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

5. Dental care 6. sexuality FACTORS AFFECTING GROWTH, DEVELOPMENT AND AGING No two individuals age the same way or at the same rate. The following are factors that affect the growth and development of a person. 1. GENETICS Diseases in the family may be inherited by unique genes that are linked to specific disorders: chromosomes carry genes that determine physical characteristics, intellectual potential and personality. 2. 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. 3. PRENATAL AND ENVIRONMENTAL FACTORS This begins in utero. It includes nutrition from the mother, exposure to alcohol, cigarette smoke, infections, drugs, radiation and chemicals. These influence the growth and development of the child.

4. FAMILY AND COMMUNITY A stimulating environment helps a child reach his/her physical potential. Family structure and community support services influence the environment in the process of growth and development of the child.

5. CULTURAL FACTORS Customs, traditions and attitudes of cultural groups influence the childs growth and development in terms of physical health, social interaction, and assumed roles.

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. Not all physiologic changes are normal signs of aging.

WHAT IS NORMAL AGING? Individuals age at extremely different rates. In fact even within one person, organs and organ systems show different rates of decline.

1. Heart. It grows slightly larger with age. Maximal oxygen consumption during exercise declines in men by about 10 percent with each decade of adult life and in women, by about 7.5 percent. However, cardiac output stays nearly the same as the heart pumps more efficiently. 2. Lungs. Maximum breathing (vital) capacity may decline by about 40 percent between the ages of 20 and 70. 3. Brain. With age, the brain loses some cells (neurons) and others become damaged. However, 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.

4. Kidneys. They gradually become less efficient at extracting wastes from the blood. Bladder capacity declines. But urinary incontinence, which may occur after tissues atrophy, can often be managed through exercise and behavioral techniques. 5. Body fat. The body does not lose fat with age but redistributes it from just under the skin to deeper parts of the body. Women are more likely to store it in the lower body (hips and thighs); men, in the abdominal area. 6. Muscles. Without exercise, estimated muscle mass declines 22 percent for women and 23 percent for men between the ages of 30 and 70. Exercise can prevent this loss. 7. Sight. Difficulty focusing close up may begin in the 40s; the ability to distinguish fine details may begin to decline in the 70s. From 50 on, there is increased susceptibility to glare, greater difficulty in seeing at low levels of illumination, and more difficulty in detecting moving targets. Age-related changes in ocular function may be divided into two groups: those related to vision (refractive changes, visual acuity, contrast sensitivity, glare, haziness, flashing lights, moving spots, and changes in color vision, dark adaptation, and visual fields), and those related to eye comfort (foreign-body sensation and headache). 8. Hearing. It becomes more difficult to hear higher frequencies with age. Hearing declines more quickly in men than in women. 9. Skin. Structural changes characteristic of aged skin include dryness, roughness, wrinkling, laxity, and increased incidence of neoplasms, both benign and malignant. Functional changes characteristic of aged skin include declines in cell replacement, barrier function, wound healing, immunologic responsiveness, and thermoregulation. 10. Hair. Hair substantially grays in about 50% of persons by age 50, apparently due to loss of melanocytes. Hair loss from the vertex and frontotemporal regions (androgenetic alopecia) in men begins between the late teens and the late 20s; by the time they reach their 60s, 80% of men are substantially bald. In women, the same pattern of hair loss may occur after menopause, although it is rarely pronounced. In contrast, diffuse alopecia normally occurs in both sexes with age. However, diffuse alopecia can also result from iron deficiency, hypothyroidism, use of certain drugs (especially anabolic steroids and antimetabolites), chronic renal failure, hypoproteinemia, or severe inflammatory skin disease such as erythroderma. 11. Personality. After about age 30, personality is stable. Sudden changes in personality sometimes suggest disease processes.

SENSORY CHANGES
Vision
30% of those over age 65 have some level of visual impairment. Cataracts are the 5th most common chronic condition in adults over age 75. 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.

Cataracts: Clouding of the crystalline lens presents as painless, progressive loss of vision can be unilateral or bilateral. Macular Degeneration: The most common cause of legal blindness in the elderly. The development of drusen deposits in the retinal pigmented epithelium leading cause of central vision loss in older adults. More common in fair haired blue eyed individuals.

Other risk factors include smoking and excessive sunlight exposure. There are wet and dry forms of macular degeneration.

