Essential Nutritional Strategies for Healthy Aging: A Guide

School

Galen College of Nursing**We aren't endorsed by this school

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NUR 257

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Nursing

Date

Dec 10, 2024

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Uploaded by nursing1000121545

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderChapter 10 Clinical Judgement to Promote Nutritional HealthWhat are the key highlights of MyPlate for the older adult. [Touhy & Jett, 2022, p. 133]A virtual depiction of daily food intake (www.ChooseMyPlate.gov)Draws attention to the unique nutritional and physical activity needs associated with advancing years.oThe MyPlate for Older Adults depicts a colorful plate composed of approximately 50% fruits and vegetables; 25% grains, many of which are whole grains; and 25% protein-rich foods suchas nuts, beans, fish, lean meat, poultry, and fat-free and low-fat dairy products such as milk, cheeses, and yogurts. Images of good sources of fluids, heart-healthy fats such as vegetable oils and soft margarines; and herbs and spices to be used in place of salt to lower sodium intake are also included.Obesity (Overnutrition) [Touhy & Jett, 2022, p. 133]Overweight and obesity are associated with increased health care costs, functional impairments, disability, chronic disease, and nursing home admission.Overweight/obese individuals are also at risk for malnutrition as a result of chronic illness or diets inadequate in appropriate nutrients.Malnutrition (Undernutrition) Malnutrition is a recognized geriatric syndrome.Consequences:Malnutrition is a precursor to frailty and has serious consequences, including infections, pressure ulcers, anemia, hypotension, impaired cognition, hip fractures, prolonged hospital stay, institutionalization, and increased morbidity and mortality (DiMaria-Ghalili, 2012; White et al., 2012). “Malnourished older adults take 40% longer to recover from illness, have two to three times as many complications, and have hospital stays that are 90% longer.”Malnutrition is a complex syndrome that develops following two primary trajectories.It can occur when the individual does not consume sufficient amounts of micronutrients (i.e., vitamins, minerals, phytochemicals) and macronutrients (i.e., protein, carbohydrates, fat, water) required to maintain organ function and healthy tissues. This type of malnutrition can occur from prolonged undernutrition or overnutrition.In contrast, inflammation-related malnutrition develops as a consequence of injury, surgery, or disease states that trigger inflammatory mediators that contribute to increased metabolic rate and impaired nutrient utilization” (Litchford, 2013, p. 38). Inflammation is increasingly identified as an important underlying factor that increases risk for malnutrition and a contributing factor to suboptimal responses tonutritional intervention and increased risk of mortality.

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderMany factors contribute to the occurrence of malnutrition in older adults. [Touhy & Jett, 2022, Fig. 10-2] – See following page.DysphagiaDifficulty swallowing: Dysphagia can be the result of behavioral, sensory, or motor problems and is common in individuals with neurological disease and dementia (Box 10.3) (see Chapters 22 and 23). Dysphagia is a serious problem and has negative consequences, including weight loss, malnutrition, dehydration, aspiration pneumonia, and even death. Aspiration (the misdirection of oropharyngeal secretions or gastric contents into the larynx and lower respiratory tract) is common in older adults.

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderRisk Factors for Dysphagia [Touhy & Jett, 2022, Box 10.3]Cerebrovascular accidentParkinson’s diseaseNeuromuscular disorders (ALS, MS, myasthenia gravis)DementiaHead and neck cancerTraumatic brain injuryAspiration pneumoniaInadequate feeding techniquePoor detentionSymptoms of Dysphagia [Touhy & Jett, 2022, Box 10.3]Difficult, labored swallowingDrooling• Copious oral secretions• Coughing, choking at meals• Holding or pocketing of food/medications in the mouth• Difficulty moving food or liquid from mouth to throat• Difficulty chewing• Nasal voice or hoarseness• Wet or gurgling voice• Excessive throat clearing• Food or liquid leaking from the nose• Prolonged eating time• Pain with swallowing• Unusual head or neck posturing while swallowing• Sensation of something stuck in the throat during swallowing; sensation of a lump in the throat• Heartburn• Chest pain• Hiccups• Weight loss• Frequent respiratory tract infections, pneumoniaInterventions for Dysphagia [Touhy & Jett, 2022, p. 136]After the swallowing evaluation, a decision must be made about the potential for functional improvement of the swallowing disorder and the safety in swallowing liquid and solid food.The goal is safe oral intake to maintain optimal nutrition and caloric needs. Nurses work closely with speech-language pathologists and the dietitian to implement interventions to prevent aspiration. Compensatory interventions include postural changes, such as chin tucks or head turns while swallowing, and modification of bolus volume, consistency, temperature, and rate of presentation. Diets may be modified in texture from pudding-like to nearly normal-textured solids. Liquids may range from spoon-thick to honey-like, nectar-like, and thin. Commercial thickeners and thickened products are also available.What are best practices in the use of feeding tubes in older adults? [Touhy & Jett, 2022, p. 136]

