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