Introduction to Oropharyngeal Changes (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Hi. Welcome to our series on geriatric nursing.

    00:04 Now, in this whole series, we're looking at age-related changes in health.

    00:09 In this specific video, we're going to talk about oropharyngeal, which that's just another really big word for mouth and swallowing.

    00:17 Now, you might wonder why we're really hitting this issue.

    00:21 Why is this such a big deal? Well, we're going to use these two friends that we've used throughout the series to help you understand why as a nurse, it's really important that you have expertise in this area.

    00:33 So take a look at Jose and Enrique. Right? They're young. They're happy. They're handsome.

    00:37 Right now, they're not having any oropharyngeal or swallowing problems.

    00:43 Keep in mind, Jose is the one who experiences normal changes of aging.

    00:48 And Enrique is our example of someone who has those extra added medical problems. Right? He has what we call co-morbidities. So he's had a lot of major life and health events.

    01:01 So you're going to see the difference. Jose is what happens with just normal aging.

    01:05 Enrique is what happens when you have those comorbidities.

    01:10 Now, when you're in practice, you are going to see all kinds of clients and especially all kinds of senior clients.

    01:17 And when it comes to assessing their mouth, you are going to see things that you may not have visualized before.

    01:24 Now, some of them will look like Jose.

    01:27 Look, he looks like he's posing for a toothpaste commercial.

    01:30 It's bright, white, smiling. Yeah, those teeth look absolutely perfect.

    01:35 He's taking good care of his teeth, and he's not had any major health issues.

    01:40 But then we have his friend Enrique and even he knows he's had some challenges in this area.

    01:47 So as we all grow old, our oral hygiene and condition don't just affect how we look or our smile, but it can also affect our vital abilities like swallowing.

    02:00 Now, Jose knows when he goes out to dinner with Enrique, he might have more excitement than he counted on.

    02:07 Like this example when they went out to a Chinese restaurant and he had eaten some rice.

    02:14 So even something as pleasant as two friends being together can become something that could be dangerous.

    02:20 Now, don't worry. You see there that Enrique is clearly choking, right? He's got that panicked look on this face and his friend is helping him.

    02:29 This story ends fine. He was able to dislodge that, and he went right along.

    02:34 So don't even worry about that.

    02:36 But what I want you to do is walk with me now as we explore the changes that can be seen in our oropharyngeal system as we age and as we identify some care strategies that you need to know to help to promote successful aging in older adults and keeping in mind these age-related changes.

    02:56 Now, here we have who? Right, that's Jose.

    03:00 So we're going to start off with just normal changes of aging.

    03:04 Now, we've got a lot of colors there but this is really a great reminder for you.

    03:09 Let's go through this review. So start at the top. You'll see that is his nasal cavity. Right? Now, remember, we have him on a side view.

    03:17 So I'm looking at you directly on. He's looking at us, we have him on a side view.

    03:22 So you see of the nasal cavity. Got that? Right. We've labelled it for you, and you're following with us. Now, I want you to look at three glands.

    03:31 On the left, you'll see the parotid gland. On the right, you've got the sublingual gland.

    03:39 Now, there's one more gland in between the parotid gland and the sublingual gland.

    03:45 Can you remember what that's called? Right. It's the sub below mandibular gland.

    03:51 Okay. Cool. We've got the glands in. We've got the nasal cavity.

    03:56 And let's look at his teeth. So you see his teeth right there.

    03:59 His tongue and we already labelled the sublingual gland.

    04:03 So working from top to bottom on that side, we have the nasal cavity, his teeth, his tongue, and then the sublingual gland.

    04:13 Now, when you swallow like I just did, we're going to show you where that food goes.

    04:19 But I want you to have these structures in mind.

    04:22 So you may need to pause the video for just a minute and make sure you're very clear.

    04:27 Now, look as we're moving down. You see the pharynx. Right? Then, there's a submandibular gland, and then it leads to the esophagus.

    04:35 So when Enrique was choking. Right? When they had that little traumatic event in the restaurant, where was the food stuck? Well, if he couldn't breathe, it was likely stuck in his esophagus and was making it difficult for him to get air in.

    04:50 Okay. So, now, you've go the pathway. This is everything that we're looking at.

    04:54 We gave you a quick review, you're welcome, because we know that everyone needs a review when you're learning things, particularly, as much as you are learning in nursing school.

    05:05 Now, we're going to go down and look at the rest of the GI Track.

    05:09 So as you saw the esophagus went right on down, and there is his stomach.

    05:14 Now, food's going to go from the stomach, right? Into the duodenum, the small intestine, then the large intestines, and out through the colon and the rectum, and the anus. Okay? So that's how the food is going to move through.

    05:30 So you see, now, we have those labels up there for you. You see the stomach.

    05:36 And then you see the duodenum.

