PHYSIOLOGIC ASPECT OF AGING

TERMS USED IN PHYSIOLOGIC ASPECT OF AGING GROWTH Is an increase in the physical size of a whole or any of its parts. This is manifested in length, weight, and width of the body. DEVELOPMENT Is the continuous, orderly series of conditions that lead to activities, and eventual patterns of behavior and education of the person. PATTERNS OF GROWTH AND DEVELOPMENT Are the variety of indications of growth and development that each individual displays from childhood to adulthood. However, there are some facts we have to take into consideration. CEPHALOCAUDAL DEVELOPMENT Is the process by which development proceeds from the center of the body outward to the extremities. DIFFERENTIATION Is the development from simple operations to more complex activities and functions. There is usually a sequential order in the stages that each child passes through during development. Each stage is affected by the preceding stage and affects the stages that follow. CRITICAL PERIOD Is the time period in which the child is especially responsive to certain environmental effects, and is sometimes called the sensitive period of growth and development. Positive and negative stimuli either enhance or deter the achievement of a skill or function. ANTICIPATORY GUIDANCE Is the process of understanding the upcoming developmental needs of the person from childhood to older years, including teaching caregivers to meet those needs.

THE DEVELOPMENT PROCESS OF AGING  From the early stages of growth and development, we are considered to be aging. GERMINAL PERIOD OF LIFE Is the period of conception to two weeks of life. EMBRYONIC PERIOD OF LIFE The life period of two weeks to eight weeks of life. FETAL PERIOD OF LIFE Is from eight weeks to 40 weeks.  From birth, we go through our infancy, toddler stage, preschool age and up to school age and onward to puberty, puberty proper and adolescence.  There is a need for parents and caregivers to know what to expect in every developmental stage. Emphasis should be focused on the following: 1. Health Habits 2. Prevention of illness and injury 3. Prevention of poisoning and accidents 4. Nutrition

With age. cardiac output stays nearly the same as the heart pumps more efficiently. GENETICS Diseases in the family may be inherited by unique genes that are linked to specific disorders: chromosomes carry genes that determine physical characteristics. WHAT IS NORMAL AGING? • • Individuals age at extremely different rates. Dental care 6. These influence the growth and development of the child. sexuality FACTORS AFFECTING GROWTH. PRENATAL AND ENVIRONMENTAL FACTORS This begins in utero. 3. traditions and attitudes of cultural groups influence the child’s growth and development in terms of physical health. CULTURAL FACTORS Customs. . DEVELOPMENT AND AGING  No two individuals age the same way or at the same rate. social interaction. Maximum breathing (vital) capacity may decline by about 40 percent between the ages of 20 and 70. Lungs. 2. radiation and chemicals. intellectual potential and personality.5. drugs.5 percent. Family structure and community support services influence the environment in the process of growth and development of the child. 4. It grows slightly larger with age. However. It includes nutrition from the mother. Physiologic Changes in Aging What are the physiologic signs of aging? • • There are normal aging signs and there are changes due to presence of diseases. infections. In fact even within one person. cigarette smoke. exposure to alcohol. Maximal oxygen consumption during exercise declines in men by about 10 percent with each decade of adult life and in women. However. 2. Not all physiologic changes are normal signs of aging. 1. the brain loses some cells (neurons) and others become damaged. organs and organ systems show different rates of decline. and assumed roles. The following are factors that affect the growth and development of a person. Brain. it adapts by increasing the number of connections between cells (synapses) and by regrowing the branch-like extensions (dendrites and axons) that carry messages in the brain. 3. 1. by about 7. FAMILY AND COMMUNITY A stimulating environment helps a child reach his/her physical potential. 5. NUTRITION This has the greatest influence on physical growth and intellectual development because adequate nutrition provides essentials for physiologic needs which in turn promote health and prevent illness. Heart.

