Age-related factors affecting Fluid and Electrolyte Balance among ELDERLY CLIENTS

What again are the factors affecting normal fluid balance???

• Fluid Intake• Oral fluids• Water in foods• By-product of food metabolism

• Fluid Output• Urine• Insensible Fluid Loss• Feces

Review of Concept:

Question #1: What makes the elderly adults more at

risk for fluid imbalance?

Answer:They have decreased fluid intake and

increased fluid loss.

Dehydration is the most common cause of fluid and electrolyte imbalance among elderly clients.

Think!

Question #2: When an elderly client is suspected of

dehydration, what possible early manifestations should the nurse note for?

a)Poor skin turgorb)Dry oral mucosa and tongue furrowsc)Change in mental status, memory or attentiond)Orthostatic Vital Signs

Think!

Question #2: When an elderly client is suspected of

dehydration, what possible early manifestations should the nurse note for?

Answer:

C ; A change in mental status, memory, or attention may be an early sign of DHN in elders. Skin turgor is a less reliable indicator of DHN. Dry oral mucosa and tongue furrows indicate DHN while orthostatic VS may not demonstrate typical changes in a dehydrated elderly client. (M/S by Lemone, p. 203: Nursing Care of the Older Adult.)

Think!

Related Concept:What about the regulatory mechanisms of

the body responsible for maintaining HOMEOSTASIS???

• Thirst • Kidneys• Antidiuretic Hormone (ADH)• Renin-Angiotensin-Aldosterone System (RAAS)• Atrial Natriuretic Factor (ANF)

Thirst Mechanism↓ ECF VOLUME

↑OSMOLALITY OF ECF

↓ SALIVA SECRETION

DRY MOUTH

STIMULATES THE OSMORECEPTORS IN

HYPOTHALAMIC THIRST CENTER

THIRSTWATER ABSORBED FROM

G.I.

↑ ECF VOLUME↓ OSMOLALITY OF ECF

The KidneysThe adult kidney reaches its maximum size of 150 to 300 grams

around 30 years of age.A gradual decrease in renal size and volume occurs during the

decades, and by 90 years of age the renal mass has fallen by 30% to 40%.

As kidney size dwindles, so does renal blood flow and glomerular filtration rate (GFR).

Normal GRF in the healthy young adult is estimated at 100 to 125 mL per minute. With time, GFR diminishes approximately 1 mL per minute after 40 years of age.

Other changes observed in the aging kidney include the decreased ability to concentrate urine, the inability to conserve sodium, and the decreased excretion of potassium. Exogenous factors such as illness, volume depletion, or medication can further exacerbate these changes, thus making the elder at greater risk for renal failure

Antidiuretic Hormone (ADH)

Atrial Natriuretic Factor (ANF)A hormone released by atrial muscle cells in response to

distention from fluid overloadAffects several body systems including the CV, renal, GI, and

endocrine systems, but primarily affects the Renin-Angiotensin-Aldosterone-System (RAAS).

Function: to oppose the RAAS by inhibiting renin secretion and blocking the secretion and Na+-retaining effects of aldosterone consequently, promoting Na+ wasting, diuresis (increased urine output) and causes vasodilation.

The Normal Elderly Clients…

lean body mass ----

body fat--------------

total body water---

The Normal Elderly Clients…

Perception of thirst

Kidney function-----

Thermoregulation-

The Elderly Clients…Other Factors which may influence F&E balance

in elders are: Increased use of diuretics for HTN and heart

diseaseDecreased intake of food and water, especially in

clients with dementia or who are dependent on others to feed them and offer them fluids.

Preparations for certain diagnostic tests that require the client on NPO for long periods of time or cause diarrhea from laxative preps.

Clients with impaired renal function, such as elders with DM.

Fever, influenza, surgery or heat exposure

Possible Nursing DiagnosesFluid Volume DeficitRisk for Fluid Volume DeficitIneffective Tissue PerfusionRisk for InjuryRisk for Imbalanced Body TemperatureIneffective Breathing PatternDecreased Cardiac outputExcess Fluid VolumeImpaired Gas Exchange

SummaryNormal aging is often described as a continuous process characterized by a decrease in lean body mass, an increase in fat, and a decrease in total body water. However, it has been pointed out that many older people, especially those aged 75 years and over, may feel healthy in spite of a chronic illness. Thus, both nutrition and hydration may be altered by chronic diseases, infection, as well as by changes in functional status, mobility disorders, confusion, impaired sensory perception, medication effects and difficulties in drinking, swallowing and eating because of the absence of teeth or ill-fitting dentures. For water balance, two factors place the elderly at risk for dehydration: a decreased fluid intake and an increased fluid loss. In the human, the normal pattern of drinking is intermittent while water is continuously lost by various routes so that dehydration occurs. Dehydration is the most common cause of fluid and electrolyte imbalance and is frequently reported in residents, hospitalized and community-dwelling elderly people. It has been stated that one of the greatest threats to the survival of any terrestrial animal, including man, is that of dehydration.

SOURCE:Nutrition and Aging:

I.H. Rosenberg; A. Sastre (eds),Nestl´e Nutrition Workshop Series Clinical & Performance Program, Vol. 6, pp. 193–206,

Nestec Ltd.; Vevey/S. Karger AG, Basel, 2002.

That’s all, Thank You!

Prepared by:

Benjamin Vera CruzLPU-Manila