Page 68 Complete Your CE Test Online - Click Here pain, while others are stoic. All expressions should be respected. For example, in some Hispanic cultures, expressions of pain may be overt and loud while Native Americans may be more stoic and not overtly express discomfort. ● ● Identify cultural and religious viewpoints concerning death and dying, life-prolonging interventions, treatment of the body after death, and funeral practices. ● ● Respect the role of authority in a family and the family spokesperson. For example, in African-American families the husband, father, or eldest male may be the family spokesperson and decision-maker. ● ● Consult appropriate resources to gather information about cultural perspectives. One such resource is cultural_profiles.html. This site offers respectful cultural profiles of various populations, resources, articles, and related links. When using websites as resources, make sure that they treat all cultures with respect. Be wary of and avoid sources that criticize or make jokes about cultures or religious practices. Nursing consideration: Remember that cultural profiles of specific populations are broad generalizations and should not be used to stereotype any individual or group. The age of a person or the generation s/he was born into also influences the way health care services are perceived. For example, the “traditional” generation, also known as “veterans,” or “traditionalists” are those adults born between 1922 and 1946, and represent the oldest members who access health care in this country. As a rule, individuals from this group are more formal in their approach to life and often preferred to be addressed as Mr., Mrs., or by other formal titles. They generally have a strong work ethic and a rigid view of hierarchy and respect for authority. This may make it difficult for them to ask questions or participate actively in their health care plans because they often view health care providers as authority figures. In contrast, members of “Generation X”, i.e. individuals born between 1965 to 1980, are skeptical of authority and value individualism. They will ask questions and expect to participate actively in healthcare decision making [12]. It is important to encourage questions and facilitate active communication between older adults and health care professionals. If possible, a reliable family member or friend should accompany the older adult to facilitate communication when needed. EBP alert! Data indicate that people of color in the U.S. will comprise the majority of the population by 2060. It is imperative that nurses and other healthcare professionals incorporate appropriate cultural considerations into all aspects of patient and/ or family care and consider the demographic population shifts that will influence their practice [8]. Nutritional assessment Nutritional assessment is more than just an evaluation of the intake of nutrients and the body’s ability to effectively use nutrients. Assessment begins with the mouth and oral cavity, and includes a patient’s ability to taste and smell, the body composition of the older adult, and his or her alcohol use, access to food, and socioeconomic factors that influence nutritional status [9,10]. Mr. Peterson is 82 years old and visits the nurse practitioner with a complaint of pain at the corners of his mouth and “ugly white patches on my tongue.” He also says his mouth is very dry “all the time.” Assessment findings include bluish-white patches of exudates on Mr. Peterson’s tongue and inside his mouth. There are also painful fissures at the corners of his mouth. Mr. Peterson is diagnosed with candidiasis, a fungal infection. Older adults are at high-risk for such infections [13]. This is just one type of infection that may be noted upon assessment of the mouth and oral cavity. Let’s see how nurses should assess the mouth and oral cavity. Assessment of the mouth and oral cavity Important questions to ask The ability to eat depends, in part, on a person’s teeth. Observe your patients’ teeth. Are they their own or do they utilize dentures? Are the dentures, including partial dentures, clean, and do they fit well? Are the teeth clean? Is there any evidence of chipped, broken or missing teeth and/or dentures? Additional important information that should be obtained about a patient’s dental habits includes [9,10,13]: ● ● How does the patient care for their teeth and/or dentures? Teeth should be brushed and flossed at least twice a day. A soft-bristled toothbrush should be used to properly clean teeth and to avoid damaging gums. ● ● Are they physically and mentally capable of taking care of their teeth and mouth? ● ● Is there bleeding from gums after brushing? ● ● How often does the patient visit a dentist? An older adult patient should see a dentist at least annually, with an ideal time frame of every six months. These visits should also include a screening for oral cancers at each visit. ● ● Does the patient use alcohol and/or tobacco products (including snuff)? Explain to patients that avoiding these products decreases the risk for oral and/or lung cancers. ● ● Does the patient have bad breath (halitosis)? What does it smell like? Halitosis may indicate poor oral hygiene or certain disease processes. For example, a fruity smelling breath suggests ketones/ hyperglycemia. ● ● Does the patient report any problems with the oral cavity, such as painful teeth or gums, bleeding gums, dry mouth, changes in the sense of taste, or problems chewing or swallowing? ● ● Does the patient complain of having a dry mouth? This is the most common oral problem in older adults and can be due to mouth breathing, dehydration, oxygen therapy, various diseases, side effects of medication, or head and neck radiation treatments. Assessment tip: A frequent complication of dry mouth is the fungal infection candidiasis, more commonly known as thrush [9,13]. Nursing consideration: Remember Mr. Peterson whose condition was described earlier in this section? Can you see what factors may have contributed to the development of his fungal infection? Mr. Peterson complained of having a dry mouth, which often contributes to the development of a fungal infection. Now, the nurses need to find out what factors may be causing Mr. Peterson’s dry mouth. Is he using oxygen therapy? Is he dehydrated? Does he have chronic conditions that cause dry mouth? What medications is he taking? Do any of them have a side effect of dry mouth? An important part of assessment is to determine what might be causing abnormal findings. Inspection Inspect the patient’s lips, teeth, tongue, gums, soft and hard palate, buccal mucosa and the back of the throat. Look for any signs of cracks, bleeding, lesions, ulcers, swelling, induration or broken or decayed teeth. If the patient wears dentures, observe how they fit, whether they are clean, and whether there is any evidence of breakage. Look for signs of leukoplakia, which is a white or gray patch that may develop on the tongue, on the floor of the mouth or on the buccal mucosa. Leukoplakia is most commonly found in older adult patients and is due to irritation from teeth or dentures that rub against the inside of the cheeks or gums or chronic irritation from use of tobacco products [10,14,9,15]. Leukoplakia is usually painless, and is generally biopsied to rule out oral cancers [16]. When inspecting the mouth and oral cavity, remain alert to signs and symptoms of oral cancer. These include [9,10]: ● ● A lump or thickening of a lip, or in the patient’s mouth. ● ● A sore in the mouth or on the lip that does not heal. ● ● White or red patches on the gums, tongue or buccal mucosa.