Definitions     Normal vision: Visual Acuity of 20/20 or better Visually Impaired: Visual Acuity of 20/50 or worse Legally Blind: Best corrected vision of 20/200 or worse Totally Blind: No light perception Vision Changes common in older adults Presbyopia: A loss of elasticity in the lens of eye leading to a decrease in the eyes ability to change the shape of the lens to focus on near objects such as fine print and decreased ability to adapt to light. 6. roughness. moving spots. 11. . laxity. and changes in color vision. diffuse alopecia can also result from iron deficiency. visual acuity. Hearing. haziness. Body fat. SENSORY CHANGES Vision 30% of those over age 65 have some level of visual impairment. 9. Functional changes characteristic of aged skin include declines in cell replacement. Hair substantially grays in about 50% of persons by age 50. Sight. Without exercise. there is increased susceptibility to glare. Difficulty focusing close up may begin in the 40s. and thermoregulation. the same pattern of hair loss may occur after menopause. contrast sensitivity. In contrast. barrier function. wrinkling. It becomes more difficult to hear higher frequencies with age. However. But urinary incontinence. 8. by the time they reach their 60s. in the abdominal area. and increased incidence of neoplasms. Hearing declines more quickly in men than in women. flashing lights. The body does not lose fat with age but redistributes it from just under the skin to deeper parts of the body. 7. diffuse alopecia normally occurs in both sexes with age.   Cataracts: Clouding of the crystalline lens presents as painless. wound healing. From 50 on. dark adaptation. Muscles. men. although it is rarely pronounced. hypoproteinemia. Kidneys. hypothyroidism. and visual fields). They gradually become less efficient at extracting wastes from the blood. Cataracts are the 5th most common chronic condition in adults over age 75. After about age 30. 10. The development of drusen deposits in the retinal pigmented epithelium leading cause of central vision loss in older adults. Personality. 80% of men are substantially bald. In women. Hair loss from the vertex and frontotemporal regions (androgenetic alopecia) in men begins between the late teens and the late 20s. Skin. can often be managed through exercise and behavioral techniques. and more difficulty in detecting moving targets. or severe inflammatory skin disease such as erythroderma. 5. use of certain drugs (especially anabolic steroids and antimetabolites). chronic renal failure. the ability to distinguish fine details may begin to decline in the 70s. Age-related changes in ocular function may be divided into two groups: those related to vision (refractive changes. personality is stable. greater difficulty in seeing at low levels of illumination. and those related to eye comfort (foreign-body sensation and headache). Macular Degeneration: The most common cause of legal blindness in the elderly. immunologic responsiveness. More common in fair haired blue eyed individuals. Hair. both benign and malignant. Exercise can prevent this loss. which may occur after tissues atrophy.4. progressive loss of vision can be unilateral or bilateral. apparently due to loss of melanocytes. glare. Women are more likely to store it in the lower body (hips and thighs). Sudden changes in personality sometimes suggest disease processes. Bladder capacity declines. estimated muscle mass declines 22 percent for women and 23 percent for men between the ages of 30 and 70. Structural changes characteristic of aged skin include dryness.

Hypertensive Retinopathy: End organ damage from poorly controlled hypertension causing background and eventual proliferative retinopathy. Risk can be reduced by tight blood sugar control. The majority of cases of glaucoma are Open angle glaucoma (95%). Starts as nonproliferative and progresses to proliferative that should be treated with laser photocoagulation. Definitions  Hearing Impaired: Defined in Decibels (dB) or level of loudness o o o o o Mild hearing impairment 20 to 40 dB Moderate 40 to 55 dB Moderately severe 55 to 70 dB Severe hearing impairment 70 to 90 dB Greater than 90 dB is profound deafness.Other risk factors include smoking and excessive sunlight exposure. or go to the emergency room immediately if symptoms develop. trauma or be spontaneous. Diabetic Retinopathy: End organ damage from diabetes causing retinopathy and spotty vision. The client should see an ophthalmologist. Detached Retina: Can occur in patients with cataracts or recent cataract surgery. It presents as malaise. Increased intraocular pressure causing atrophy and cupping of the optic nerve head causing visual field deficits that can progress to blindness. intolerance to glare. Temporal Arteritis: Autoimmune disorder that causes inflammation of the temporal artery. Impact on Safety o o o o     Implication of Vision Change  Inability to read medication lables Difficulty navigating stairs of curbs Difficulty driving Crossing streets Reduces ability to remain independent Difficulty or unable to read  Impact on Quality of Life o o  Falls Hearing Hearing loss is the 3rd leading chronic condition affecting adults over 75 years of age. There are wet and dry forms of macular degeneration. unable to hear sound . Should see an ophthalmologist or proceed to the emergency room immediately. This vision loss is a medical emergency but is potentially reversible if identified immediately.  Glaucoma: A potentially serious form of eye disease. scalp tenderness. jaw claudication. Vision changes include loss of peripheral vision. Presents as a curtain coming down across vision. Usually treated with laser photocoagulation and tight blood pressure control. and sudden vision loss (usually unilateral). unilateral temporal headache. decreased perception of contrast and decreased ability to adapt to the dark.