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderThe American Geriatrics Society (AGS) (2013) does not recommend feeding tubes for older adults withadvanced dementia (Box 10.2). The AGS guidelines suggest that careful hand feeding for patients with severedementia is at least as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status,and patient comfort (Box 10.5). Further, tube feeding is associated with agitation, increased use of physical andchemical restraints, and worsening of pressure ulcers (Teno et al., 2012).Decisions about feeding tube placement are challenging and require thoughtful discussion with patients andcaregivers, who should be free to make decisions without duress and with careful consideration of the patient'sadvance directives, if available. Individuals have the right to use or not use a feeding tube but should be giveninformation about the risks and benefits of enteral feeding, particularly in late-stage dementia. In difficultsituations, an ethics committee 138may be consulted to help make decisions. It is important that everyoneinvolved in the care of the patient be knowledgeable about the evidence related to the risks and benefits of tubefeeding. The decision should never be understood as a question of tube feeding versus no feeding. No familymember should be made to feel that he or she is starving his or her loved one to death if a decision is made not toinstitute enteral feeding. Efforts to provide nutrition should continue, and patients should be able to take any typeof nutrition they desire any time they desire.Regardless of the decision, an important nursing role is to journey with the patient's loved ones, providingsupport and encouraging expression of feelings. Making these decisions is very difficult and loved ones “have tomake peace with their decisions.”Nutritional ScreeningIs the first step in identifying individuals who are at risk for malnutrition or have undetected malnutrition and determines the need for a more comprehensive assessment and nutritional interventions.The Nutrition Screening Initiative Checklist The Mini Nutritional AssessmentThe Minimum Data Set 3.0Nutrition Interventions[Touhy & Jett, 2022]Interventions are formulated around the identified nutritional problem or problems and nursing interventions are centered on techniques to increase food intake and enhance and mange the environment to promote increased food intake.Nutritional Care[Touhy & Jett, 2022, Box 10.7]Assessment of the individual for issues related to performance at mealtimes.Modification of the environment to be pleasurable for eating.Supervision of eating.Provision of guidance and support to staff on feeding techniques.Evaluation of outcomes.Chapter 11 Clinical Judgement to Promote Hydration and Oral HealthHydration ManagementPromotion of an adequate fluid balance, which prevents complications resulting from abnormal or undesirable fluid levels.Age-related changes, medication use, functional impairments, and some comorbid medical and emotional illnesses place some older adults at risk for changes in fluid balance, especially dehydration.Dehydration[Touhy & Jett, 2022, p. 145]

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderDefined clinically as “a complex condition resulting in a reduction in total body water.A geriatric syndrome that is frequently associated with common diseases (diabetes, respiratory illness, heart failure) and frailty.The majority of older people develop dehydration as a result of increased fluid losses combined with decreased fluid intake, related to decreased thirst. The condition is rarely attributable to neglect.Risk Factors for Dehydration [Touhy & Jett, 2022, Box 11.1]Age-related changesMedications: diuretics, laxatives, angiotensin-converting enzyme (ACE) inhibitors, psychotropicsUse of four or more medicationsFunctional deficitsCommunication and comprehension problemsOral problemsDysphagiaDeliriumDementiaHospitalizationLow body weightDiagnostic procedures requiring fastingInadequate assistance with fluid/food intakeDiarrheaFeverVomitingInfectionsBleedingDraining woundsArtificial ventilationFluid restrictionsHigh environmental temperaturesMultiple comorbiditiesSimple Screen for Dehydration [Touhy & Jett, 2022, Box 11.2]DDrugsEEnd of lifeHHigh feverYYellow urine turns darkDDizzinessRReduced oral intakeAAxilla dryTTachycardiaIIncontinence (fear of)OOral problemsNNeurological impairmentSSunken eyesInterventionsInterventions are derived from a comprehensive assessment and consist of risk identification and hydration management.Hydration Management[Touhy & Jett, 2022, Box 11.3]

