Now, why is there an increased risk of GERD?
Remember this. Gastroesophageal reflux disease.
So stop for a minute and break that word down in your mind.
Gastroesophageal, oh, gastro is always GI tract. Esophageal
reflex disease, okay.
Yeah. It's really true that geriatric clients have a higher
risk for this.
Now, there's other risk factors for GERD, but we're just
focusing in on the geriatric population.
Now, one more clue. You'll see here that Jose is very fit
and trim. Right?
He looks incredibly healthy. Enrique has this little grandpa
and I'll talk about that in just a minute.
But when we're focused on geriatric clients, let's go
All right. So we already know that it came in through the
It goes down to the upper esophageal sphincter.
Now, we're in the lower esophageal sphincter. And now, we're
into the stomach.
Now, that sphincter at the bottom should stay closed.
We want to make sure that that gastric acid that's rolling
around in your stomach
doesn't go back up through that valve and into your
because it's going to burn and be painful.
That's what gastroesophageal reflux disease is.
That means that gastric acid is not staying in the stomach.
So your stomach's - it's designed to kind of deal with that
You need the gastric acid to help your body start breaking
up the food and all the nutrients in it,
so you can get it into your intestines and your blood
and get it into the cells where you need it.
But other tissues can't handle gastric acid.
In my stomach, I have a stomach lining. I've got
I've got this thick mucus. So it's well-protected.
But if it scoots out of there like look at this picture.
If that sphincter doesn't close tightly and securely, if
it's open, that gastric acid
is going to bubble up in that esophagus. And it is not a
good day when that happens.
That's what we call reflux. And it is miserable for
I've had some patients that had GERD that was so bad,
they thought they were having a heart attack.
Once we calmed down that GI tract, they were fine.
But this is really important that you help your patients
as we age, everyone develops a little bit more of a risk for
If you're overweight, there's even a higher risk.
So Enrique is - well, grandpa belly puts him at an even
greater risk for developing GERD.
And we do some things at night with them.
We'll encourage them to sleep with their shoulders elevated
a little bit,
so they're not completely laying flat. Yeah. Why?
Well, think about what you know about the anatomy.
We can kind of use gravity to keep that gastric acid in the
stomach versus laying flat
where he's more at risk for it to be flowing up and burning
So what do you do? We've got Enrique here, and we've got a
So the nurse is going to know because of Enrique's age that
he's an increased risk for GERD.
She's also going to know that he has some extra weight.
We're not judging.
We're just looking that as a risk factor that,
"Okay, that's going to make it even worse for him."
So she's going to ask or he, whoever the nurse happens to
They're going to ask some really specific nursing admission
So as she's meeting Enrique, no matter what the setting is.
It could be in the community. It could be in the hospital.
But she's going to take a look at Enrique and say, "Hey, I'm
going to ask about GERD
because I know that geriatric patients have an increased
So I'm going to ask really specific questions. I'm not going
to say, "Enrique, do you have GERD?"
No. I'm going to say, "Hey, have you ever felt like you had
a burning sensation in your esophagus
or maybe heartburn? Did you ever experience that?
What foods caused that for you? Just to kind of gently open
the door for them
because don't use our medical terminology with clients.
It really kind of distances us until you make sure
they understand exactly what you're talking about.
So you don't talk down to patients but you talk it at an
They may not have taken the medical terminology class that
And so you have to think about,
"How can I ask this question in a way that's going to get me
the assessment information I really need?"
Because that's how you identify potential problems.