Review of GI Risks for Geriatric Patients (Nursing)

by Rhonda Lawes, PhD, RN

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    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.

    About the Lecture

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

    Included Quiz Questions

    1. Immune response decreases with age.
    2. Aging decreases the antimicrobial effects of saliva.
    3. Changes to the intestinal walls increase the risk of inflammation.
    4. Colon motility significantly decreases with age.
    5. Blood flow to the intestines increases.
    1. Medication-induced dry mouth increases the risk of swallowing difficulties.
    2. The normal aging process significantly impairs the ability to swallow.
    3. Elderly clients with and without medical comorbidities have the same risk of developing swallowing difficulties.
    4. Tooth loss does not impact swallowing ability.
    1. Aging
    2. Medical comorbidities
    3. Obesity
    4. Plant-based diet
    5. Hypotension
    1. High fat, low fiber
    2. High fiber, high protein
    3. High carbohydrate, low fat
    4. Low protein, low carbohydrate
    1. Non-steroidal anti-inflammatory drugs
    2. Benzodiazepines
    3. Anticholinergics
    4. Opioids
    1. Small pockets push through the walls of the large intestine
    2. Backflow of gastric acid into the esophagus
    3. Ulceration in the stomach lining caused by prescription medication use
    4. Decreased rectal elasticity, leading to fecal incontinence
    1. Changes to carbohydrate metabolism
    2. Genetic predisposition
    3. Sedentary lifestyle
    4. Obesity
    1. Older adult clients with medical comorbidities are at high risk for developing swallowing difficulties.
    2. The risk of developing diabetes is the same for older adult clients with and without medical comorbidities.
    3. The normal aging process results in a significant decline in liver function.
    4. Only older adult clients with medical comorbidities are at risk of developing gastroesophageal reflux disease.

    Author of lecture Review of GI Risks for Geriatric Patients (Nursing)

     Rhonda Lawes, PhD, RN

    Rhonda Lawes, PhD, RN

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