00:01
Let's play a game together.
00:04
Anytime you can incorporate
gains into your studying,
it's going to be more fun, which is
important because I get bored easily,
and it's going to help
it stick in your mind.
00:14
So I'm going to walk you through
a study tool that you can use
when I'm not with you on
a video that will help you
when you're comparing
one thing to another.
00:25
Now, in this case,
we're going to compare José's experience
that we've just talked
through in this series
to what Enrique is
likely to experience.
00:34
It's that P word
again, prediction.
00:37
The work your brain has to do those
mental gymnastics to try to predict
what Enrique is risks
or responses are,
are really going to help
you learn the content.
00:48
Okay, are you ready?
Now don't forget to include
the why of your prediction.
00:53
Let's try the first one.
00:55
So there's Enrique, we've got our
magic spinning wheel in the corner.
00:59
Do you see that?
So tell me if you can
predict Enrique's risks for
his ability to chew.
01:10
Okay, well, we know that José kind of
had, he might have some risks.
01:14
Remember, the mastication muscles are a
little weaker than when he was younger,
he might have some challenges with
teeth, of tooth loss.
01:22
So Enrique with all
of his health events,
he's going to have more
significant changes.
01:28
He'll have a harder time chewing,
he may have lost more teeth.
01:31
Because remember, José was like,
perfect toothpaste advertisement.
01:35
So his risks or his impact
is going to be bigger
when it comes to
his ability to chew.
01:41
Now if he can't chew well,
there's also another risk that
comes up with that, right?
He'll have some challenges
with swallowing, tooth loss.
01:51
Well, we know where this
is going to come from.
01:53
We already talked about it.
And I love the picture here, right?
So this is a bit
of a brain break,
but just take a look at
what they did for you.
02:00
They knocked out some of his teeth
in this graphic to help you remember
that Enrique's risk
for losing teeth
is greater than someone in normal
aging, like José.
02:11
Why?
Well, he's had lots of inflammatory
processes with all of his health diseases.
02:17
He has gum disease, so it just adds
up to a higher risk for tooth loss.
02:24
Now, dry mouth.
02:26
We said that José might have
a slight risk of dry mouth.
02:30
But Enrique,
what do you think his risk is?
So I'm going to pause
and let you think.
02:39
Right, his risk is greater.
02:41
That's a good answer,
but not good enough.
02:44
I want you to dig down a thing,
know specifically what's
different for Enrique than José?
Well, Enrique is more likely to be on
medications that can cause a dry mouth.
02:58
You know that José has
less saliva as you age,
but Enrique is likely to experience
a really more significant dry mouth
because of his medications, because of his
aging, because of other disease processes.
03:11
This might really
be a risk for him.
03:15
Now put all those
first ones together.
03:18
When you're looking at this,
what's the swallowing risk for Enrique?
Okay, we are probably fine and have
like, oh, it's worse or it's bigger.
03:27
You know that's really
not all you want to know.
03:30
What is it?
Why is swallowing a bigger risk?
How many things can you list?
So I'm going to pause and ask you to try
come up with like four examples or reasons
that he may have more
difficulty with swallowing.
03:48
Okay, so let's talk about it.
03:50
Why does Enrique have a bigger
challenge with swallowing?
Well, just the things
we've talked about, right?
He might have more tooth
loss, he has weaker chewing,
that means he's not going to be able to
grind his food into small enough bites.
04:04
So they're going to be bigger,
that's an obvious risk for chewing.
04:08
So that was like, wow, teeth,
muscle mastication, his ability to chew
that's gonna be less,
he's gonna have a drier mouth
from some of the
medications that he's on.
04:18
And then you remember those
esophageal sphincters.
04:21
Remember, they don't have the control
that they would in someone like José.
04:25
So for all those reasons,
Enrique has a much higher risk to
choke or to aspirate something,
so swallowing is going to
be more problematic for him.
04:38
Now, GERD is gastroesophageal
reflux disease.
04:42
We know that José,
our example of normal aging
does have an increased risk
to develop this as he ages.
04:48
But Enrique had some
different things.
04:51
Can you remember the reasons why Enrique
has an even greater risk for GERD?
Excellent, I think some of you are
really starting to get that out there.
05:06
Well, we know that Enrique has a
little barrel around his body, right.
05:11
He carries his weight
all right around here
and he is carrying extra
rate than his friend José,
who is very trim and very fit.
05:20
So extra weight also put you
at increased risk for GERD,
aging puts you at an
increased risk for GERD.
05:26
And with all the other health
issues he's experienced,
those also add to additional
risk for developing GERD.
05:33
So José versus Enrique,
you're seeing a really common theme.
05:38
Normal aging,
there should be a minor risk.
05:41
Aging with comorbidities like
Enrique with other risk factors,
there's a lot higher risk
for him to develop GERD.
05:50
Now, what about NSAIDs?
We know that geriatric clients
particularly take a lot of NSAIDs.
