Which of the following is an effective way for a nursing assistant help prevent dehydration?
WHY: Aspiration (the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract) is common in older adults with dysphagia and can lead to aspiration pneumonia. In fact, the risk of pneumonia is three times higher in patients with dysphagia (Hebert et al., 2016). Other harmful sequelae of dysphagia include malnutrition and dehydration (Wilmskoetter et al., 2017). Dysphagia is a significant predictor of worse clinical outcomes in hospitalized patients with dementia (Paranji et al., 2017). Show TARGET POPULATION: Dysphagia is common in persons with neurologic diseases such as stroke, Parkinson’s disease, and dementia. The older adult with one of these conditions is at even greater risk for aspiration because the dysphagia is superimposed on the slowed swallowing rate associated with normal aging. Conditions that suppress the cough reflex (such as sedation) further increase the risk for aspiration. BEST PRACTICES: ASSESSMENT AND PREVENTION ASSESSMENT: A multidisciplinary approach to identify dysphagic patients is important (Aoki et al., 2016). While dysphagia screening by nurses does not replace assessment by other health professionals, it enhances the provision of care to at-risk patients by allowing for early recognition and intervention (Hines et al., 2016; Palli et al., 2017). Assessment may begin at the bedside, using a variety of tools. Most swallow screens use varying volumes of water to assess the ability to swallow (Smithard, 2016). For more specific swallowing assessments, fiberoptic endoscopy of swallowing (FEES) or videofluoroscopy (VFS) may be used (Gallegos et al., 2017). BEST PRACTICES: PREVENTION Clinical Symptoms of Aspiration:
Aspiration Pneumonia:
PREVENTION OF ASPIRATION DURING HAND FEEDING:
PREVENTION OF ASPIRATION DURING TUBE FEEDING: For patients with tube feedings, the following considerations are important:
PREVENTION OF ASPIRATION PNEUMONIA BY ORAL CARE:
MORE ON THE TOPIC: Aoki, S., Hosomi, N., Hirayama, J., et al. (2016). The multidisciplinary swallowing team approach decreases pneumonia onset in acute stroke patients. PLoS ONE (Electronic Resource), 11(5)e0154608. Aslan, M., & Vaezi, M.F. (2013). Dysphagia in the elderly. Gastroenterology & Hepatology, 9(12), 784-795. Boullata, J.I., Harvey, A.L, Hudson, L., et al. (2017). ASPEN Safe Practices for Enteral Nutrition Therapy. Journal of Parenteral and Enteral Nutrition, 41(1), 15-103. Gallegos, C., Brito-de la Fuente, E., Clave, P., Costa, A., & Assegehegn, G. (2017). Nutritional aspects of dysphagia management. Advances in Food and Nutrition Research, 81, 271-318. Hebert, D., Lindsay, M.P., McIntyre, A., et al. (2016). Canadian stroke best practice recommendations: Stroke rehabilitation practice guidelines, update, 2015. International Journal of Stroke, 11(4), 459-484. Hines, S., Kynoch, K., & Munday, J. (2016). Nursing interventions for identifying and managing acute dysphagia are effective for improving patient outcomes: A systematic review update. Journal of Neuroscience Nursing, 48(4), 215-223. Joyce, A., Robbins, J., & Hind, J. (2015). Nutrient intake from thickened beverages and patient-specific implications for care. Nutrition in Clinical Practice, 30(3), 440-445. Maeda K., & Akagi, J. (2014). Oral care may reduce pneumonia in the tube-fed elderly: A preliminary study. Dysphagia, 29(5), 616-621. Moran, C., & O’Mahony, S. (2015). When is feeding via a percutaneous endoscopic gastrostomy indicated? Current Opinion in Gastroenterology, 31(2), 137-142. Murray, J., Miller, M., Doeltgen, S., & Scholten, I. (2013). Intake of thickened liquids by hospitalized adults with dysphagia after stroke. International Journal of Speech-Language Pathology, 16(5), 486-494. Onur, O.E., Onur, E., Guneysel, O., Akoglu, H., Denizbasi, A., & Demir, H. (2013). Endoscopic gastrostomy, nasojejunal and oral feeding comparison in aspiration pneumonia patients. Journal of Research in Medical Sciences, 18(12), 1097-1102. Palli, C., Fandler, S., Doppelhofer, K., et al. (2017). Early dysphagia screening by trained nurses reduces pneumonia rate in stroke patients: A clinical intervention study. Stroke, 48(9), 2583-2585. Paranji, S., Paranji, N., Wright, S., & Chandra, S. (2017). A nationwide study of the impact of dysphagia on hospital outcomes among patients with dementia. American Journal of Alzheimer’s Disease & Other Dementias, 32(1), 5-11. Sarin, J., Balasubramaniam, R., Corcoran, A.M., Laudenbach, J.M., & Stoopler, E.T. (2008). Reducing the risk of aspiration pneumonia among elderly patients in long-term care facilities through oral health interventions. Journal of the American Medical Directors Association, 9(2), 128-135. Smithard, D.G. (2016). Dysphagia management and stroke units. Current Physical Medicine and Rehabilitation Reports, 4(4), 287-294. Wilmuskoetter, J., Herbert, T.L., Bonilha, H.S. (2017). Factors associated with gastrostomy tube removal in patients with dysphagia after stroke: A review of the literature. Nutrition in Clinical Practice, 12(2), 166-174. What is the best way for a nursing assistant to prevent infection?Hand washing is the most important precaution a CNA can take to prevent the spread of infection. Thorough hand washing removes germs from the skin. Wash hands before and after any resident or body fluid contact.
Which of the following statements is true of a nursing assistant's role in restorative care *?Which of the following statements is true of a nursing assistant's role in restorative care? The NA should recognize that setbacks occur and reassure the resident.
How many ounces of water should residents be encouraged to drink each day?3.7 liters (or about 130 fl oz) for men. 2.7 liters (about 95 fl oz) for women.
When bathing a resident a nursing assistant should?CNAs should wash the resident's entire body, one part at a time. The best time for a bath is usually after elimi- nation has occurred, and it can be given along with oral care and a change of bed linens. Always allow and encourage residents to wash as much of themselves as possible.
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