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.
Use that same strategy. So now, thinking about this topic,
can you recognize the normal aging, Jose, from the
Enrique, and how would you develop appropriate interventions
to keep them both safe?
Second, make sure you're very clear how the age-related
may put Jose at a little bit extra risk to certain diseases.
Lastly, look at the interactions of normal aging, Jose, and
how they present symptoms
and how they respond to treatment and to outcomes.
Okay. So we went over a lot in the oral pharyngeal section.
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
May you make yourself a chart or a graph?
Whatever speaks to your brain most in helping you remember
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.
Now, remember, Enrique, he has an increased risk of
everything that is not fun.
So he's an increased risk of choking or aspiration
because of his health history and the medications that he's
So he's got a dry mouth. He doesn't have the strongest
muscles of chewing.
His sphincters aren't working as well. He's got a lot of
So we want to encourage him to eat and drink only in an
Okay. So why is that? We want this to be a straight a shot
as it can be.
If he's laid back, you got an increased risk of him
And that means instead of going down his esophagus, it goes
down his trachea.
Right. My grandpa used to say, "Oh. That went down the wrong
Which is kind of fair. Your esophagus, trachea, you got all
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
So encourage Enrique to make sure that he is eating and
drinking only in a full, upright position.
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
Encourage him to take smaller bites. Right?
And think about softer or thicker food consistencies as
Depends on how difficult the swallowing is for him.
No one likes to eat, you know, pureed foods and those types
That's a really extreme diet.
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.
They need smaller bites. So it can be very touchy and very
personal for someone,
but just let them know it's okay.
That the reason we're encouraging this is it's a normal part
Your mouth's a little drier. Your esophageal things are
working a little differently in there.
So it'll be safer for you if you take a smaller bite.
Now, this model is through outer courses.
Right? The NCSBN Nursing Clinical Judgement Model. Now it
looks kind of like, "Whoa.
That's a lot of stuff." But what I want you to focus on is
like what cues should you be looking for as a nurse when
with elderly clients in regards to our topic?
Oropharyngeal and swallowing changes because of normal aging
and for aging with comorbidities and medications.
So that's what I want you to focus on.
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
in the stems or the wording of that question.
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
when you have any client, but particularly, a geriatric
Make sure you assess the inside of the client's mouth and
Now, I wanted to say something here because our friends Jose
they have their natural teeth. Right?
And we've talked about the change in processes with natural
But you may also have clients who have dentures.
So you want to ask them some specific questions
and ask them if they've noticed any sores that have a
Or are their dentures uncomfortable?
Sometimes, it's the fit or there's some other type of
intervention that needs to happen.
But make sure you ask those who wear dentures about their
how well the dentures are working
because that could also increase their risk for having
choking or swallowing.
And then follow up with them.
You may need to make a referral in the community for them to
have access to those resources.
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.
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
Is there something else going on that is not normal for this
And if appropriate, you should assess the client's
So you'll have to take that cue depending on what your
But if we're in an acute care setting, you absolutely want
to observe them swallowing
and make sure that they're safe.
So when you go in and you take those medications to your
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.
So thank you for joining us for this section of our video
series on oropharyngeal and swallowing health.