Patients with tinnitus should be referred to ENT Meniere's Disease: characterized by fluctuating hearing loss. Conductive hearing loss: Involves the outer and or middle ear. and fibrous changes in the small blood vessels that supply the cochlea. viral or bacterial infections. noise exposure. Central auditory processing disorder: An uncommon disorder that includes an inability to process incoming signals and is often found in stroke patients and older adults with Alzheimer Dementia. and otosclerosis. diseases and tobacco use. z. Sensorineural hearing loss: involves damage to the inner ear. trauma. medications. Unable to hear car coming when crossing the road. Due to gradual loss of hair cells. Possible causes of Meniere's disease include: hypothyroidism. the cochlea. Changes in smell and taste common to older adults   Common changes in smell include a decline in the sensitivity to airborne chemical stimuli with aging. otitis media. Tinnitus: Ringing in the ears may fluctuate can be due to damage to the hair receptors of the cochlear nerve and age related changes in the organs of hearing and balance. . Common changes in taste include a decreased ability to detect foods that are sweet. tumors. This can be problematic for safety reasons. or the fibers of the eighth cranial nerve. dizziness and tinnitus.Hearing Changes common in older adults  Presbycusis: Loss of high frequency. Background noise further aggravates hearing deficit. Impact on quality of life Impairs ability to communicate with others o o   Diseases that alter hearing seen more frequently as people age    Implications of Hearing Changes  Adds to social isolation Leads to depression or low self-esteem Unable to hear instructions. diabetes and neurosyphillis. sh. The person's hearing is intact but their ability to process the sound is impaired. cardiovascular conditions. ototoxic drugs and Meniere's disease. Most changes in taste are thought to occur due to decreased sense of smell. Difficulty hearing high pitched sounds such as s. ruptured eardrum. Has a gradual onset is progressive and is bilateral. Causes of conductive hearing impairment include: cerumen impactions or foreign bodies. such as how to take medications. An inability to smell smoke for instance could put an older adult at risk. horns honking Unable to hear phone or doorbell ringing or knocking at the door (if emergency occurs may be unaware)  Safety issues o o o Smell and Taste The sense of smell and ability to identify odors decreases due to normal changes in aging. and ch. sensorineural hearing loss. Causes of sensorineural hearing loss include: hereditary causes.