Glaucoma: A potentially serious form of eye disease. The majority of cases of glaucoma are Open angle glaucoma (95%). Increased intraocular pressure causing atrophy and cupping of the optic nerve head causing visual field deficits that can progress to blindness. Vision changes include loss of peripheral vision, intolerance to glare, decreased perception of contrast and decreased ability to adapt to the dark. Diabetic Retinopathy: End organ damage from diabetes causing retinopathy and spotty vision. Risk can be reduced by tight blood sugar control. Starts as nonproliferative and progresses to proliferative that should be treated with laser photocoagulation. Hypertensive Retinopathy: End organ damage from poorly controlled hypertension causing background and eventual proliferative retinopathy. Usually treated with laser photocoagulation and tight blood pressure control. Temporal Arteritis: Autoimmune disorder that causes inflammation of the temporal artery. It presents as malaise, scalp tenderness, unilateral temporal headache, jaw claudication, and sudden vision loss (usually unilateral). This vision loss is a medical emergency but is potentially reversible if identified immediately. The client should see an ophthalmologist, or go to the emergency room immediately if symptoms develop. Detached Retina: Can occur in patients with cataracts or recent cataract surgery, trauma or be spontaneous. Presents as a curtain coming down across vision. Should see an ophthalmologist or proceed to the emergency room immediately. Impact on Safety
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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

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Falls

Hearing
Hearing loss is the 3rd leading chronic condition affecting adults over 75 years of age. Definitions

Hearing Impaired: Defined in Decibels (dB) or level of loudness

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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, unable to hear sound

Hearing Changes common in older adults

Presbycusis: Loss of high frequency, sensorineural hearing loss. Has a gradual onset is progressive and is bilateral. Due to gradual loss of hair cells, and fibrous changes in the small blood vessels that supply the cochlea. Difficulty hearing high pitched sounds such as s, z, sh, and ch. Background noise further aggravates hearing deficit. Conductive hearing loss: Involves the outer and or middle ear. Causes of conductive hearing impairment include: cerumen impactions or foreign bodies; ruptured eardrum, otitis media, and otosclerosis. Sensorineural hearing loss: involves damage to the inner ear, the cochlea, or the fibers of the eighth cranial nerve. Causes of sensorineural hearing loss include: hereditary causes, viral or bacterial infections, trauma, tumors, noise exposure, cardiovascular conditions, ototoxic drugs and Meniere's disease. 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. The person's hearing is intact but their ability to process the sound is impaired. 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. Patients with tinnitus should be referred to ENT Meniere's Disease: characterized by fluctuating hearing loss, dizziness and tinnitus. Possible causes of Meniere's disease include: hypothyroidism, diabetes and neurosyphillis. Impact on quality of life Impairs ability to communicate with others
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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, such as how to take medications, Unable to hear car coming when crossing the road, horns honking Unable to hear phone or doorbell ringing or knocking at the door (if emergency occurs may be unaware)

Safety issues
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Smell and Taste

The sense of smell and ability to identify odors decreases due to normal changes in aging. This can be problematic for safety reasons. An inability to smell smoke for instance could put an older adult at risk. 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. Common changes in taste include a decreased ability to detect foods that are sweet. Most changes in taste are thought to occur due to decreased sense of smell, medications, diseases and tobacco use.

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. There may be several contributing factors: Vitamin B deficiencies, local trauma, gastrointestinal disorders causing reflux, allergies, salivary dysfunction and diabetes. Implications of Taste and Smell Changes

Inability to smell
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Effects quality of life -- Scents such as smell of Christmas tree, flowers or coffee brewing may not be detectable. Diminished taste of favorite foods or beverages. Nutritional decline - inability to smell food aromas may reduce nutritional intake Safety hazard -- inability to smell smoke in a fire or a gas leak. May result in inability to recognize spoiled food resulting in nausea, vomiting or infectious diarrhea.

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Decreased sense of taste

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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, 2004). 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, 2004). Changes in peripheral sensation common to older adults

Peripheral nerve function that controls the sense of touch declines slightly with age. Two-point discrimination and vibratory sense both decrease with age. The ability to perceive painful stimuli is preserved in aging. However, there may be a slowed reaction time for pulling away from painful stimuli with aging. Peripheral neuropathy: Nerve pain in the distal extremities related to nerve damage from circulatory problems or vitamin deficiencies. Common vitamin deficiencies which impact peripheral nerves include B 6, B 12 and Folate. Diabetic neuropathy: End organ damage to the peripheral nerves from microvascular changes which occur with diabetes. 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. It is extremely important to teach diabetics and patients with peripheral neuropathy to provide special care to their feet. Phantom Limb pain: The experience of pain that can range from dull ache to crushing pain where an amputated limb once was. 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, analgesics, and psychosocial support Acute Sensory Loss: May be due to a stroke, acute nerve entrapment in the spine or compartment syndrome due to trauma to a limb. Will present with acute onset of numbness, tingling or lack of sensation and function in the effected extremity. Falls - due to inability to recognize position sense or inability to ascertain where feet are on floor.