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and Bladder1.Calculate a daily fluid goal.All older adults should have an individualized fluid goal determined by a documented standard for daily fluid intake. At least 1500 mL of fluid/day should be provided.2.Compare current intake to fluid goal to evaluate hydration status.3.Provide fluids consistently throughout the day.Provide 75% to 80% of fluids at mealtimes and the remainder during non-mealtimes such as medication times.Offer a variety of fluids and fluids that the person prefers.Standardize the amount of fluid that is offered with medication administration (e.g., at least 6 oz).4.Plan for at-risk individuals.Have fluid rounds midmorning and midafternoon.Provide two 8-oz glasses of fluid in the morning and evening.Offer a “happy hour” or “tea time,” when residents can gather for additional fluids and socialization.Provide modified fluid containers based on resident's abilities—for example, lighter cups and glasses, weighted cups and glasses, plastic water bottles with straws (attach to wheelchairs, deliver with meals).Make fluids accessible at all times and be sure residents can access them—for example, filled water pitchers, fluid stations, or beverage carts in congregate areas.Allow adequate time and staff for eating or feeding. Meals can provide two-thirds of daily fluids.Encourage family members to participate in feeding and offering fluids.5.Perform fluid regulation and documentation.• Teach individuals, if possible, to use a urine color chart to monitor hydration status.• Document complete intake including hydration habits.• Know volumes of fluid containers to accurately calculate fluid consumption.• Frequency of documentation of fluid intake will vary among settings and is dependent on the individual's condition. In most settings, at least one accurate intake and output recording should be documented, including amount of fluid consumed, difficulties with consumption, and urine specific gravity and color.• For individuals who are not continent, teach caregivers to observe incontinent pads or briefs for amount and frequency of urine, color changes, and odor, and report variations from individual's normal pattern.Oral Health [Touhy & Jett, 2022, p. 148]Orodental health is integral to general health. It is a basic need that is increasingly neglected with advanced age, debilitation, and limited mobility. The presence of medical conditions, the practice of poor dental hygiene, and lack of dental care contribute to poor oral health.Poor oral health is recognized as a risk factor for dehydration and malnutrition, as well as a number of systemic diseases,