    05:38 And then we have the small intestine, the large intestine, and the anus. Okay.

    05:42 That's the travel of food from your mouth to your exit valve, right? That's where it goes. But there's a couple other things we want you to keep in mind.

    05:52 Now, what are some structures that we haven't identified yet? I want to leave them blank for you and see if you can fill those in.

    06:08 Okay. How many did you get? Did you find the liver? Yeah. We've got a great picture there. Now, what's tucked underneath the liver? It's your pancreas. Excellent. Remember, they're all connected in that hepatobiliary system.

    06:22 Now, there's one tiny little organ. What do we call that? Well, it's really not an organ.

    06:28 It's just kind of a cavity. Right? It's the appendix.

    06:31 So always use these times to remind yourself to review your anatomy because the more you visualize in your mind how your body works, the information is going to stick in your mind so much better.

    06:45 And that's really what we all want. Right? We want you to learn more, but we want you to be able to study less because what you're doing is really proven to be an effective strategy.

    06:56 So, hi, Jose. There he is again.

    06:59 We're going to talk about what else is involved in the oropharyngeal area.

    07:03 And we're talking about chewing. So you see we have the muscles of mastication.

    07:09 Mastication is a very big word just like we talked about, or the official and proper word of talking about chewing.

    07:17 That's what this part is on. So we're going to look at the muscles of mastication.

    07:21 We're going to talk about the health of their teeth.

    07:24 And we're going to talk about the production of saliva, because as we age, that can be a problem.

    07:30 Well, your mouth can be kind of dry. Right? So we'll talk about some strategies and things you can be aware of. So check, check, and check.

    07:40 As we're moving forward, tell yourself, "Alright. We have a scaffold.

    07:44 We're looking at these three things; muscles of mastication, teeth health, production of saliva." Want to be a rock star studier? Pause the video, look away from your notes, and see if you can recall the three things we're going to study without looking at your notes.

    08:11 Hey, welcome back. I hope you took advantage of that time.

    08:16 That's using a strategy called pause and recall.

    08:19 Anytime you force your brain to try to recall something without reading it in your notes, you are doing incredibly great work in helping that information go in your brain in an orderly fashion and in a way that you're going to remember it and be able to retrieve it. Keep in mind, just because you can read a word, doesn't mean your brain knows how to put it in in an ordered way.

    08:43 You take control of that system and I promise, your studying is going to be much more effective.

    08:49 So that was Jose. Now, we're looking at Enrique.

    08:53 Poor little guy. I mean, he's had so much go on in his life.

    08:57 And we're going to use him again as our poster boy for things that happen with comorbidities in the oral cavity.

    09:04 So we're going to look at his muscles of mastication, his teeth health, and his production of saliva.

    09:10 Well, it kind of goes without saying, whatever Jose is experiencing, Enrique will experience that and usually, on a more severe or intense level.

    09:20 So he is going to have some challenges in all these areas and more than Jose.

    09:27 That's why when they go out to eat, it can be, remember that dramatic scene at the beginning? Right. That can be a problem. So his teeth health, we're going to keep a close eye on that, and I'm going to explain to you why we have this increased risk for tooth loss because all the other things and inflammation that is going on in his body, you're an increased risk for gum disease and the eventual tooth loss.

    09:51 Now, at the bottom, remember we talked about that. The production of saliva.

    09:57 Well, it's even worse for Enrique. And it might be because of a disease process.

    10:03 Or it could be because of some type of medication that he's taking.

    10:07 So why is that problematic? Well, anticholinergic medications, we use them for lots of applications. It causes your eyes to dry out, your mouth to dry out.

    10:18 It can cause constipation, and they also cause urinary retention.

    10:22 All things that Enrique does not need to be made worse in his life.

    10:27 But if I don't have enough saliva, it's uncomfortable.

    10:31 Saliva is not available to help keep my mouth healthy.

    10:35 And that's why it makes it more difficult, another one of the reasons why it makes it more difficult for him to swallow.

    10:42 Okay. So we talked about Jose, right? Then we talked about poor Enrique in these three areas that the slight problems or changes that Jose will see will be magnified or exaggerated in Enrique because of his comorbidities.

    About the Lecture

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

    Included Quiz Questions

    1. Parotid gland
    2. Submandibular gland
    3. Sublingual gland
    4. Pituitary gland
    5. Pineal gland
    1. Disease processes and certain medications can decrease saliva production.
    2. Decreased saliva production negatively impacts mouth health.
    3. Saliva production naturally decreases with age to help prevent choking.
    4. Increased saliva production is common in the older adult.
    5. Anticholinergic medications increase saliva production.
    1. Dry mouth
    2. Inability to swallow
    3. Tooth decay
    4. Gum inflammation

    Author of lecture Introduction to Oropharyngeal Changes (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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