1. Chapter 17 Elimination

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, (6 th ed.). Philadelphia: Lippincott, Williams & Wilkins (ISBN 0-7817-4428-8).