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and Bladderincluding pneumonia, joint infections, cardiovascular disease, and poor glycemic control in type 1 and type 2 diabetes(Jablonski, 2010; O'Connor, 2012; Stein et al., 2014).In frail older adults at the end of life, poor oral hygiene facilitates the colonization of respiratory pathogens on the surfaces ofthe teeth and dentures and increases the risk of life-threatening respiratory tract infections. Pain from infected teeth, ill-fittingdentures, or oral candidiasis can limit eating ability and compromise comfort and quality of life.Age-Related ChangesWear and tear of teeth cause increased risk of tooth decay.Gums recede, causing increased risk of oral and cardiac disease.Promoting Oral Health[Touhy & Jett, 2022, Box 11.5]Encourage annual dental exams, including individuals with dentures.Brush and floss twice daily; use a fluoride dentifrice and mouthwash.Ensure dentures fit well and are cleaned regularly.Maintain adequate daily fluid intake (1500ml)Avoid tobaccoLimit alcoholEat a well-balanced dietUse an ultrasonic toothbrush (more effective at removing plaque)Use a commercial floss handle for easier flossingAdapt toothbrush if manual dexterity is impaired. Use a child’s toothbrush or enlarge the handle of an adult-sized toothbrush by adding a foam grip or wrapping it with gauze or rubber bands to increase handle size.If medications cause a dry mouth, ask your health care provider if there are other drugs that can be substituted. If dry mouth cannot be avoided, drink plenty of water, chew sugarless gum, and avoid alcohol and tobacco.Common Oral Problems[Touhy & Jett, 2022]Xerostomia (mouth dryness)Xerostomia and hyposalivation are present in approximately 30% of older adults and can affect eating, swallowing, and speaking and contribute to dental caries and periodontal disease. Medications that have a side effect of hyposalivation include:More than 500 medications have a side effect of hyposalivation, including antihypertensives, antidepressants, antihistamines, antipsychotics, diuretics, and antiparkinsonian agents.DenturesOlder adults and those who may care for them should be taught proper care of dentures and oral tissue to prevent odor, stain, plaque buildup, and oral infections. Dentures are very personal and expensive so the utmost care should be taken when handling, cleaning, and storing dentures.Summarize Providing Denture Care[Touhy & Jett, 2022, Box 11.10]:1. Remove dentures or ask individual to remove dentures. Observe ability to remove dentures.2. Inspect oral cavity.3. Rinse denture or dentures after each meal to remove soft debris. Do not use toothpaste on dentures because it abrades denture surfaces.4. Once each day, preferably before retiring, remove denture and brush thoroughly.a. Although an ordinary soft toothbrush is adequate, a specially designed denture brush may clean more effectively. (Caution: Acrylic denture material is softer than natural teeth and

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and Bladdermay be damaged by being brushed with very firm bristles.)b. Brush denture over a sink lined with a facecloth and half-filled with water. This will prevent breakage if the denture is dropped.c. Hold the denture securely in one hand, but do not squeeze. Hold the brush in the other hand. Never use a commercial tooth powder because it is abrasive and may damage the denture materials. Plain water, mild soap, or sodium bicarbonate may be used.d. When cleaning a removable partial denture, great care must be taken to remove plaque from the curved metal clasps that hook around the teeth. This can be done with a regular toothbrush or with a specially designed clasp brush.5. After brushing, rinse denture thoroughly; then place it in a denture-cleaning solution and allow it to soak overnight or for at least a few hours. (Note: Acrylic denture material must be kept wet at all times to prevent cracking or warping.) In the morning, remove denture from the cleaning solution and rinse it thoroughly before inserting it into the person’s mouth. Use denture paste if necessary to secure dentures.6. Dentures should be worn constantly except at night (to allow relief of compression on the gums) and replaced in the mouth in the morningOral hygiene in Hospitals and Long-Term Care[Touhy & Jett, 2022, p. 152]Oral care is an often a neglected part of daily nursing care and should receive the same priority as other kinds of care. Lack of attention to oral hygiene contributes significantly to poor nutrition and other negative outcomes such as aspiration pneumonia. Managing Oral Hygiene Using Threat Reduction Strategiesare interventions to deliver oral hygiene and decrease care-resistant behavior within the context of person-centered, relationship-based care. Strategies include:Individuals with cognitive impairment may be resistive to mouth care, and this is one of the reasons caregivers may neglect oral care. Nursing home residents with dementia are three times more likely to have more tooth decay than those who allow mouth care. Jablonski-Jaudon and colleagues (2016) describe the MOUTH (Managing Oral Hygiene Using Threat Reduction Strategies) interventionto deliver oral hygiene and decrease care-resistant behavior within the context of person-centered, relationship-based care. Strategies include placing yourself at eye level, establishing rapport, using touch judiciously, explaining all actions in step-by-step instructions with cues and gestures, and using distractions. Even with individuals who need help, caregivers should encourage as much self-care as possible. Caregivers can have the person hold the toothbrush but place their hand over the person's hand (hand-over-hand technique).

