Further GI Assessment (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now we're gonna move on from pain and talk about have you had a change in your bowel habits.

    00:06 Now, you may ask a patient that and that's really not a very clear question for a client, young, geriatric any client, that's really, they don't know what it is, and sometimes people want to rush through this studying.

    00:20 But you want to ask things like, has the frequency changed? how often you have a bowel movement? has the consistency of it changed.

    00:28 Everyone looks at what they deposit in the toilet.

    00:31 Nobody wants to talk about it, but everyone looks so you're going to know what it looked like.

    00:36 You want to know what it felt like for consistency.

    00:40 Ask them if they've experienced constipation, or diarrhea.

    00:44 Those are things where you might have to walk through of those specific examples to help them recognize what you're asking.

    00:51 Or you may just say, have you had a change in your bowel habits? And they say, 'Oh, absolutely, I have been so constipated', or 'I've been having diarrhea every day and that's not normal for me'.

    01:01 So you're just gonna have to wait and assess how your patient's feeling and what they're processing.

    01:07 So you know the right questions to ask.

    01:10 The last one, do you use laxatives and how often do you use them? Occasional laxative use is fine, but you want to check in if someone is having to use like an enema or suppositories on a really regular basis, we need to find a better solution for them.

    01:28 So depending on what the answer is, keep in mind that geriatric clients, those normal changes they experience.

    01:35 So because they may not be interested in eating, their taste buds have changed, they might not have that partner or their person to eat with, their diet might not be very healthy.

    01:47 So they may be eating a poor diet, they might have a sedentary lifestyle.

    01:51 Well, back to diet and exercise.

    01:54 This is a touchy topic with everyone, because we all know we should eat healthy, and we should be active at whatever age we're at.

    02:02 So come open minded when you're talking to the patient, just say, 'Hey, describe a typical meal to me' And you might have to get specific and say, 'Do you ever order food from a takeout or a drive thru', and then keep that face that says - no judgment - you just are gathering information so you can put these cues together, analyze them and make a hypothesis.

    02:25 So he might be more likely to have a poor diet, not be getting around very much.

    02:31 And there also might be some drugs that are leading this constipation.

    02:34 That's our job to figure out.

    02:36 Yes, us as nurses.

    02:39 We ask great questions so that we can help the physician, the healthcare provider, the nurse practitioner, determine the best plan of care.

    02:49 We are a vital part of that process.

    02:52 And you want to make sure that you're contributing to that process.

    02:55 Oftentimes, nurses will pick up on things, because of the amount of time we spend talking and listening to our clients.

    03:03 That way, we can report that information and share that with a healthcare provider so he gets even better care.

    03:10 Remember, geriatric clients are really sensitive to fluid and volume loss.

    03:15 So just like young babies are really sensitive to fluid volume loss.

    03:20 Adults, that are geriatric clients are also very sensitive.

    03:24 So they have nausea and vomiting, their fluid and electrolytes can get off, way off much quicker than a middle aged adult.

    03:32 So make sure you take a look at the client's drug list.

    03:35 Send it to the Pharm D, sit down with someone that's their specialty.

    03:39 All it takes is getting an accurate drug list from your clients and a lot of electronic medical records or electronic health records, that information is in there and pretty accurate.

    03:51 So get an accurate list of what the patient is still taking, and ask the pharmacist to evaluate and see if there's any risk of drug to drug interactions.

    04:00 If you're taking two medications, there's something of a risk of a possible reaction.

    04:05 But a geriatric client is usually taking more than two medications, then we're at an increased risk for reactions.

    04:12 So these are the cues I'm looking for when I ask these questions about, 'have you had a change in your bowel habits?' I give them some more questions and descriptors so they know what I'm asking.

    04:24 And these are the things that I'm keeping in the back of my mind, what geriatric clients are at risk for if they're constipated.

    04:30 I know those are the risk factors.

    04:32 That's why I asked those questions.

    04:34 I know they're really sensitive to fluid and volume loss, I want to be on alert for that.

    04:38 And I know that drugs are often the culprit of both constipation, or diarrhea.

    04:45 So I want to make sure if they're taking a medication that's causing either one of those, we determine what's the next best step with that client.

    04:53 Now, what about have you had any problems with chewing or tooth pain? Now remember, Jose has all his natural teeth so this is really important that we ask that because we want to determine if there's any problems.

    05:06 So no matter if you get a 'yes' or a 'no', like, 'no, no, I'm not having any problems'.

    05:11 Take the extra step of doing a good assessment of the inside of their mouth.

    05:17 So make sure you wear gloves, use a pen light to illuminate the inside of their mouth, even use a tongue depressor to help keep their tongue out of the way because that's really hard to do.

    05:27 We do it and look into the mouth.

    05:30 Now, what do you think you're looking for? Well, we're asking to see, is there anything that looks abnormal about their teeth, about their gums? Do you see any sores in their mouth? Ask them when they've had their most recent dental visit.

    05:46 Now, here's a tip.

    05:48 Don't ask them while you have the tongue depressor in their mouth.

    05:52 Once you're done assessing them, remove the tongue depressor and then ask them questions.

    05:57 Always before you start an assessment on a patient, you're going to touch them, explain what you're going to do.

    06:02 Say hey, would you mind if I looked inside your mouth? It's just polite and professional for you to ask like, 'Okay, I'm going to wear gloves, I'm going to use a tongue depressor and I'm going to use my pen light to make sure I can see really well in there'.

    06:16 'Are you okay with that?' They will most often say yes, then you'll start the exam.

    06:21 Explain to them what you're doing.

    06:23 But don't ask them questions when you've got their tongue pinned down with a tongue depressor.

    06:28 But take your time, do a good and thorough assessment.

    06:32 The patient may have a sore in there that they didn't think to tell you about that we can help deal with before it becomes really problematic.

    06:41 Oh, this is the one that not very many people like, right? You want to take a weight because we want to look at trends.

    06:49 Now sometimes we get really fixated on a scale and what the number is, but just reassure them, this is just another assessment.

    06:58 There's not judgment here but we want to look at what's going on with the trends.

    07:02 What did the patient weigh the last time they came in? Or the time before? Because we're looking at trends, what seems to be the patient's baseline? Are they up, or are they down, or are they pretty close to where they were? You want to be careful about documenting increases or decreases and figure out if you can ask the right questions to kind of determine why the patient's weight has changed.

    07:26 Now, if they've been sad, or they have meal out of the house, or they're not cooking their own meals anymore, so they're eating all super processed foods, that could explain weight gain.

    07:39 If they've lost weight, it may because they're sad, they're not interested in eating, their tastebuds have changee, it never is the same reason for all patients.

    07:50 So that's the cool part about our job is you kind of get to play detective, where you're trying to figure out how can you best help this individual client?

    About the Lecture

    The lecture Further GI Assessment (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. “Has the consistency, size, or frequency of your bowel movements changed recently?”
    2. “Have your bowel habits changed?”
    3. “Do you find yourself going to the bathroom more than usual?”
    4. “Are you constipated?”
    1. Older adults have increased sensitivity to fluid volume loss.
    2. Increased activity levels increase the risk for constipation.
    3. All older adults must be encouraged to take laxatives daily.
    4. Frequent diarrhea is a result of the normal aging process.
    1. Gloves
    2. Pen light
    3. Tongue depressor
    4. Padded tongue blade
    5. Saline rinse

    Author of lecture Further GI Assessment (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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