Discussion: Nutrition and Hydration

Geriatric patients have many nutritional and hydration concerns that impact their health and ability to acquire sufficient nutrients. Advanced practice nurses evaluating these patients must be able to account for all barriers that prevent elders from obtaining adequate nutrition, including medical conditions, transportation, finances, physiologic changes, and functional abilities. When evaluating patients, it is important to consider how they eat, what their diet consists of, and whether they have any special dietary needs that are not being met. Assessment tools, such as the Lawton Instrumental Activities of Daily Living (IADL) Scale, are an integral part of this evaluation process as they help providers identify potential obstacles for patients. In this Discussion, you assess a patient at your current practicum site and consider strategies for improving any nutrition or hydration issues.

To prepare:

• Review this week’s media presentation, as well as 29 and 30 of the Resnick text.
• Assess a patient using tools for inpatient and long-term patient care, such as the Lawton IADL Scale.

Note: You should coordinate this opportunity with the Preceptor at your practicum site.

• Consider whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Reflect on whether the patient is able to go out and get food to eat, cook meals, safely use the stove, etc.
• Consider the patient’s diet and whether they have any special dietary needs due to medical conditions, such as congestive heart failure, end-stage kidney disease, diabetes, oral health issues, etc. Reflect on whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet.
• Based on your patient assessment, think about strategies for improving any nutrition issues that might have presented (e.g., nutritional supplements, community resources such as Meals on Wheels, referral to a nutritionist or dietician, etc.).

By Day 3

Post a description of the patient assessment you performed using a tool for inpatient and long-term patient care, such as the Lawton IADL Scale. Explain whether nutrition and/or hydration might be impacted by the patient’s functional abilities. Then, describe the patient’s diet and whether he or she has any special dietary needs due to medical conditions. Address whether or not the patient is attempting to compensate for a medical issue and thus creating a deficiency or excess in his or her diet. Finally, explain strategies for improving any nutrition issues that might present during the patient assessment.

ANSWER

Description of Patient Assessment

            A well-wisher brought Mrs. Kentel, a widow aged 79 years to the facility after she was found disoriented and wandering. X-ray examination proved pneumonia and dehydration. In addition, her mucous membranes are characteristically dry. She is unable to explain her history on top of being anxious and restless. As an initial care, Mrs. Kentel is provided with fluids, oxygen and antibiotics.

Assessing the Patient Using Lawton Instrumental Activities of Daily Living Scale (IADL)

            IADL scale refers to an assessment tool that examines the ability of an individual to perform important but not necessarily actions that are required in order to live independently. The eight major activities that are examined include transportation, shopping, housework, managing personal finances, meal preparations, managing medications and basic communication skills. When the assessment was administered in form of an interview, it was eminent that the patient could not perform most of the IADL activities pointing out problems in her physical functions.

Impact of Function Abilities On Hydration and Nutrition             The ability of an individual to perform basic functions affects hydration (Lecko and Best, 2013). Older people are at risk of dehydration arising from physiological changes due to ageing process, physical frailty and other disease conditions (Begum and Johnson, 2010). Cognitive impairments such as difficulties in swallowing and dementia may led to dehydration (British Nutrition Foundation, 2018). In addition, lack…