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderChapter 12 Clinical Judgement to Promote Bowel and Bladder HealthUrinary IncontinenceIt is more common in women, with the peak incidence around the time of menopause. In men, there is a steady increase in prevalence with age.Risk Factors for Urinary Incontinence[Touhy & Jett, 2022, Box 12.2]Many of the risk factors associated with UI are unrelated to changes in the urinary tract.AgeImmobility, functional limitationsDiminished cognitive capacity (dementia, delirium)Medications (those with anticholinergic properties, diuretics)SmokingHigh caffeine intakeLow fluid intakeObesityConstipation, fecal impactionPregnancy, vaginal delivery, episiotomy, forceps birth, large babyEnvironmental barriersHigh-impact physical exerciseDiabetes, stroke, Parkinson's disease, multiple sclerosis, spinal cord injuryHysterectomyPelvic muscle weakness, pelvic organ prolapseChildhood nocturnal enuresisProstate surgeryEstrogen deficiencyArthritis and/or back problemsMalnutritionDepressionHearing or visual impairmentsDementiadoes not cause urinary incontinence but affects the ability of the person to find a bathroom and recognize the urge to void. Mobility problems and dependency in transfers are better predictors of continence status than dementia, suggesting that persons with dementia may have the potential to remain continent as long as they are mobile. Drugs that increase urinary output and sedatives, tranquilizers, and hypnotics, which produce drowsiness, confusion, or limited mobility, promote incontinence by dulling the transmission of the desire to urinate.Types of Urinary Incontinence[Touhy & Jett, 2022, p. 156]Incontinence is classified as either transient (acute) or established (chronic).Transient:

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderTransient incontinence has a sudden onset, is present for 6 months or less, and is usually caused by treatable factors such as urinary tract infections (UTIs), delirium, constipation and stool impaction, and increased urine production caused by metabolic conditions such as hyperglycemia and hypercalcemia. Hospitalized older adults are at risk of developing transient UI and may also be at risk of being discharged without resolution of the condition. Use of medications such as diuretics, anticholinergic agents, antidepressants, sedatives, hypnotics, calcium channel blockers, and alpha-adrenergic agonists and blockers can also lead to transient UI.Established:Established UI may have either a sudden or a gradual onset and is categorized into the following types: (1) stress;(2) urge; (3) urge, mixed, or stress UI with high postvoid residual (PVR) (originally termed overflow UI); (4) functional UI; and (5) mixed UI.Types and Symptoms of Urinary Incontinence[Touhy & Jett, 2022, Table 12.1]TYPESYMPTOMSStressLoss of small amount of urine with activities that increase intra-abdominal pressure (coughing, sneezing, exercising, lifting, bending)More common in women but can occur in men after prostate surgery/treatment.PVR (Post-Void Residual) lowUrgeLoss of moderate to large amount of urine before getting to toilet, inability to suppress need to urinate.Frequency and nocturia may be present.PVR lowMay be associated with overactive bladder characterized by urinary frequency, nocturia, urgency, with or without UI.Urge, mixed, or stresswith high residuals (overflow)Nearly constant urine loss (dribbling), hesitancy in starting urine, slow urine stream, passing small volumes of urine,feeling of incomplete bladder emptying.PVR highFunctionalLower urinary tract intact but individual unable to reach toilet because of environmental barriers; physical limitations; cognitive impairment; lack of assistance; difficulty managing belts and zippers or getting a dress up and undergarments down; or difficulty sitting on a toilet.May occur with other types of UI; more common in individuals who are institutionalized or cognitively impaired.MixedCombination of more than one UI problem; usually stress and urge.Behavioral InterventionsScheduled (timed) voiding.Bladder training.