Diseases that alter peripheral sensation seen more frequently as people age

Implications of Peripheral Sensation Changes

Calluses or serious foot lesions.

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

Hearing

Taste and Smell

Peripheral Sensation

Ensure or have family bring in adequate foot wear that protects the individual's feet. Most medical supply places carry diabetic healing shoes that have wide toe boxes and Velcro closed often under $50. Refer diabetics to facilities with Certified Diabetes Educator. Implement fall precautions and initiate referral to physical therapy for diabetics with peripheral neuropathy. Refer older adults with decreased sensation to a podiatrist for ongoing foot care. Baseline visual acuity and hearing acuity for all older patients will be performed prior to discharge from the hospital, home care or nursing home. Evidence of fall precautions for all older patients with sensory impairments. Avoidance of falls and injuries to extremities with decreased sensation of lower extremities. Avoidance of accidental exposure to toxins either in the air or in food due to decreased sense of smell or taste.

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, usually of rapid onset Caused most frequently by CVAs, but can occur as a result of traumatic brain injury (motor vehicular accident)

Mild cognitive impairment (MCI) Considered a transitional state between normal, age-related cognitive problems and dementia

Parkinsons 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

Movement programming problems (apraxia) Perceptions stripped of meaning (agnosia) Disturbance in executive functioning (such as planning, organizing ideas, etc.)

Strategies in Improving Communication on the Elderly Allow extra time for older patients. Because of their increased need for information and their likelihood to communicate poorly, to be nervous and to lack focus, older patients are going to require additional time. Do not appear rushed or uninterested. Your patients will sense it and shut down, making effective communication nearly impossible.

Avoid distractions. Patients want to feel that you have spent quality time with them and that they are important. Researchers recommend that if you give your patients your undivided attention in the first 60 seconds, you can create the impression that a meaningful amount of time was spent with them. Of course, you should aim to give patients your full attention. When possible, reduce the amount of visual and auditory distractions, such as other people and background noise.

Sit face to face. Some older patients have vision and hearing loss, and reading your lips may be crucial for them to receive the information correctly. Sitting in front of them may also reduce distractions. This simple act sends the message that what you have to say to your patients, and what they have to say to you, is important. 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.

Maintain eye contact. Eye contact is one of the most direct and powerful forms of nonverbal communication. It tells patients that you are interested in them and they can trust you. Maintaining eye contact creates a more positive, comfortable atmosphere that may result in patients opening up and providing additional information.

Listen. The most common complaint patients have about their health care providers is that they dont listen. Good communication depends on good listening, so be conscious of whether you are really listening to what older patients are telling you. 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.

Speak slowly, clearly and loudly. The rate at which an older person learns is often much slower than that of a younger person. Therefore, the rate at which you provide information can greatly affect how much your older patients can take in, learn and commit to memory. Dont rush through your instructions to these patients. Speak clearly and loudly enough for them to hear you, but do not shout.

Use short, simple words and sentences. 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. Do not use medical jargon or technical terms that are difficult for the layperson to understand. In addition, do not assume that patients will understand even basic medical terminology. Instead, make sure you use words that are familiar and comfortable to your patients.

Stick to one topic at a time. Information overload can confuse patients. To avoid this, instead of providing a long, detailed explanation to a patient, try putting the information in outline form. This will allow you to explain important information in a series of steps.

Use charts, models and pictures. Visual aids will help patients better understand their condition and treatment. Pictures can be particularly helpful since patients can take home a copy for future reference.

Frequently summarize the most important points. As you discuss the most important points with your patients, ask them to repeat your instructions. If after hearing what the patient has to say you conclude that he or she did not understand your instructions, simply repeating them may work, since repetition leads to greater recall.

Give patients an opportunity to ask questions and express themselves. Once you have provided all the necessary information, give your patients ample opportunity to ask questions. This will allow them to express any apprehensions they might have, and through their questions you will be able to determine whether they completely understand the information and instructions you have given.

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. Filtration by the Nephrons H2O, glucose, amino acids, urea, creatinine, major electrolytes Not normally large proteins or blood cells Proteinuria is a sign of glomerular injury

Normal adult 24hr output = 1500-1600ml.

