Now we're gonna move on from pain and talk about
have you had a change in your bowel habits.
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.
But you want to ask things
like, has the frequency changed?
how often you have a bowel movement?
has the consistency of it changed.
Everyone looks at what they deposit in the toilet.
Nobody wants to talk about it, but everyone looks
so you're going to know what it looked like.
You want to know what it felt like for consistency.
Ask them if they've experienced
constipation, or diarrhea.
Those are things where you might have to
walk through of those specific examples
to help them recognize what you're asking.
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'.
So you're just gonna have to wait and assess how
your patient's feeling and what they're processing.
So you know the right questions to ask.
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.
So depending on what the answer is,
keep in mind that geriatric clients,
those normal changes they experience.
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.
So they may be eating a poor diet,
they might have a sedentary lifestyle.
Well, back to diet and exercise.
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.
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.
So he might be more likely to have a poor
diet, not be getting around very much.
And there also might be some drugs
that are leading this constipation.
That's our job to figure out.
Yes, us as nurses.
We ask great questions so that we can help
the physician, the healthcare provider,
the nurse practitioner,
determine the best plan of care.
We are a vital part of that process.
And you want to make sure that
you're contributing to that process.
Oftentimes, nurses will pick up on things,
because of the amount of time we spend talking
and listening to our clients.
That way, we can report that information
and share that with a healthcare provider
so he gets even better care.
Remember, geriatric clients are really
sensitive to fluid and volume loss.
So just like young babies are really
sensitive to fluid volume loss.
Adults, that are geriatric
clients are also very sensitive.
So they have nausea and vomiting, their
fluid and electrolytes can get off, way off
much quicker than a middle aged adult.
So make sure you take a look
at the client's drug list.
Send it to the Pharm D, sit down
with someone that's their specialty.
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.
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.
If you're taking two medications, there's
something of a risk of a possible reaction.
But a geriatric client is usually
taking more than two medications,
then we're at an increased risk for reactions.
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.
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.
I know those are the risk factors.
That's why I asked those questions.
I know they're really sensitive to fluid and
volume loss, I want to be on alert for that.
And I know that drugs are often the
culprit of both constipation, or diarrhea.
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.
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.
So no matter if you get a 'yes' or a 'no',
like, 'no, no, I'm not having any problems'.
Take the extra step of doing a good
assessment of the inside of their mouth.
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.
We do it and look into the mouth.
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.
Now, here's a tip.
Don't ask them while you have the
tongue depressor in their mouth.
Once you're done assessing them, remove the
tongue depressor and then ask them questions.
Always before you start an assessment on
a patient, you're going to touch them,
explain what you're going to do.
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'.
'Are you okay with that?'
They will most often say yes,
then you'll start the exam.
Explain to them what you're doing.
But don't ask them questions when you've got
their tongue pinned down with a tongue depressor.
But take your time, do a
good and thorough assessment.
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.
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.
Now sometimes we get really fixated on a scale
and what the number is,
but just reassure them, this
is just another assessment.
There's not judgment here but we want to
look at what's going on with the trends.
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.
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.
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.
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?