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Chapter 17 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

JasminFlorian
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Chapter 17 Elimination

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  1. Chapter 17Elimination

  2. 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

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

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

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

  6. 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.

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

  8. 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

  9. 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.

  10. 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.

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

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

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

  14. 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

  15. 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.

  16. 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.

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

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

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

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