Gastrointestinal Tract (Nursing)

00:01 Remember, this is one of our favorite strategies because we know it's the most effective.

00:06 Ask yourself a question and try and answer it.

00:09 So why don't we need extra caution with NSAIDs and geriatric clients? Well, NSAIDs are just a group category of non-steroidal anti-inflammatory drugs.

00:19 So it's gonna be like naproxen or ibuprofen, those are examples or aspirin.

00:25 Those are examples of NSAIDs that are over-the-counter.

00:28 Now, healthcare providers can also write a script for a much stronger dosage, but we're going to lump these all together.

00:35 And I want you to think about, we're talking about the GI track.

00:39 So what is the extra caution that we might need for our geriatric clients? Did you get this one? Right.

00:47 It increases the risk of NSAID induced stomach ulcers.

00:51 Now, let's break that down as to why that happens.

00:56 Geriatric clients have reduced mucin secretion.

00:59 So you may be ask yourself, "And what does that mean?" Well stick with me, I've got you covered.

01:06 Let's walk through how important mucin is in your body.

01:10 Now we have listed for you there, all the places that you have mucus.

01:15 Lots of places, right? From the entry to some people's exits, you have mucus in multiple places.

01:22 Now mucin, what we talked about, remember, geriatric clients have less of it.

01:26 Mucin is the protein that's made by the cells, and they use it to make that thick mucus.

01:32 Now remember, head to toe.

01:34 So this is through a lot of your body.

01:37 And geriatric clients will have less of the mucin that helps the mucus be produced.

01:44 So this can be especially problematic for our geriatric clients.

01:49 Let's look at their stomach specifically.

01:51 It affects all those areas we just talked about, but I want you to look at their stomach.

01:55 Now we have a drawing for you there.

01:57 See that where we pulled out that close up.

02:00 You see the layers that you have there, the muscle layers, the submucosa, but I want you to put your finger on the mucosa.

02:07 See, that's the fragile inner lining of the stomach, and it needs to be protected from the gastric acid that's in the stomach.

02:15 Well, what protects that fragile mucosa from the gastric acid? Mucus and it's also got some bicarbonate in it.

02:22 But remember, geriatric clients don't have as much mucin.

02:26 So they don't have as much mucus, and they don't have as much protection of that gastric lining.

02:32 And NSAIDs can just make that whole process worse.

02:38 Our next stop on the GI tract is the small intestine.

02:42 Now keep in mind, motility and most functions of absorption remain the same in a geriatric client and when they were younger.

02:49 But take a minute and focus yourself where you are, find the stomach, look at the duodenum, the small intestine, and then you see that we've got the large intestine and then the rectum out of the body.

03:02 So what's going on in all these different places? Well, this is where we started absorbing things in your body.

03:08 So the absorption of vitamin B12, folic acid, carbohydrates, which are delicious, vitamin D and calcium, all decline in geriatric clients.

03:20 Now, I mean, that's a big list of things like B12 that gives us some kind of energy and folic acid, carbohydrates, vitamin D, calcium.

03:31 Hey, look at all the areas we're going to have problems.

03:34 Without enough vitamin D and calcium, you know, that's going to start really impacting your bones.

03:39 So, know that the motility and function of absorption usually remains about the same.

03:46 But these specific items be aware.

03:49 This may lead to that malnutrition in a geriatric client.

03:52 B12, folic acid, carbohydrates, vitamin D and calcium.

03:58 Those are five that I want you to really keep in mind when you're considering a geriatric client's nutritional status.

04:05 Now, the large intestine, that's on your way out of the body, the wall of the large intestine becomes weaker.

04:13 Now, remember how the intestine moves, right? It's kind of get that peristalsis moving that moves things along.

04:20 If that wall is weaker, then it's gonna have some problems like it could have an increased risk of diverticulosis, which that's these little pockets of things that things can get kind of caught up and might even get infected.

04:34 So, because that wall is weaker in the large intestine, that's why geriatric clients are at an increased risk of diverticulosis.

04:44 And let's take a closer look at what that looks like.

04:47 Now, we've zeroed in so you see just the large intestine and then you see all the diverticula that are out of that.

04:55 Now, why is that there? Remember, as you age, that wall that large intestine gets weaker, that's why you have like kind of all those little pockety things juggling out so that is diverticula.

05:08 But when it becomes inflamed, you have diverticulitis, that's when we might have an infection going on in there which is extremely problematic.

05:19 Here we're going to take a closer look at the colon.

05:22 So first, just kind of pull back and take a look at that.

05:25 You see that we have the large colon right on the outside.

05:30 Usually the small intestine would all be tucked in there, but we took that out for you.

05:34 So you just focus on the colon.

05:37 Now for José, calling motility is preserved with age, right? It's just about the same, not a major difference.

05:44 So his ascending colon which is the part of the colon that's going up is transverse colon, which goes across the top, descending colon, sigmoid colon and rectum.

05:54 He may not experience any major differences.

05:58 But someone like Enrique is really at an increased risk to have problems.

