Metabolism (Nursing)

by Rhonda Lawes, PhD, RN

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    00:02 I wish I had better news about metabolism.

    00:04 But as we age, it also goes through some changes.

    00:08 Now, particularly, I want you to pay attention to carbohydrate metabolism.

    00:12 This is one of the big risks that changes with aging, particularly if your client has a family risk of developing diabetes, because carbohydrate metabolism changes is going to increase their risk for diabetes.

    00:26 And if they already have a genetic predisposition to have diabetes, it could accelerate this.

    00:31 So keep in mind, we know that the metabolism is different.

    00:35 As we age, carbohydrate is one of the main things I want you to focus on, because you want to ask key questions about, do they ever feel really thirsty? Have they noticed an increase in the amount of urine? Those classic questions we asked to assess for the signs and symptoms of diabetes.

    00:54 Now let's talk about the gallbladder.

    00:57 So we're looking at the gallbladder.

    00:59 You know, that's that little tiny organ that's meant to just house bile.

    01:03 The liver makes the bile, stores it in the gallbladder.

    01:07 And then when it's needed, like when you eat or it's stimulated with high fat food, it'll squish out the bile into that biliary common bile duct.

    01:16 So age-related changes, we know that as you age, you're going to have an increased risk of gallstones.

    01:22 In fact, my dad had his gallbladder until he was about 78 years old, and then it had to go.

    01:30 So know that your patients are at an increased risk develop gallbladder disease, particularly with the development of stones.

    01:37 Now the liver is pretty big organ.

    01:39 It's a super cool organ.

    01:41 It does so many things.

    01:43 But right here, we're going to focus on what are the things that happened to it structurally.

    01:49 Now, the blood flow to the liver is how it all works, right? It's like this giant filter, and it's a factory that does all these things.

    01:56 But as you age, blood flow starts to decline as it's going through the liver.

    02:02 So it's not perfused as well, which is pretty much like the rest of your body, but it has less perfusion as you age.

    02:10 Now, the reserve capacity is enough to maintain function.

    02:14 So you know, we talked about how mostly if people are at rest or their body is not stressed, they're doing fine.

    02:20 But if we stress that organ or that system, it's harder for a geriatric patient to respond.

    02:28 So the liver enzymes will remain normal.

    02:31 If there's no other problems with the liver, those should remain normal.

    02:35 But you are more susceptible to the things, we've talked about overloading that liver.

    02:41 Well, things like alcohol and tobacco and other stressors can damage the liver.

    02:46 And it takes a lot of the livers energy to process that alcohol.

    02:51 So as you age, that's going to be different.

    02:54 Now, we talked about the liver not functioning the same when you go after drugs with the P450 system, right? That's that cytochrome P450 system that you study in pharmacology.

    03:06 It's not working the same as when he was younger.

    03:10 So this might impact the clearance of some medications, including things like benzodiazepines.

    03:16 And that's why you want to be very careful with administering benzodiazepines to geriatric clients and monitoring them very closely.

    03:25 Now lastly, geriatric patients have an increased risk for adverse reactions related to the dosage.

    03:33 Okay, so usually these medications have to be adjusted by the healthcare provider.

    03:38 And it's really not a simple process.

    03:40 Each geriatric client deserves a healthcare provider, a physician, a nurse practitioner, who is skilled in gerontology and knows how to adjust the dosages of different medications to keep the administration safe for each patient.

    03:56 Are you ready for another question? Why did geriatric clients have a higher risk for infections and inflammatory disease of the GI tract? So pause and take a minute and see if you can answer that question.

    04:15 Okay, let's talk about three of those reasons.

    04:18 First of all, remember the immune response as we age is less rigorous, so we can't fight back as hard.

    04:26 That's why we always encourage vaccinations in our elderly population, because they don't have the immune response that they used to have.

    04:35 It also leads to geriatric patients present in an atypical manner.

    04:39 They may not show you things like fever that they normally would with an infection.

    04:44 So keep that in mind.

    04:45 First reason why they have a higher risk for infections and inflammatory disease of the GI tract is they have a higher risk for infections, because we don't necessarily pick them up as early because they don't have similar symptoms to someone in their 30s or 40s.

    05:04 Now that isn't all, our saliva, one of the way it protects us is that has an antimicrobial action.

    05:11 But as we age, it is less antimicrobial.

    05:15 And remember, patients also experienced a drier mouth.

    05:19 So we have less saliva, and the saliva they do have has less antimicrobial activity.

    05:27 Third option.

    05:28 They're in higher risk for infections and inflammatory diseases of the GI tract as you age.

    05:34 Remember, we talked about diverticulosis and the weakening of that wall, which can lead to those little pockets, the diverticuli that can become infected.

    About the Lecture

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

    Included Quiz Questions

    1. Carbohydrates
    2. Fats
    3. Proteins
    4. Minerals
    1. The risk of gallstones increases.
    2. Blood flow to the liver increases.
    3. Liver enzymes decrease.
    4. The Cytochrome p450 system remains unchanged.

    Author of lecture Metabolism (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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