05:56
Because they can get
it over-the-counter
or they have a prescription written
by their healthcare provider.
06:01
But when you take the medication
for the aches and the pains,
it can increase your
risk for an ulcer.
06:08
So we call these
NSAID-induced ulcers.
06:11
Now José feels pretty good.
06:13
He still runs,
he's not taking a lot of NSAIDs.
06:17
So his risk is minimal,
simply because he's not taking many NSAIDs.
06:22
Enrique,
look at this little guy.
06:24
I mean, his facial
expressions are priceless.
06:27
They kind of help you
see the problem there.
06:30
He's on NSAIDs.
06:32
Look, he has to have a
cane to help him walk.
06:35
He has difficulty with mobility.
06:37
So it's not much of a
stress for you to think,
"Hmm, yeah, he probably has joint
pain, muscle pain,
he doesn't get around very well."
So he likely is taking
a lot more NSAIDs.
06:50
And we know he's taking
more NSAIDs than José.
06:53
So his risk for an NSAID-induced
ulcer is clearly higher than José.
06:59
But we know why.
07:01
Because of his
other health issues,
he's going to be taking
NSAIDs on a regular basis.
07:06
Remember,
NSAIDs suppress prostaglandins,
which means he's going to have less
protective mucus and bicarbonate
in his stomach lining to protect
him from developing an ulcer.
07:19
This is the weird one, right?
Diverticulosis,
we know there's some change in that,
the wall, the large intestine,
but who has a higher risk?
Okay, well, that's an easy one.
07:31
Of course, Enrique has a higher
risk, we got that.
07:34
But why? Why is that?
Well,
his changes are exacerbated.
07:40
His wall would be weaker
because of all the other
disease processes he's dealt
with and health events.
07:46
So he is more likely to
develop diverticulosis.
07:50
Those little pockets.
07:51
Remember, the wall of your intestine
should be straight and flat.
07:57
And each of those little
appendages you see sticking out
is a place for food or waste to get
trapped in and could cause infection.
08:04
And poor Enrique, it's just another
thing that he has a higher risk for.
08:10
Let me give you a
nursing tip here.
08:12
Now I know the thought of someone
dealing with bathroom issues
can be kind of uncomfortable
to talk to them.
08:20
But the biggest favor
you can do your patient
is to act like it is no
problem for you to discuss it.
08:27
So maintain eye
contact with him,
have kind eyes when
you talk to them,
and just ask them
about the risks.
08:34
So if I was dealing
with Enrique,
I would ask him if he's had any trouble
controlling his bowel movements.
08:40
Does he feel like he recognizes when
he needs to have a bowel movement,
and he's able to get to
the bathroom in time.
08:47
Again, straight face, eye contact,
acting like it's no big deal.
08:52
Of course, all of us would know if
you're having a challenge with this,
it could potentially be
difficult to talk about.
08:59
But that's what our
job is as nurses
to take things that might feel
uncomfortable for patients,
and make them feel comfortable and
safe when they're talking to us.
09:09
So José might have some
rectal elasticity changes.
09:13
But really, he's going to be aware,
more aware of when he needs to defecate.
09:18
Enrique, on the other hand,
just like you have predicted,
it's going to be more
difficult for him.
09:24
So we have more significant
changes to his rectal elasticity.
09:27
And remember, we need it to be
able to contract and expand.
09:31
And he may not be as aware
of his urge to defecate.
09:35
You as the nurse are the key
to getting that information
for your patient in a
compassionate and kind way.
09:42
Because this could be life
changing for a patient.
09:46
If you can help them
resolve some of this,
they're not going to be as
afraid to go to a social setting
or somewhere where they're not
sure they can get to a restroom.
09:54
So remember that,
we're here to advocate for everyone.
10:01
Okay,
what about digestive capacity?
Well comparing José to when he was
young, what do you remember?
Right,
José couldn't eat as much.
10:13
What about Enrique?
Yeah, same deal.
10:17
He's going to experience those things
and maybe to a larger proportion,
but just won't have the
same appetite, right?
His taste buds have changed.
10:26
And because of the medications,
and other comorbidities he's had,
his taste buds might
be even more blunted
or not able to pick up salty
and sweet flavors as José.
10:37
So there you go.
10:38
Poor Enrique, this story does feel
sadder and sadder, doesn't it?
Oh, this is a serious one.
10:45
What was José risk of diabetes?
What do you think
Enrique's risk is?
Well, sadly, right, it matches
that reading on that glucometer,
it's probably pretty high.
11:01
Because we know,
we may not have got to tell you yet
that he has a family
history of diabetes.
11:08
We also know that he's
carrying some extra weight.
11:11
And it's right
around his middle,
which puts them in an increased
risk for metabolic syndrome.
11:16
So his risk for
diabetes is also high.
11:20
Because he doesn't
move around much.
11:22
He's very sedentary
as difficulty moving.
11:25
So all of those things add up,
family history, sedentary
lifestyle, extra weight,
and right around the middle.