and psychosocial support Acute Sensory Loss: May be due to a stroke. vomiting or infectious diarrhea. salivary dysfunction and diabetes. allergies. Diabetic neuropathy: End organ damage to the peripheral nerves from microvascular changes which occur with diabetes. Falls . analgesics.Diseases that alter smell and taste seen more frequently as people age Burning Mouth Syndrome : This is a sensation that one's tongue is tingling or burning. Implications of Taste and Smell Changes  Inability to smell o Effects quality of life -. tingling or lack of sensation and function in the effected extremity. Nutritional decline .inability to smell smoke in a fire or a gas leak. flowers or coffee brewing may not be detectable. There may be several contributing factors: Vitamin B deficiencies. An assessment of 894 participants in the Women's Health and Aging Study indicated that 58% of women showed evidence of neuropathy by age 65 (Vinik. The sensory cortex of the brain has influence in this mechanism. This pain is often chronic and requires special interventions to control and manage the pain including electronic prosthetics. B 12 and Folate. gastrointestinal disorders causing reflux. It is extremely important to teach diabetics and patients with peripheral neuropathy to provide special care to their feet. Will present with acute onset of numbness. Two-point discrimination and vibratory sense both decrease with age. o o  Decreased sense of taste o Peripheral Sensation Peripheral neuropathy is one of the most common neurological disorders encountered in a general medical practice with estimates of 2% to 7% of all patient populations having symptoms of neuropathy (Smith and Singleton. acute nerve entrapment in the spine or compartment syndrome due to trauma to a limb.due to inability to recognize position sense or inability to ascertain where feet are on floor. Diminished taste of favorite foods or beverages. Changes in peripheral sensation common to older adults    Peripheral nerve function that controls the sense of touch declines slightly with age. Common vitamin deficiencies which impact peripheral nerves include B 6. there may be a slowed reaction time for pulling away from painful stimuli with aging. local trauma. Peripheral neuropathy: Nerve pain in the distal extremities related to nerve damage from circulatory problems or vitamin deficiencies. Often leads to loss of sensation in the feet of diabetics leading to undetected trauma to the extremities which can lead to refractory infections due to poor vascular supply to the extremity. The ability to perceive painful stimuli is preserved in aging. May result in inability to recognize spoiled food resulting in nausea. Diseases that alter peripheral sensation seen more frequently as people age    Implications of Peripheral Sensation Changes  .inability to smell food aromas may reduce nutritional intake Safety hazard -. However. 2004).Scents such as smell of Christmas tree. 2004). Phantom Limb pain: The experience of pain that can range from dull ache to crushing pain where an amputated limb once was.

Notify the primary care provider of any acute change in vision. Avoid glare whenever possible. Nursing Care Strategies Vision     Avoid disruption in the management of chronic eye conditions by obtaining past history and assuring continuation of ongoing regimens such as eye drops for glaucoma. Annual dilated exam for patients with diabetes and hypertension by ophthalmologist Assess for cerumen impactions. Educate seniors to have carbon monoxide detectors in their home and to evaluate food with other methods other than sense of smell and taste. Encourage the use of the patient's eyeglasses. Request cerumen softening drops followed by irrigation (if needed) or ENT consultation. Have family provide lighted magnification if needed (these are the large magnifiers with a light attached. Get the person's attention and face them before speaking to assist the individual with lip reading. Take all complaints of inability or decreased ability to smell or taste seriously. Patient teaching should focus on safety issues with odors of gas and spoiled food. Calluses or serious foot lesions. Add contrast to the fixtures in the room if light switches blend into the wall or faucets blend into the sink. Have at least one Pocket amplifier on the nursing unit to use with hard of hearing individuals. Patient may need an ENT referral. calluses or red areas. Examine feet daily and inform primary provider if lesions. Encourage annual eye exams either with an Optometrist or Ophthalmologist. Before sending bed linens or clothing to the laundry make sure the patient has hearing aid is in their ear or in their designated location (bedside table or medication cart) Notify the primary care provider of any sudden change in hearing. Do not shout at people with hearing impairments. If this is an abrupt change in taste or smell notify primary care provider. Referral to audiologist and/or ENT as indicated. use brush provided to gently clean the tubes to reduce wax accumulation. but rather use lower tones of your voice. Assure appropriate care for hearing aids: remove batteries out at night. You can get them at low vision centers). Provide written instructions (use large black marker if person also is visually impaired).    Hearing         Taste and Smell    Peripheral Sensation   . Clean and thoroughly dry feet prior to applying lotion. a common compensatory mechanism for older adults. Encourage the use of good lighting in patient rooms.

