Geriatric Oropharyngeal and Swallowing Assessment Cues (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Now, let's get serious because I know you want to know how do I prepare for exams? Well, these are three key points in your geriatric course that are important that you see if you can pause and recall.

    00:15 Use that same strategy. So now, thinking about this topic, can you recognize the normal aging, Jose, from the pathological processes, Enrique, and how would you develop appropriate interventions to keep them both safe? Second, make sure you're very clear how the age-related changes may put Jose at a little bit extra risk to certain diseases.

    00:41 Lastly, look at the interactions of normal aging, Jose, and how they present symptoms and how they respond to treatment and to outcomes.

    00:52 Okay. So we went over a lot in the oral pharyngeal section.

    00:56 Here is a brilliant time for you to pause, think back for everything that you can recall without looking at your notes. Then go back and look at that content.

    01:06 May you make yourself a chart or a graph? Whatever speaks to your brain most in helping you remember that information and lay it out in an organized way? I'm going to give you some specifics, right? So now that you're back and you've written your notes, let's start looking at some specific things.

    01:22 Now, remember, Enrique, he has an increased risk of everything that is not fun.

    01:27 So he's an increased risk of choking or aspiration because of his health history and the medications that he's taking.

    01:34 So he's got a dry mouth. He doesn't have the strongest muscles of chewing.

    01:39 His sphincters aren't working as well. He's got a lot of challenges.

    01:43 So we want to encourage him to eat and drink only in an upright position.

    01:49 Okay. So why is that? We want this to be a straight a shot as it can be.

    01:54 If he's laid back, you got an increased risk of him aspirating.

    01:58 And that means instead of going down his esophagus, it goes down his trachea.

    02:03 Right. My grandpa used to say, "Oh. That went down the wrong tube." Which is kind of fair. Your esophagus, trachea, you got all that.

    02:12 Yeah. They're both tubes. But aspirating means we're going to get something in the lungs that can cause an infection and pneumonia and a really bigger problem.

    02:22 So encourage Enrique to make sure that he is eating and drinking only in a full, upright position.

    02:28 If he's in his big old recliner and he's kicked way back, that is not the best position for him to be drinking and eating.

    02:35 Encourage him to take smaller bites. Right? And think about softer or thicker food consistencies as appropriate.

    02:43 Depends on how difficult the swallowing is for him.

    02:47 No one likes to eat, you know, pureed foods and those types of things.

    02:52 That's a really extreme diet.

    02:54 But sometimes, when they're used to just cutting off a big old piece of steak and taking a bite, they forget that they can't do that anymore at this age.

    03:04 They need smaller bites. So it can be very touchy and very personal for someone, but just let them know it's okay.

    03:14 That the reason we're encouraging this is it's a normal part of aging.

    03:17 Your mouth's a little drier. Your esophageal things are working a little differently in there.

    03:22 So it'll be safer for you if you take a smaller bite.

    03:25 Now, this model is through outer courses.

    03:29 Right? The NCSBN Nursing Clinical Judgement Model. Now it looks kind of like, "Whoa.

    03:35 That's a lot of stuff." But what I want you to focus on is the levels like what cues should you be looking for as a nurse when you're interacting with elderly clients in regards to our topic? Oropharyngeal and swallowing changes because of normal aging and for aging with comorbidities and medications.

    03:54 So that's what I want you to focus on.

    03:56 If you want to know the key to really doing well on exams, one of the keys is to know what cues you should be looking for in the stems or the wording of that question.

    04:08 So let me give you a few examples. But I'm telling you, when you're studying, always think, "What cues could I see in exam question?" And hopefully, that will transfer to you like, what cues will you look for in your real live patients? So be careful to don't allow your uncomfortableness to skip this part when you have any client, but particularly, a geriatric client.

    04:32 Make sure you assess the inside of the client's mouth and teeth.

    04:36 Now, I wanted to say something here because our friends Jose and Enrique, they have their natural teeth. Right? And we've talked about the change in processes with natural teeth.

    04:46 But you may also have clients who have dentures.

    04:49 So you want to ask them some specific questions and ask them if they've noticed any sores that have a difficulty healing? Or are their dentures uncomfortable? Sometimes, it's the fit or there's some other type of intervention that needs to happen.

    05:04 But make sure you ask those who wear dentures about their comfort, how well the dentures are working because that could also increase their risk for having choking or swallowing.

    05:14 And then follow up with them.

    05:16 You may need to make a referral in the community for them to have access to those resources.

    05:21 Now, and then a person with natural teeth, you want to look for abnormal tooth loss, look for gum disease in both those with dentures or with their natural teeth, and look at their tongue health. What color should it be? Yeah. It should be kind of that normal pinkish kind of color has different hues depending on the patient's skin color.

    05:41 So take that into consideration what is the normal color of this patient's tongue, and then what do I see? Is it white? Is it filmy? Is it pasty? Is there something else going on that is not normal for this patient? And if appropriate, you should assess the client's swallowing.

    05:59 So you'll have to take that cue depending on what your setting is.

    06:03 But if we're in an acute care setting, you absolutely want to observe them swallowing and make sure that they're safe.

    06:10 So when you go in and you take those medications to your patient, make sure what position do you want them in? Right. You want them in a sitting, upright position whenever you have them take their meds or when you have them eat their meals.

    06:23 So thank you for joining us for this section of our video series on oropharyngeal and swallowing health.

    About the Lecture

    The lecture Geriatric Oropharyngeal and Swallowing Assessment Cues (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. Food or liquid enters the trachea instead of the esophagus
    2. Stomach acid empties into the intestines
    3. Decreased tongue mobility leading to choking
    4. Impaired salivary gland excretion
    1. Ensure the client is eating or drinking in a fully upright position.
    2. Ensure the client’s dentures fit correctly.
    3. Encourage the client to take small bites.
    4. Switch the client to intravenous fluids only.
    5. Have the client swallow the medication while reclined at a 30-degree angle

    Author of lecture Geriatric Oropharyngeal and Swallowing Assessment Cues (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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