Overview of Urinary System Kidneys Ureters Connect kidneys to bladder 10 -12 in length, 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

Bladder Distensible, muscular sac Reservoir for urine ( approx. capacity = 600mls ) Organ of excretion ( norm. voiding= 300mls) Lies in pelvic cavity behind symphysis pubis

Urethra Short, muscular tube Urine from bladder to meatus and from the body Female 4-6.5cm (1 - 2 in.) length Male 20cms ( 8 in.) Urinary and reproductive systems

Meatus External opening of the urethra, male & female

The need to void is a conscious awareness

Age-Associated Changes in the Renal and Genitourinary Systems Etiology 1. Decreases in kidney mass, blood flow, GFR (10% decrement/decade after age 30). Decreased drug clearance. 2. Reduced bladder elasticity, muscle tone, capacity. 3. Increased postvoid residual, nocturnal urine production. 4. In males, prostate enlargement with risk of BPH.

Implications 1. Reduced renal functional reserve; risk of renal complications in illness. 2. Risk of nephrotoxic injury and adverse reactions from drugs. 3. Risk of volume overload (in heart failure), dehydration, hyponatremia (with thiazide diuretics), hypernatremia (associated with fever), hyperkalemia (with potassium-sparing diuretics). Reduced excretion of acid load. 4. Increased risk of urinary urgency, incontinence (not a normal finding), urinary tract infection, nocturnal polyuria. Potential for falls.

Nursing-Care Strategies A. Monitor nephrotoxic and renally cleared drug levels. B. Maintain fluid/electrolyte balance. Minimum 1,500-2,500 mL/day from fluids and foods for 50- to 80kg adults to prevent dehydration. C. For nocturnal polyuria: limit fluids in evening, avoid caffeine, use prompted voiding schedule. D. Fall prevention for nocturnal or urgent voiding

Age-Associated Changes in the Oropharyngeal and Gastrointestinal Systems Etiology 1. Decreases in strength of muscles of mastication, taste, and thirst perception.

2. Decreased gastric motility with delayed emptying. 3. Atrophy of protective mucosa. 4. Malabsorption of carbohydrates, vitamins B12 and D, folic acid, calcium. 5. Impaired sensation to defecate. 6. Reduced hepatic reserve. Decreased metabolism of drugs.

Implications 1. Risk of chewing impairment, fluid/electrolyte imbalances, poor nutrition. 2. Gastric changes: altered drug absorption, increased risk of GERD, maldigestion, NSAID-induced ulcers. 3. Constipation not a normal finding. Risk of fecal incontinence with disease (not in healthy aging). 4. Stable liver function tests. Risk of adverse drug reactions.

Nursing-Care Strategies 1. Monitor drug levels and liver function tests if on medications metabolized by liver. Assess nutritional indicators. 2. Educate on lifestyle modifications and over-the-counter (OTC) medications for GERD. 3. Educate on normal bowel frequency, diet, exercise, recommended laxatives. Encourage mobility, provide laxatives if on constipating medications. 4. Encourage participation in community-based nutrition programs; educate on healthful diets.

Common Problems Urinary Retention Accumulation of urine in the bladder Inability to empty Pressure, discomfort and tenderness

Residual Urine = urine retained in the bladder after voiding Incontinence Loss of voluntary control to void Infection, nerve damage to bladder or brain, spinal cord injury, or aging process Total incontinence = no control Stress incontinence = sm. amts. 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 - 100mls/24h

Promoting Healthy Urinary Elimination Urinate as soon as the urge is felt Avoids stasis and distention Prevents urgency, infection, and incontinence

Drink about 2liters fluid/day Limit Na, caffeine, and alcohol For people with Nocturia Decrease fld. Intake in the p.m. 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. & side effects on urination, color, and volume

Facilitating Micturition Nursing Measures to promote voiding in people who are having difficulty: 1. Privacy and natural position 2. Providing commode or bathroom 3. Running water 4. 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. ( Sitz bath or warm tub ) If unsuccessful- urinary catheterization may be indicated Promoting complete bladder emptying Prevention of infection Good perineal hygiene Adequate fld. Intake Bowel Elimination Function- excrete/eliminate waste products of digestion. Maintaining normal bowel elimination is essential to health and efficient body functions. Dilutes urine & flushes urethra

Acidifying urine ( inhibits microorganisms) Cranberry juice, whole grain breads, meats, eggs, prunes and plums.

GI System Small Intestine Absorption nutrients & electrolytes 20 ft length, 1 in. diameter 3 sections Large Intestine Absorbs H2O and electrolytes Temporarily stores waste products Main function is elimination 5 6 ft. length, 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, postpone BM, constipation

Activity & exercise Immobile- decreases activity in colon

Medications Laxatives Narcotics with codiene

Emotions Anxiety - increases peristalsis & diarrhea Depression

Common Problems 1. Constipation difficult passage of hard, dry stool; infrequent movements

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