Evidence of fall precautions for all older patients with sensory impairments.    Expected Outcomes     Communication and Aging Communication Changes… • • • • • • • • Expansion of semantic memory (expressive and receptive vocabularies – fact based memories) Word finding problems Changes in auditory acuity Increased loquaciousness (talkativeness) Declining speaking rate Frequency of men in speaking increases and that of women generally drops Tip of the Tongue phenomenon (TOT Phenomenon) Common Communication Disorders Aphasia – – • Is a syndrome of language problems that result from focal damage. Avoidance of accidental exposure to toxins either in the air or in food due to decreased sense of smell or taste. Most medical supply places carry diabetic healing shoes that have wide toe boxes and Velcro closed often under $50. usually of rapid onset Caused most frequently by CVA’s. Avoidance of falls and injuries to extremities with decreased sensation of lower extremities. Baseline visual acuity and hearing acuity for all older patients will be performed prior to discharge from the hospital. Refer diabetics to facilities with Certified Diabetes Educator. Implement fall precautions and initiate referral to physical therapy for diabetics with peripheral neuropathy. Ensure or have family bring in adequate foot wear that protects the individual's feet. age-related cognitive problems and dementia • Parkinson’s disease – A progressive degenerative neurological disorder that results from disruptions to the substantia nigra and its dopaminergic neurotransmitter system • Dementia – – An acquired progressive degenerative syndrome that affects multiple cognitive systems and processes Memory impairment plus any of the following: • Language problems . Refer older adults with decreased sensation to a podiatrist for ongoing foot care. but can occur as a result of traumatic brain injury (motor vehicular accident) Mild cognitive impairment (MCI) – Considered a transitional state between normal. home care or nursing home.

Sitting in front of them may also reduce distractions. – The most common complaint patients have about their health care providers is that they don’t listen. do not assume that patients will understand even basic medical terminology. such as other people and background noise. you should aim to give patients your full attention. • Avoid distractions. older patients are going to require additional time. you can “create the impression that a meaningful amount of time was spent with them. etc. It tells patients that you are interested in them and they can trust you. • Maintain eye contact. so be conscious of whether you are really listening to what older patients are telling you. – Patients want to feel that you have spent quality time with them and that they are important.• • • • Movement programming problems (apraxia) Perceptions stripped of meaning (agnosia) Disturbance in executive functioning (such as planning. In addition. • Sit face to face. Do not appear rushed or uninterested. comfortable atmosphere that may result in patients opening up and providing additional information.) Strategies in Improving Communication on the Elderly Allow extra time for older patients. • Use short. Do not use medical jargon or technical terms that are difficult for the layperson to understand. When possible. – The rate at which an older person learns is often much slower than that of a younger person. – Because of their increased need for information and their likelihood to communicate poorly. – Some older patients have vision and hearing loss. Instead. – Eye contact is one of the most direct and powerful forms of nonverbal communication. and what they have to say to you. Therefore. to be nervous and to lack focus. This simple act sends the message that what you have to say to your patients. Researchers have found that patient compliance with treatment recommendations is greater following encounters in which the health care provider is face to face with the patient when offering information. Researchers recommend that if you give your patients your undivided attention in the first 60 seconds. learn and commit to memory. clearly and loudly. Many of the problems associated with noncompliance can be reduced or eliminated simply by taking time to listen to what the patient has to say. make sure you use words that are “familiar and comfortable” to your patients. Speak clearly and loudly enough for them to hear you. • Listen. . – Simplifying information and speaking in a manner that can be easily understood is one of the best ways to ensure that your patients will follow your instructions. Your patients will sense it and shut down. • Speak slowly. the rate at which you provide information can greatly affect how much your older patients can take in. reduce the amount of visual and auditory distractions. is important. organizing ideas. and reading your lips may be crucial for them to receive the information correctly. making effective communication nearly impossible. simple words and sentences. Maintaining eye contact creates a more positive. but do not shout.” Of course. Good communication depends on good listening. Don’t rush through your instructions to these patients.

