Welcome to our series on Geriatric Nursing.
In this one, we're going to look at
the age related changes in health,
specifically, gastrointestinal tract changes.
You may know that as the GI tract.
Now here's our framework, this is what
we're looking at throughout the video.
We want to make sure you can recognize normal
aging, from pathological processes, right
and know what to do to develop
We want you to be able to understand how
age-related changes can make you more likely
to have a certain type of disease.
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.
So here's that model.
Remember, it's teaching you how to recognize
a systematic way of thinking through
how you make a sound and safe clinical judgment.
So you're gonna have to
recognize and analyze cues.
And that's what this video is all about.
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.
So when we talk about
assessment cues, here they come.
So let's take this kind of setting here
where our nurse is talking to Jose.
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.
So let's start with an
example of the first question.
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.
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.
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.
So you see our nurse, notice that he's
sitting down, Jose is sitting down.
So you want to be at eye level with your client.
Where's his computer?
Yeah, it's not in front of him.
He's not making eye contact with his
computer, and typing while he talks.
He's having a conversation with
Jose, so that's what's important.
If you want to really develop a
therapeutic relationship with your patient,
you have to practice active listening.
And that cannot be accomplished in building
trust if you're looking at your computer,
rather than looking at the patient.
So we're very specific to put
this graphic here to remind you,
now the nurse has asked Jose
about his changes in appetite.
These are the cues that he'll be listening for.
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.
So Jose is either going to say he has a
decreased appetite, or an increased appetite.
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.
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.
But let's go back to the decreased.
I wanted to hit that one, because that can
sometimes be more common, what you'll experience.
So if they tell you that they're decreased,
we really need to ask some more questions.
We want to figure out if the
client is at risk for malnutrition,
we want to look at their
weight and their lab values.
So we can get a really clear picture
as we're continuing to recognize cues,
analyze cues, and develop our hypothesis.
So you can explain the regular things to geriatric
clients that their stomach has floor emptying
and ask them what they think has happened.
Patients are the experts on their own bodies.
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.
You know, I tell students, you
are the expert on your brain.
And if I can just ask you some of the right
questions, we can develop a better study plan.
Same thing works when taking care of
any patient, treat them as an expert.
Don't talk down to them.
Don't talk to them like they're a child.
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.
Now the next question.
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.
So the nurse is talking to Jose
and asked him this question.
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.
He has an increased risk for GERD.
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.
He already has a less of an
appetite, because of his age.
If he's nauseated, he's really not
going to be interested in eating.
If he's vomiting, then we've got some challenges
with fluid and electrolyte imbalances.
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.
So when we ask this question,
we're just looking for
just kind of open and a broad type of question.
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.
Remember, we also check with the elderly clients.
If they have nausea, they may be experiencing
constipation and not be aware of it.
So if they tell you they're
experiencing nausea, keep that in mind
as you continue through these questions.