Chapter 17EliminationChapter 17Elimination

Age Related Changes Affecting EliminationAge 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.)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 RetentionSymptoms of Urinary Retention

• Urinary frequency

• Straining

• Dribbling

• Palpable bladder

• Feeling that the bladder has not been emptied

Measures to Enhance VoidingMeasures 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 FiltrationEffect 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 ElderlyReasons 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.)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 UseProblems 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.)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 ConstipationNatural 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 FlatulenceCauses of Flatulence

• Constipation

• Irregular bowel movements

• Certain foods

• Poor neuromuscular control of the anal sphincter

Measures to Relieve ConstipationMeasures 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 ImpactionIndications 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 ImpactionCorrecting 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 ElderlyExcretion 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 FastingEffects of Fasting

• Coated tongue

• Unpleasant taste

• Halitosis

• Increased body odor

• Skin dryness

• Fatigue

• Dizziness

Effects of Fasting (cont.)Effects of Fasting (cont.)

• Insomnia

• Nausea

• Aching joints

• Reduced pulse and blood pressure

• Cardiac arrhythmias may occur

• Weight loss

SourceSource

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