creatinine. • Give patients an opportunity to ask questions and express themselves. Pictures can be particularly helpful since patients can take home a copy for future reference.  Filtration by the Nephrons     H2O. This will allow you to explain important information in a series of steps. ½ in diameter in adult Peristaltic waves  Renal colic Bean shaped organs Either side of vertebral columns T12 – L3 Right kidney lower due to liver Urine produced with filtration of blood through nephrons Major role in fluid & electrolyte balance . detailed explanation to a patient. give your patients ample opportunity to ask questions. To avoid this. since repetition leads to greater recall. try putting the information in outline form. – As you discuss the most important points with your patients. Elimination Functions of Urinary System    Remove wastes from blood to form urine Remove nitrogenous waste products of cellular metabolism Regulates fluid and electrolyte balance The nephron = functional unit of the kidney and forms the urine Goal of Urinary System  To maintain chemical homeostasis of the blood. • Use charts. – Visual aids will help patients better understand their condition and treatment. models and pictures. amino acids. glucose. major electrolytes Not normally large proteins or blood cells  Proteinuria is a sign of glomerular injury Normal adult 24hr output = 1500-1600ml. simply repeating them may work. and through their questions you will be able to determine whether they completely understand the information and instructions you have given. instead of providing a long. – Once you have provided all the necessary information. Overview of Urinary System Kidneys       Ureters    Connect kidneys to bladder 10 -12 in length. – Information overload can confuse patients. urea. This will allow them to express any apprehensions they might have. • Frequently summarize the most important points. If after hearing what the patient has to say you conclude that he or she did not understand your instructions.• Stick to one topic at a time. ask them to repeat your instructions.

D. hypernatremia (associated with fever). muscle tone. 3. Reduced renal functional reserve. Nursing-Care Strategies A. For nocturnal polyuria: limit fluids in evening. nocturnal urine production.)  Urinary and reproductive systems   Meatus  External opening of the urethra. Fall prevention for nocturnal or urgent voiding Age-Associated Changes in the Oropharyngeal and Gastrointestinal Systems Etiology 1. 2. GFR (10% decrement/decade after age 30). hyperkalemia (with potassium-sparing diuretics). B. Maintain fluid/electrolyte balance. voiding= 300mls) Lies in pelvic cavity behind symphysis pubis  Urethra     Short. capacity = 600mls ) Organ of excretion ( norm.to 80kg adults to prevent dehydration. Risk of volume overload (in heart failure). Risk of nephrotoxic injury and adverse reactions from drugs. Potential for falls. 4. prostate enlargement with risk of BPH. 2. blood flow.500-2. hyponatremia (with thiazide diuretics). Reduced bladder elasticity. risk of renal complications in illness. incontinence (not a normal finding). urinary tract infection. Implications 1. Increased risk of urinary urgency. C. In males. Bladder     Distensible. and thirst perception. 4.500 mL/day from fluids and foods for 50.2 ½ in. avoid caffeine.5cm (1 ½ . Decreases in kidney mass. male & female The need to void is a conscious awareness Age-Associated Changes in the Renal and Genitourinary Systems Etiology 1. capacity.) length Male 20cms ( 8 in. nocturnal polyuria. muscular tube Urine from bladder to meatus and from the body Female 4-6. 3. dehydration. muscular sac Reservoir for urine ( approx. Decreased drug clearance. Monitor nephrotoxic and renally cleared drug levels. Reduced excretion of acid load. Minimum 1. Increased postvoid residual. . taste. use prompted voiding schedule. Decreases in strength of muscles of mastication.

Decreased metabolism of drugs. NSAID-induced ulcers. amts. Educate on lifestyle modifications and over-the-counter (OTC) medications for GERD. Monitor drug levels and liver function tests if on medications metabolized by liver. Impaired sensation to defecate. exercise. provide laxatives if on constipating medications. 4. Reduced hepatic reserve. 6. 2. maldigestion. Gastric changes: altered drug absorption.100mls/24h . 3. Encourage mobility. 4. poor nutrition. increased risk of GERD. Malabsorption of carbohydrates. or aging process Total incontinence = no control Stress incontinence = sm. Atrophy of protective mucosa. Constipation not a normal finding. Urine excreted involuntarily with coughing or laughing     Frequency & Urgency Nocturia Enuresis – involuntary discharge of urine Nocturnal Enuresis     During sleep Bed-wetting children 5yrs and older Oliguria 30mls/hr or 720 mls/24hrs  Renal anuria  cessation of urine production . educate on healthful diets. calcium. 2. Decreased gastric motility with delayed emptying. Risk of adverse drug reactions. Educate on normal bowel frequency. Risk of chewing impairment. Stable liver function tests. Assess nutritional indicators.2. Encourage participation in community-based nutrition programs. Nursing-Care Strategies 1. folic acid. spinal cord injury. vitamins B12 and D. recommended laxatives. 3. discomfort and tenderness Residual Urine = urine retained in the bladder after voiding Incontinence  Loss of voluntary control to void    Infection. Risk of fecal incontinence with disease (not in healthy aging). nerve damage to bladder or brain. 4. 5. diet. Implications 1. 3. Common Problems  Urinary Retention      Accumulation of urine in the bladder Inability to empty Pressure. fluid/electrolyte imbalances.