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderPelvic floor muscle exercises.Prompted voiding.Lifestyle modifications.Urinary CathetersIntermittent catheterization may be used in people with urinary retention related to a weak detrusor muscle, those with a blockage of the urethra, or those with reflux incontinence related to a spinal cord injury. Indwelling catheter use is not appropriate for long term management (more than 30 days) except in certain clinical conditions.Indications for indwelling urinary catheter use [Touhy & Jett, 2022, Box 12.7]• Presence of acute urinary retention or bladder outlet obstruction• Need for accurate measurements of urinary output in critically ill patients• Perioperative use for selected surgical procedures: urological or other surgery on contiguous structures of the genitourinary tract; anticipated prolonged surgery duration (should be removed in postanesthesia unit); patients anticipated to receive large-volume infusions or diuretics during surgery; need for intraoperative monitoring of urinary output• Assistance in healing of open sacral or perineal wounds in incontinent patients• Requirement for prolonged patient immobilization (e.g., potentially unstable thoracic or lumbar spine, multiple traumatic injuries such as pelvic fractures)• Improvement in comfort for end-of-life care if neededSafety Alert [Touhy & Jett, 2022, p. 163]Long-term catheter use increases the risk of recurrent urinary tract infections leading to urosepsis, urethraldamage in men, urethritis, or fistula formation. Catheter-associated urinary tract infection is the most frequenthealth care–associated infection in the United States. Indwelling catheters should be inserted only for appropriateconditions and must be removed as soon as possible. A comprehensive evaluation of continence status should beperformed to determine the most appropriate interventions to maintain bladder health.Prevention of CAUTI (ABCDE) [Touhy & Jett, 2022, Box 12.8]Adherence to general infection control principles (hand hygiene, surveillance, aseptic catheter insertion, education, and proper maintenance of a sterile, closed, unobstructed drainage system)Bladder ultrasound may aid indwelling catheterizationCondom catheters or other alternatives to an indwelling catheter such as intermittent catheterization should be considered in appropriate patientsDo not use the indwelling catheter unless you must. Do not use antimicrobial catheters. Do not irrigate catheters unless obstruction is anticipated (e.g., as might occur with bleeding after prostatic or bladder surgery). Do not clean the periurethral area with antiseptics (cleansing of the metal surface during daily bathing or showering is appropriate)Early removal of the catheter using a reminder or nurse-initiated removal protocolBowel EliminationBowel function of the older adult, although normally only slightly altered by the physiological changes of age can be a sourceof concern and a potentially serious problem especially for the older person who is functionally impaired.Constipation [Touhy & Jett, 2022, p. 164]

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderA reduction in the frequency of stool or difficulty in formation or passage of stool. It is one of the most common gastrointestinal complaints encountered in clinical practice in all settings. It is a symptom not a disease.Fecal Impaction [Touhy & Jett, 2022, p. 164]A major complication of constipation.Unrecognized, unattended, or neglected constipation eventually leads to fecal impaction.Symptoms of fecal impaction:oSymptoms of fecal impaction include malaise, urinary retention, elevated temperature,incontinence of bladder or bowel, alterations in cognitive status, fissures, hemorrhoids, andintestinal obstruction.oParadoxical diarrhea, caused by leakage of fecal material around the impacted mass, mayoccur. Digital rectal examination for impacted stool and abdominal x-rays will confirm thepresence of impacted stool. Continued obstruction by a fecal mass may eventually impairsensation, leading to the need for larger stool volume to stimulate the urge to defecate, whichcontributes to megacolon.InterventionsAssessment and management of bowel function is an important nursing responsibility. Precipitants and causes of constipation must be included in the evaluations of the individual. Nursing interventions are aimed at managing and/or restoring bowel continence.Non-pharmacological treatmentThe first intervention is to examine the medications the person is taking and eliminate those that produce constipation, preferably changing to medications that do not carry that side effect. Medications are the leading cause of constipation, and almost any drug can cause it. Other interventions that have been implemented and evaluated are as follows: (1) fluid and diet related, (2) physical activity, (3) environmental manipulation, (4) toileting regimen, and (5) a combination of these.Dietary changesPhysical activityPositioningToileting regimen: Establishing a routine for toileting promotes or normalizes bowel function (bowel retraining)oOlder people dependent on others to meet toileting needs should be assisted to maintain normal routines and provided opportunities for routine toilet use.oBowel Training Program [Touhy & Jett, 2022, Box 12.11]Pharmacological treatmentWhen changes in lifestyle are not effective the use of laxatives can be considered.Bulk laxatives are often the first prescribed because of their safety. Enemas may also be prescribed. Accidental Bowel Leakage/Fecal Incontinence

Key Concepts WorksheetUnit 5Topics:Clinical Judgment to Promote Nutritional Health; Hydration and Oral Health; Bowel and BladderThe involuntary loss of liquid or solid stool that is a social and hygienic problem. FI is often associated with urinary incontinence.Contributing factors shared by both include damage to the pelvic floor as a result of surgery or trauma, neurological disorders, functional impairment, immobility, and dementia.