Question

You have a geriatric patient with the following problems that are contributing to poor nutrition. Develop interventions to address each problem:-

1) Parkinson's disease with difficulties feeding self

2)Weight loss with low BMI

3) Decubitus ulcers

4) Dysphagia

5) Low albumin/low prealbumin

Answer 1

1. ANSWEr

Parkinsons disease a slowly progressive neurologic movement disorder that eventually leads to disability,

it is associated with the decrease level of dopamine resulting from destruction of pigmented neuronal cells in the substantia nigra in the basal ganglia region of the brain.

clinical manifestations are

1. rigidity.

2. tremor.

3. bradykinesia.

4. postural instability.

the patient may have difficulty in maintaining weight, eating becomes a very slow process, requiring concentration due to dry mouth and also due to the medication, and difficulty chewing and swallowing,

monitoring weight on a weekly basis indicates whether caloric intake is adequate.

Intervention can be done as.

Swallowing difficulties and choking is common in patient with Parkinson's disease, these can lead to the problem with poor head control, tongue tremor, hesitancy in initiating swallowing, difficulty in shaping food into a bolus, etc,

it can be managed by

1.keeping patient sit in an upright position during mealtime,

2. a semi-solid diet with thick liquids is easier to swallow than solid.

3.  thin liquid should be avoided.

4. the patient is taught to put the food on the tongue close the lips teeth, lift the tongue up and then back, and swallow.

5. the patient is encouraged to chew first from one side of the mouth then to the other side.

6. to avoid pooling of saliva patient is advised to keep the head in the upright position and make efforts to swallow.

7. massaging facial and the neck muscle before swallowing may have a good effect.

2. ANSWER

BODY MASS INDEX is the index to tell whether the individual maintains the normal weight or not, just like higher BMI low BMI is also the matter of concern and it should be treated well to achieve a normal healthy life.

an individual should maintain his health by maintaining his BMI.

IT SI CALCULATED AS

BMI= KG / METRE X METRE

WEIGHT IN KG AND HEIGHT IN METRES.

If the BMI is less than 18.5 then that individual is at the greater risk of developing diseases and the illnesses, a low BMI can lead to serious problems of lungs, digestive systems and the bones.

Interventions that can be done with low BMI are

1. Eat calories which are healthy

By adding certain food in your diet which is rich in omega 3 fatty acids and the vitamin E such as almonds, nuts, sunflower, etc can help you maintaining BMI, these healthy calories can boost your health.

2. Eat healthy and nutritious food.

it is important to add protein and other important nutrients to your diet than consuming an empty calorie diet from junk foods, nutrition-rich diet can be meat, fish and whole grains such as brown rice and multigrain food.

3. Avoid eating unhealthy snacks.

A snack contains proteins and good carbohydrates can help in building health and increasing BMI, a snack can be taken which is rich in protein and carbohydrates such as peanut butter, protein shake, and fruits like avocado etc,

4. Small and frequent diet

some individual has lack of appetite due to various conditions which makes food difficult to digest in one go, OR also doesn't feel good in taste, it is advised to a client to eat meal frequently but in less amount can help in achieving the normal BMI.

5. WORK OUT AND EXERCISE.

to build muscle mass and to avoid bad fat accumulation it is advised to the client to perform the daily exercise and other daily work out such as running and walking, it doesn't only help in maintaining strength but also it helps in maintaining BMI, and muscle strength.

3. ANSWER

DECUBITIS ULCERS also called pressure sores or the bed sores developed especially on the bony parts due to the friction between the surface of the bed and the client's body parts due to the confinement of the client on the bed for a longer period of time.

CAUSES ARE

1. FRICTION.

2. MOISTURE.

3. LACK OF DIET

4. LACK OF MOVEMENT.

5. DEHYDRATION ETC

INTERVENTION TO PREVENT PRESSURE SORES.

AVOID DIRECT PRESSURE ON THE BONY PROMINENCE

1. Move client and change position frequently.

2. Provide the type of mattress and the pillow which is filled with water and air to avoid direct contact.

3. Don't pull the bony area such as elbow and the bony area while changing position.

4. maintain dry and clean skin of the client.

5. bedsheets material should be either silk or cotton fabric.

6. keep the client hydrated throughout the day.

7. avoid talcum powder as it causes the skin dry.

8. apply moisturizer every 2 hourly to maintain the natural oil balance of the skin.

9. note any skin changes and report it to the physician.

4. DYSPHAGIA

DYSPHAGIA is defined as the difficulty in swallowing food, fluids, and saliva from the mouth into the pharynx,

there are various conditions that can lead to dysphagia such as

oropharyngeal cancer, mouth cancer, fracture of the jaw, stroke, Parkinson's disease, and other neurological disorders, etc.

interventions that can be done are;

1. strengthen swallowing muscle by performing exercises especially if the problem is due to the neurological cause.

2. avoid eating solid food and start eating semi-solid food or liquid food that can be swallowed easily.

3. a surgical procedure called dilation is performed to broaden the esophagus which makes difficult swallowing.

4. endoscopy is also performed to check if anything is stuck into the esophagus.

5. surgery is done in case when there is an obstruction in the mouth is due to the abnormal mass or the tumor, it is removed to facilitate easy flow of the food from the mouth to the esophagus and further.

6. in some cases dysphagia may occur due to the infection and the sores associated with it is treated with the antibiotics.

7. IV fluids and total parenteral nutrition can be initiated when a patient cannot take food into the mouth at all.

8. if dysphagia is due to the acid reflux then it is treated with the antacids.

9. Botox treatment is performed in a client when there is structural deformity is present which makes swallowing impossible or difficult.