Introduction to Gastrointestinal Changes (Nursing)

00:01 Hi, welcome to our series on Geriatric Nursing where we're looking at age-related changes in health.

00:07 Now in this particular part, we're going to talk about gastrointestinal tract changes or the GI tract.

00:14 Here's our friends, José and Enrique.

00:17 This is when they were young.

00:18 And remember, José has experienced normal aging.

00:22 Enrique has had a bit of a rough go because he's had several major health events.

00:28 Now these guys hook up, they get together, they decide, you know, let's go back to that restaurant.

00:33 Remember, we used to go in the good old days, we would have those cheeseburgers and french fries, maybe drink a beer with that, maybe some bacon on the side of that, you know what I'm talking about, okay.

00:47 So they go back to their favorite restaurant from when they were young, and they decide to have lunch together.

00:53 And the food was as good as they remembered it.

00:58 So after they had great conversation, they caught back up with each other in their lives and their grandkids and all that's going on, they both part their ways and go back to their homes.

01:07 Now, here's where they have a very different experience.

01:12 Look at Enrique saying, "Oh, why?!".

01:15 He just feels miserable.

01:18 And he felt like his chest was on fire.

01:21 And he just kept burping and burping and burping.

01:24 I mean, this is not a pleasant experience.

01:27 So he wondered what's going on with José? Look at José, he's feeling perfectly fine.

01:33 It's chill, kick back, doing some reading.

01:36 So I hope you're starting to ask yourself, why is that? Well, I'm going to show you.

01:42 Stay with me and we'll talk about age-related changes that you experience in the GI tract with normal aging.

01:49 Remember with José as our example.

01:51 And then what happens with comorbidities.

01:54 And we'll use poor, Enrique.

01:57 So we're showing you here, the oropharyngeal area and how it connects down to the bottom of the GI tract, right? So we've got all these different structures here.

02:09 What I'd love for you to do is try to pause the video and try and label all those things that we have there.

02:16 So try and recall what are each one of these anatomical features.

02:20 And remember, it is to this side, so you want to see what you can label.

02:32 Okay, I hope you did that, because that will really help you cement that in your memory.

02:37 But we have the top the nasal cavity, then the white area is their teeth.

02:42 And that pinkish area is his tongue.

02:44 Underneath his tongue, you get the one sublingual gland and you've got the submandibular gland.

02:51 Now on the other side, you've got the parotid gland, the pharynx and the esophagus, which is the tube down to the stomach.

03:00 Now we're gonna slide on down to the stomach and look where you have there, you see the esophagus at the very top, Food is going to move through the stomach to the small intestine.

03:13 It's going to pick up things from the liver and the pancreas, right? It's got bile and it's got enzymes that will help break up that food.

03:20 It's going to travel through the duodenum and the small intestine to the large intestine, and then out of the body.

03:28 So this is another great example for you to get a visual on how this part of the GI tract is all connected.

03:35 It's a minimum expectation that each nurse understands the path that food will take from the mouth all the way through to the exit from their body as stool or fecal matter.

03:49 So as you age, you see young José, old José, know that the most important thing is that gastric motility slows down.

03:57 Okay, so your stomach moves in all different kinds of areas that kind of help you start to digest that food, but it's just not going to be as strong.

04:05 It's going to be a little slower than when he was a young man, that's an age specific change, right? That something that you would expect in normal healthy aging.

04:16 Now because that gastric motility is slowed down, the stomach is going to empty slower so foods going to be in there a little bit longer, have an increased risk of GERD that is gastroesophageal reflux disease.

04:30 So you want to keep this in mind.

04:31 This is a part of normal aging.

04:36 Here's one of our favorite strategies.

04:39 We know that asking yourself questions or even someone in your study group questions.

04:44 This is the best way to retain information.

04:47 So we've given you one here, let's see if you can answer it.

04:51 What common GI disease to geriatric clients have an increased risk of due to their decreased gastric motility and delayed MTA? Okay, that is a full on question like you could see on an exam.

05:06 So make sure you break that down.

05:08 Put it into your own words.

05:10 And even if you don't know the answer, just the effort of trying makes your studying that much more effective.

05:17 So we're breaking this down, we're looking for a common GI disease in geriatric clients that have an increased risk of getting because of their decreased gastric motility.

05:28 They're delayed emptying.

05:29 So what's your answer? If you said (GERD) Gastroesophageal Reflux Disease, you're right.

05:38 Okay, so we have the stomach there, we say it's a normal healthy stomach.

05:41 It's follow that gastric acid, and it's that lower esophageal sphincter that helps keep that gastric acid in your stomach.

05:50 Because your stomach can handle it.

05:52 Remember, it's got that mucus and bicarbonate that can protect that fragile lining.

05:56 And that lower esophageal sphincter is meant to keep that gastric acid in there because it is what I say, right? Acid, anywhere that bubbles up into the esophagus, you're going to have a burning sensation.

06:11 What did Enrique complain of after he had that cheeseburger and french fries? He felt like his chest was on fire.

06:19 This is why.

06:21 His esophagus isn't as good at keeping all that gastric acid in the stomach.

06:25 And so it's bubbling up into the esophagus, and it burns because it's acidic.

06:33 So let's compare the eating behaviors of young Enrique to old Enrique.

06:38 But before we go there, can you look at the expression on his face? It looks like such a little curmudgeon in this picture.

06:45 But we do that just because we want to emphasize that he's not feeling comfortable about things.

06:50 And these are the things that are challenging for geriatric clients.

06:54 So young Enrique, look at there, he could take back a whole pizza.

06:58 Reminds me of college days, when you watch Friends, take down a whole pie, right? They could do that without any problems.

07:05 But as we age, things change.

07:07 We already talked about your motility, your stomach changing, we've talked about GERD.

07:12 But there's some other changes.

07:14 They're going to be less hungry, so they don't have the same appetite that they used to had.

07:18 And that's pretty common.

07:19 I know when I eat with my mom and we give her just a moderate sized portion, she will usually cut that in half and make two meals out of it.

07:28 She just doesn't have the same appetite that she used to have.

07:32 Now also, when it comes to seasonings, their taste buds are different.

07:36 So if my mom is salting something for us, it's going to be, "Whoa".

07:41 It could be super salty because those flavors don't register as easily as they did when they were younger.

07:48 So between young Enrique and old Enrique, you're going to see a change in their appetite.

07:55 You're also going to see a change in their taste buds.

07:57 And now they can taste salty and sweet will be dampened or lessened.

08:01 But there's a real risk for malnutrition in the elderly.

08:05 There's lots of psychosocial factors, maybe their partner is no longer with them.

08:10 I know, my mom's a widow.

08:12 And it's just really not that exciting for her to eat a meal.

08:15 She's used to eating with someone who were married for 65 years.

08:20 When her husband passed away, when my dad passed away, she now eats all her meals by herself.

08:26 So she just doesn't feel like cooking things.

08:28 So we work really hard to make sure that she has prepared meals in an appropriate size, ready to go so all she has to do is just heat them up.

08:38 So keep that in mind, especially when you're nursing with clients look for malnutrition.

08:44 Weight is not always the best indicator of how nourished they are, or how good and healthy the food is that they're eating.

08:51 So be careful to be alert, to watch for the signs and to ask specific questions to help identify some of these challenges.