11:34
Enrique has a much higher
risk to develop diabetes.
11:37
But what was the part
about metabolism?
What particular incident do
we talk about that's different
in geriatric metabolism
than when they're younger?
Did you guess carbohydrate?
Right.
11:54
Remember, that's just one more reason
why is it an increased risk for diabetes.
12:01
Gallbladder disease?
Well, we know José could have
an increased risk for that.
12:06
But what about Enrique?
What would be different
in his world or his life
that would put them at a
higher or a lower risk?
Yeah I know, I'm not fooling you,
you know, it's gonna be a higher risk.
12:18
But can you think about why?
Well, as we age,
things are slowing down,
you do have a higher risk
for gallbladder disease.
12:25
But think about Enriquez diet.
12:28
He likely has a higher fat,
lower fiber kind of diet,
which could also put him in an
increased risk for gallbladder disease.
12:38
Liver function.
12:40
Now think about the normals
that we talked about with José.
12:43
We talked about the blood flow
and how it functions as a factory.
12:47
We know that it's not going to be at the
same capacity as when they were young.
12:52
So as long as the liver
isn't overstressed in José,
you should be relatively okay.
12:59
But if you are hammering your
liver with other substances
that are difficult or
hard on your liver,
you're gonna have an even bigger
impact on your liver function.
13:09
Well,
José has been a teetotaler.
13:12
Enrique has not.
13:14
And there's been times
when he hasn't really had
really good control of how
much alcohol he consumed.
13:23
So what does that do
for his liver risk?
That's right.
13:28
You're gonna see as an increased risk
to have decreased liver function.
13:35
So let's give a real
specific example.
13:37
We already talked about alcohol.
13:38
But let's look at
benzodiazepines.
13:41
Well, in general, for geriatric
patients, including José,
we want to be very careful with these
because it's metabolized by the liver.
13:50
What about Enrique?
Think about what you
know about his liver,
about his lifestyle,
about his health history.
14:00
Right, Enrique is going
to be at even higher risk
if he's receiving
benzodiazepines.
14:06
So the health care provider,
the physician, the nurse practitioner,
the person who is writing a
prescription for these medications
is going to be very
careful about dosage.
14:17
And then they'll need close monitoring
after taking benzodiazepines.
14:21
Oh, look at poor Enrique.
14:23
Now we talk about infections
and inflammatory diseases.
14:26
Remember,
let's talk about infections.
14:28
What is the difference between
José, young José and old José
and how he would
respond to infections?
Remember, as we age,
your ability to fight off infections
can be lower or less than
when you were younger.
14:45
Look at Enrique.
14:47
Yeah, he's going to have an even
harder time fighting off infections,
because of all of his comorbidities
and the impact on his immune system.
14:55
And inflammatory GI disease is
one particular example we used
in this video series because he wanted
you to focus on the area of the body.
15:03
So yeah, he's at an increased risk for
infectious and inflammatory GI diseases.
15:09
And we won't necessarily
recognize that he's in trouble,
because he doesn't have
that strong immune response
that he would have
as a younger man.
15:19
Okay, remember,
here's our framework.
15:21
These are the three things
you want to think about
whether it's an
end of course exam,
the NCLEX exam,
but most important to all of us,
when you're caring for live
human valuable geriatric clients.
15:35
You think you can go back
and recognize the differences
between normal aging from
the pathological processes?
Can you recognize
the differences?
Can you list those?
Can you remind
yourself of those?
Do you understand how
age-related changes
can predispose older
clients to certain diseases?
Now in this video,
we talked about,
"Wow, Enrique had the risk
factors for developing diabetes."
Remember those?
Yes, pay key attention
to risk factors,
mostly because that's
our role as nurses
to help gently educate patients
about their risk factors,
and guide them through the steps
to start taking positive steps
towards minimizing those risks.
16:16
Lastly, you want to know how the
interaction of just normal aging
and how they present in symptoms, how they
respond to treatments, and their outcomes,
make sure you're aware on how this is
different for our geriatric clients.
16:30
Now, here's our NCSBN nursing
clinical judgment model.
16:33
I know it looks intimidating.
16:35
And I say that every
time I show it to you,
but please notice, all this is is a visual
representation of how good nurses think.
16:45
This just gives you a systematic
way that you can break down
how you're going to
think through a problem.
16:51
So take a look at the bottom, you'll see
that nurses recognize and analyze cues.
16:56
Okay, stop right there.
16:58
Nurses need to recognize cues
and be able to analyze them.
17:03
That's why we do what we do.
17:04
That's why you're spending
time in this video series
and answering practice questions
and doing spaced repetition.
17:11
Because we want you to be very
aware of what the cues are
and what those cues mean.
17:18
So that you don't miss
something in a possible way
that you can help a patient be healthier
or have a better quality of life.
17:26
So that's why we go
over all the cues
and we want you to know
how to put them together
so you can form a hypothesis and what's
the next best step for your patient.
17:36
Thank you for watching us
in this video series today.