Privacy and natural position 2. Warm water to dangle fingers 5. Warm water over perineum ( measure if on In/Out )   Gently stroking inner thighs or pressure to symphysis pubis Pain relief Warmth to the bladder & perineum relaxes muscles & facilitates voiding. and alcohol For people with Nocturia    Decrease fld. Maintaining normal bowel elimination is essential to health and efficient body functions. .urinary catheterization may be indicated   Promoting complete bladder emptying Prevention of infection    Good perineal hygiene Adequate fld. Providing commode or bathroom 3. infection. and incontinence Drink about 2liters fluid/day Limit Na.Promoting Healthy Urinary Elimination  Urinate as soon as the urge is felt      Avoids stasis and distention Prevents urgency. caffeine. & side effects on urination. and volume Facilitating Micturition Nursing Measures to promote voiding in people who are having difficulty: 1. color. prunes and plums. meats. eggs. Running water 4.excrete/eliminate waste products of digestion. Intake   Bowel Elimination   Function. Dilutes urine & flushes urethra Acidifying urine ( inhibits microorganisms) Cranberry juice. whole grain breads.m. Intake in the p. Decrease caffiene and alcohol Void before bedtime  For Women     Wipe perineum front to back Void soon after intercourse Wash hands Pelvic – floor strengthening exercises (Kegel Exercises) Client Education      S & S of infection Fluid intake ( if no restrictions 2-5 L/day ) Perineal hygiene Meds. ( Sitz bath or warm tub ) If unsuccessful.

postpone BM. constipation Activity & exercise Immobile.GI System  Small Intestine    Absorption nutrients & electrolytes 20 ft length.decreases activity in colon Medications Laxatives Narcotics with codiene Emotions Anxiety . Constipation – difficult passage of hard. diameter 3 sections     Large Intestine     Absorbs H2O and electrolytes Temporarily stores waste products Main function is elimination 5 – 6 ft. 1 in.increases peristalsis & diarrhea Depression Common Problems 1. infrequent movements . dry stool. 6 – 7 cm. diameter      Cecum Ascending colon ( Right side ) Transverse colon Descending colon Duodenum Jejunum Ileum Factors affecting elimination Fiber ( undigestible residue ) provides bulk                  Pain Surgery   Anaesthetic causes temporary cessation of peristalsis Direct manipulation of the bowel stops peristalsis Absorbs fluid Increases stool mass Bowel wall stretches Peristalsis stimulated Defecation results Personal habits Busy schedule. length.

# liquid stool 4. Flatulence – abd. Defecation pattern 10. BM. oozing of diarrheal stool develops 3. Diarrhea. Hemorrhoids 1. 8. Internal / external 4.diarrheal agents  Enemas  disimpaction  Bowel routine  Daily time clock  Hot drinks  Stool softeners  Privavy  Position and abdominal pressure  Bearing down . Daily BM Not essential. Increased pressure when straining 3. Fecal Impaction – unrelieved constipation. Defecate – all mean waste products expelled via the bowel Promoting Healthy Bowel Elimination  Privacy  Squatting position  Bedpan position  Cathartics & laxatives  Anti. Stool. feces wedged in rectum.2. Feces. no BM usually 3days. Distention & pain 5.  2 / week a concern 9. Incontinence – inability to control passage of stool 6. Bleeding 7. Dilated engorged veins 2.

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