06:04 So let's break down kind of what these things do.

06:07 We said ascending goes up, transverse across, then a descending colon, and the sigmoid colon.

06:14 Now way to remember the sigmoid colon, it's an S-shaped portion of the large intestine.

06:20 Now, if you want some anatomical landmarks, it starts about on the front of the pelvic brim, and then it keeps going down to the rectum, which is about at the third sacral vertebra.

06:32 So if you want to have the directions of where that is, I'd encourage you pause it for just a minute and try and find those landmarks on your own body.

06:41 Now, geriatric clients often report constipation, but let me tell you what's going on here.

06:47 Anyone's colon, no matter how young or how advanced in age you are, need some things to stay healthy and keep the waste moving through at the appropriate space.

06:59 See people get constipated if the waste ends up getting stuck in there or staying in there too long or the motility is not what it should be.

07:08 So the things you can do to increase motility or at least maintain motility include things like what you're eating, you need fibers like think fresh fruits, fresh vegetables, things that will stimulate that colon to move.

07:22 And also, you need activity.

07:25 I'm not talking about your colon being active, I'm talking about the person being active.

07:30 If someone has got into more of a sedentary lifestyle, and they don't move very much, and they eat mostly processed foods which are new don't really do much to stimulate the colon and digestion, they're going to be an increased risk for constipation.

07:46 Sounds like anyone you know? Well, it's not José, right? Because he's moving all the time.

07:50 But Enrique, because of his history, because it just he's just gotten into that mode where he watches a lot of TV from his chair, and he's not up and moving very well.

08:02 The other piece I want you to keep in mind, some medications can really exacerbate constipation.

08:10 Things like anticholinergic medications can cause that, some calcium channel blockers can cause that.

08:16 So don't gloss over the topic of constipation.

08:20 Sometimes it feels kind of weird to talk to a patient about it.

08:24 But this is brutal.

08:25 If you've never experienced constipation, man, you would understand why someone can be so focused on this.

08:33 And it's a simple thing to fix.

08:35 With activity, with diet, maybe we look at some types of stool softeners that we can use with the client.

08:41 But if we don't ask the patient, they may not offer that information because they're just too embarrassed to talk about it.

08:48 So we've talked about the risk of constipation, right? Now, can you remember two or three reasons why someone is at an increased risk of constipation? Good.

09:06 Remember, all that work you're doing that recall is going to help you remember things.

09:11 Now, if you didn't get all three of them, just go back and look at your notes and write them down.

09:15 Now, as we're helping you develop your clinical nursing judgment, we want to make sure that we outline these cues for you to watch for in constipation.

09:25 So whether it's an exam question, or really more, much more important, a real life patient, look out for these things.

09:32 Now, everyone has a different bowel pattern.

09:35 But here's the kind of a minimum standard, a good rule of thumb.

09:39 The patient should have at least one bowel movement every three days.

09:43 If it's longer than that we need to investigate further.

09:47 Sometimes patients complain of nausea, and so they try and treat the nausea but what they don't realize is they're nauseated because they're actually constipated.

09:56 So treating the nausea is not going to help the problem.

09:59 We want to make sure that we help them get cleaned out, we get that waste moving through and out of their body again, and the nausea will resolve.

10:08 A good tip is to listen for the bowel sounds.

10:11 Now remember, you're gonna listen in four quadrants when you're auscultation bowel sounds, and if someone is constipated, your bowel sounds maybe dampened.

10:20 So take a listen for that as another step in your queue for assessment.

10:25 Now, here's something that used to trip people up even when I was in the acute care setting.

10:30 You'd ask if they had a bowel movement. Really, like yeah, it was kind of liquidy.

10:32 But yeah, they're having bowel movements. They should be fine.

10:35 Well, here's the deal.

10:37 If someone is really constipated or impacted, sometimes liquid stool can kind of leak around that.

10:45 Now for patients at home.

10:47 They may also think they've had a bowel movement, but really, they have not.

10:51 So you have to ask some really personal questions.

10:54 And keep these cues in mind when you're completing your assessment and helping your patient problems solved.

11:01 Now speaking of that leaking stool, there's also an increased risk for fecal incontinence.

11:07 Now, this is primarily for patients who have had some type of bowel surgery, right.

11:10 It's gone through some kind of trauma or they've had some type of bowel disease, it's not necessarily a normal part of aging.

11:18 But here's the things that can make that even worse, they have diminished rectal elasticity.

11:24 So it's just not as able to bounce back as it once could.

11:28 The sphincter can get kind of thick.

11:30 Well, a thick sphincter is not an efficient one, right? Because it needs to be able to close tight and to open when needed.

11:37 Also, sometimes the sensation to defecate is impaired.

11:41 So they don't even realize that they need to have a bowel movement, which can further delay things.

11:47 So remember, this is not a normal part of aging.

11:50 But patients who've had bowel disease or bowel surgery are at an increased risk for fecal incontinence, that means they're going to have fecal leaking, and they can't really control that.