZINESS WEIGHT AND MEMORY LOSS DEPRESSION  DIAGNOSIS CLINICAL SYNDROME WITH 3 OR MORE OF THE FOLLOWING: UNINTENTIONAL WEIGHT LOSS IN THE PAST YEAR (10 LBS) EXHAUSTION/FATIGUE WEAKNESS SLOW WALKING SPEED LOW PHYSICAL ACTIVITY  Adequate protein and caloric intake – nutrition consult Megestrol acetate (Megace) *Beers criteria FAILURE TO THRIVE MANAGEME Vit D supplement 800 IU NT Regular exercise – PT consult Include families in education and support measures  SPECIALIZED MEDICAL CARE FOR PEOPLE WITH SERIOUS ILLNESS FOCUS: RELIEF OF SYMPTOMS – NOT ONLY PHYSICAL BUT ALSO PSYCHOSOCIAL AND SPIRITUAL -----NOT TO BE CONFUSED WITH HOSPICE CARE PATIENT-CENTERED PALLIATI GOAL: VE CARE IMPROVE QUALITY OF LIFE FOR PATIENT AND FAMILY INTERDISCIPLINARY APPROPRIATE AT ANY STAGE, AGE IN SERIOUS ILLNESS, CAN BE PROVIDED WITH CURATIVE TREATMENT WHICH TYPES OF ELDERLY PATIENT POPULATION CAN BENEFIT FROM THIS SERVICE?  PALLIATIVE CARE HOSPICE PROGRAM OF CARE DESIGNED IN THE LAST 6 MONTHS OF LIFE USES PALLIATIVE CARE PRINCIPLES TO SUPPORT THE PATIENT AND FAMILY COVERED BY INSURANCE 2011 DATA – 44.6% RECEIVED HOSPICE; 35% DIED WITHIN 7 DAYS; MEDIAN IS 21 DAYS  Frequently used criteria for determining non-disease- specific decline in clinical status that correlate with a six- month prognosis may include: Weight loss not due to reversible causes Recurrent or intractable infections CRITERIA Recurrent aspiration and/or inadequate oral intake due to intractable dysphagia Progressive decline in Karnofsky Performance status Progressing dementia by objective measures Progressive pressure ulcers (stage 3 or 4) despite optimal care  Understand patients preferences Identify goals of care ADVANC E CARE 5 Wishes: PLANNIN The person I want to make G decisions for me when I can’t The kind of medical treatment I want or do not want How comfortable I want to be How I want people to treat mem What I want my loved ones to know NJ POLST