Chapter 17 Elimination Age Related Changes Affecting Elimination

Chapter 17 Elimination

Age Related Changes Affecting Elimination • Loss of nephrons; approximately 50% decrease in glomerular filtration rate • Decreased resorption of glucose from filtrate; less concentration of urine • Weaker bladder muscles; decreased bladder capacity; slower micturition reflex; prostate enlargement

Age Related Changes Affecting Elimination (cont. ) • Decreased colonic peristalsis; duller neural impulses for signal to defecate • Weaker respiratory muscles; inefficient cough response

Symptoms of Urinary Retention • Urinary frequency • Straining • Dribbling • Palpable bladder • Feeling that the bladder has not been emptied

Measures to Enhance Voiding • Voiding in upright position • Massaging bladder area • Rocking back and forth • Running water • Soaking hands in warm water

Effect of Altered Renal Filtration • Reduced renal filtration can affect the elimination of drugs. • Altered renal filtration can affect the renal threshold for glucose. – The elderly can be hyperglycemic without evidence of glycosuria. • Urinary incontinence is not a normal finding – Age related factors increase the risk for this problem.

Reasons for Increased Constipation in the Elderly • Slower peristalsis • Inactivity • Reduced food and fluid intake • Drugs • The ingestion of less bulk food

Reasons for Increased Constipation in the Elderly (cont. ) • Decreased sensory perception causing signal for bowel elimination to go unnoticed • Tendency toward incomplete emptying of the bowel with one bowel movement

Problems Associated with Chronic Laxative Use • Dehydration – Diarrhea can occur and deplete fluids rapidly. • Electrolyte Imbalance – The high amounts of sodium and other substances in laxative preparations can alter blood levels of electrolytes.

Problems Associated with Chronic Laxative Use (cont. ) • Digestion Disturbances – Magnesium-based preparations can reduce the already lowered amount of gastric acid. • Vitamin depletion – Fat-soluble vitamins A, D, K, and E can dissolve in oil -based laxatives and be excreted.

Natural Measures to Prevent Constipation • Good fluid intake • A diet rich in fruits and vegetables • Activity • Establishment of a regular time for bowel elimination

Causes of Flatulence • Constipation • Irregular bowel movements • Certain foods • Poor neuromuscular control of the anal sphincter

Measures to Relieve Constipation • Achieving a regular bowel pattern. • Avoiding flatus-producing foods. • Administering specific medications intended for this purpose. • Sitting upright after meals.

Indications of a Fecal Impaction • Distended rectum • Abdominal and rectal discomfort • Oozing of fecal material around the impaction; often mistaken as diarrhea • Palpable, hard fecal mass • Fever

Correcting Fecal Impaction • Correct a fecal impaction promptly and carefully. – Use an oil retention enema. – If an enema is not effective, break up impaction with lubricated gloved finger. • Should be done only after consulting with a physician.

Excretion through the Skin: Changes in the Elderly • Perspiration and oil production are decreased, making less frequent bathing necessary. • Reduced hydration and vascularity of the dermis make the skin less elastic and more delicate. • Dryness, itching, and breakage of the skin can result from too much bathing.

Effects of Fasting • Coated tongue • Unpleasant taste • Halitosis • Increased body odor • Skin dryness • Fatigue • Dizziness

Effects of Fasting (cont. ) • Insomnia • Nausea • Aching joints • Reduced pulse and blood pressure • Cardiac arrhythmias may occur • Weight loss

Source • Eliopoulos, C. (2005). Gerontological Nursing, (6 th ed. ). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0 -7817 -4428 -8).