Key GI Assessment Questions (Nursing)

by Rhonda Lawes, PhD, RN

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    00:01 Welcome to our series on Geriatric Nursing.

    00:04 In this one, we're going to look at the age related changes in health, specifically, gastrointestinal tract changes.

    00:11 You may know that as the GI tract.

    00:13 Now here's our framework, this is what we're looking at throughout the video.

    00:17 We want to make sure you can recognize normal aging, from pathological processes, right and know what to do to develop appropriate interventions.

    00:27 We want you to be able to understand how age-related changes can make you more likely to have a certain type of disease.

    00:34 Last, picture you can recognize the interaction of normal aging, and how the symptoms response to treatment and outcomes might present for each of your patients.

    00:45 So here's that model.

    00:46 Remember, it's teaching you how to recognize a systematic way of thinking through how you make a sound and safe clinical judgment.

    00:56 So you're gonna have to recognize and analyze cues.

    00:59 And that's what this video is all about.

    01:02 So you're going to recognize those cues, analyze those cues, and I'll give you the foundation for starting to form hypotheses when you're making clinical judgments with geriatric patients.

    01:12 So when we talk about assessment cues, here they come.

    01:18 So let's take this kind of setting here where our nurse is talking to Jose.

    01:24 And so I'm going to talk about key GI assessment questions that he could ask Jose, to really make sure that even though Jose looks fit and happy, there may be things that he didn't think to tell you, or that you could help him recognize he's experiencing.

    01:39 So let's start with an example of the first question.

    01:42 He would ask Jose, have you experienced a change in your appetite? If they say yes, you're going want to ask them if it's increased or decreased.

    01:51 We're going to ask them if they have any nausea or vomiting, if they've had pain in their stomach or their abdomen, if they've had any change in their bowel habits, if they've had episodes of diarrhea, or constipation, or we're going to ask them if they choke or cough, often when eating.

    02:08 Now we know based on the rest of this video series why we're asking those six questions, but let's walk through it as if it was in a real setting.

    02:17 So you see our nurse, notice that he's sitting down, Jose is sitting down.

    02:22 So you want to be at eye level with your client.

    02:26 Where's his computer? Yeah, it's not in front of him.

    02:31 He's not making eye contact with his computer, and typing while he talks.

    02:35 He's having a conversation with Jose, so that's what's important.

    02:40 If you want to really develop a therapeutic relationship with your patient, you have to practice active listening.

    02:47 And that cannot be accomplished in building trust if you're looking at your computer, rather than looking at the patient.

    02:54 So we're very specific to put this graphic here to remind you, now the nurse has asked Jose about his changes in appetite.

    03:02 These are the cues that he'll be listening for.

    03:05 So say for example, we know that a geriatric client normally has a decreased appetite than what they used to have when they were younger.

    03:13 So Jose is either going to say he has a decreased appetite, or an increased appetite.

    03:19 Either one of those two possible answers, we need to make sure that we do more follow up, right? So if he has an increased appetite, we definitely need to figure out why that is, maybe he's more active, or maybe there's something else going on.

    03:35 Developing diabetes can also cause an increase in feelings of hunger, because that patient can get that energy out of their bloodstream and into their cell.

    03:44 But let's go back to the decreased.

    03:46 I wanted to hit that one, because that can sometimes be more common, what you'll experience.

    03:50 So if they tell you that they're decreased, we really need to ask some more questions.

    03:56 We want to figure out if the client is at risk for malnutrition, we want to look at their weight and their lab values.

    04:02 So we can get a really clear picture as we're continuing to recognize cues, analyze cues, and develop our hypothesis.

    04:12 So you can explain the regular things to geriatric clients that their stomach has floor emptying and ask them what they think has happened.

    04:22 Patients are the experts on their own bodies.

    04:25 Trust what they report to you what they're feeling and what they're experiencing, especially if it's different from what you anticipated, because that will just give you more cues and ideas of where you need to dig deeper.

    04:38 You know, I tell students, you are the expert on your brain.

    04:42 And if I can just ask you some of the right questions, we can develop a better study plan.

    04:47 Same thing works when taking care of any patient, treat them as an expert.

    04:53 Don't talk down to them.

    04:55 Don't talk to them like they're a child.

    04:57 Treat them as they're an expert and you are just an observer or you're just the one who's supposed to ask really good, respectful questions to get the right information out of them so you can put the whole picture together.

    05:12 Now the next question.

    05:13 He's going to ask, have you had any nausea or vomiting? I don't like either one of those, but let's get back to our story.

    05:20 So the nurse is talking to Jose and asked him this question.

    05:24 Well, we're gonna keep in mind that we know that Jose has slower stomach emptying, he has more increased acid in his stomach, because he has less mucin.

    05:34 He has an increased risk for GERD.

    05:36 But we're gonna have to dig in deeper and find out what's going on with his nausea because nausea impacts your desire to eat, right.

    05:44 He already has a less of an appetite, because of his age.

    05:47 If he's nauseated, he's really not going to be interested in eating.

    05:52 If he's vomiting, then we've got some challenges with fluid and electrolyte imbalances.

    05:57 And sometimes, older men, especially, really want to avoid drinking, if they have some prostate issues because they don't want to have to get up and down to the bathroom more often.

    06:09 So when we ask this question, we're just looking for just kind of open and a broad type of question.

    06:16 I know it looks like a yes, no but once we get that initial, if we get a yes, these are the kinds of things we want to have in the back of our mind as we're analyzing the cues.

    06:26 Remember, we also check with the elderly clients.

    06:30 If they have nausea, they may be experiencing constipation and not be aware of it.

    06:35 So if they tell you they're experiencing nausea, keep that in mind as you continue through these questions.

    About the Lecture

    The lecture Key GI Assessment Questions (Nursing) by Rhonda Lawes, PhD, RN is from the course Assessment of the Geriatric Patient: Gastrointestinal System (Nursing).

    Included Quiz Questions

    1. “Have you noticed if you have lost any weight recently?”
    2. “That is normal for someone your age.”
    3. “Don’t you know you need to eat more not to become malnourished?”
    4. “It is very unusual for your appetite to be decreased; I will let the doctor know.”
    1. Gastric emptying slows.
    2. Stomach acid decreases.
    3. Appetite increases.
    4. The risk for gastroesophageal reflux disease decreases.
    1. It can be caused by constipation.
    2. In male clients, it is usually the result of prostate enlargement.
    3. The risk for nausea-related dehydration is reduced in older adults.
    4. It is always accompanied by diarrhea.

    Author of lecture Key GI Assessment Questions (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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