Older age delayed gastric emptying and weakened les

Older age (delayed gastric emptying and weakened
LES tone)
 Sleep apnea
 NG Tube
o
 Review bowel assessment, constipation, diarrhea
o Bowel assessment:
 Inspect → Auscultate → Percuss →
Palpate
o Constipation
 Monitor for
 Abdominal bloating
 Abdominal cramping
 Straining at defecation

 Presence of dry, hard feces at defecation.
 Irregular bowel movements, or reduced frequency from
client’s normal pattern.
 hypoactive bowel sounds
 Nursing Care
 Increase fiber and water consumption (unless
contraindicated) before more invasive interventions
 Give bulk-forming products before stool softeners,
stimulants, or suppositories
 Enemas are last resort for stimulating defecation.
o Diarrhea
 Monitor for
 Frequent loose stools
 Abdominal cramping
 Stool of water consistency
 hyperactive bowel sounds
 Nursing Care
 Help determine and treat the cause
 Administer medications to slow peristalsis
 Provide perineal care after each stool, and apply
moisture barrier
 After diarrhea stops, suggest eating yogurt to help re-
establish an intestinal balance of beneficial bacteria
 Review acid-base imbalances, signs/symptoms (see chart)
o Normal Values
 pH = 7.35 - 7.45
 PaCO2 = 35 - 45
 HCO3 = 21- 28
o Respiratory Acidosis : HYPOventilation
 Results from:
 Brain tumors, cerebral aneurysm, stroke, or
overhydration, trauma, or neurologic diseases
 Inadequate chest expansion due to muscle weakness,
pneumothorax/ hemothorax, flail chest, obesity, sleep
apnea, tumors, or deformities.
 Airway obstruction from neck edema, localized lymph
node enlargement, foreign bodies or mucus
 Alveolar-capillary blockage secondary to a pulmonary
embolus, thrombus, acute respiratory distress

syndrome, chest trauma, drowning, or pulmonary
edema
 Inadequate mechanical ventilation
 Results in
 Increase CO2
 Decreased pH
 S&S
 Vitals: Tachycardia, tachypnea, increased blood
pressure
 Dysrhythmias
 Anxiety, Irritability, confusion
 Ineffective shallow, rapid breathing
 Pale or cyanotic
 Seen in clients with COPD, pulmonary disease, sleep
apnea, and obesity.
o Respiratory Alkalosis: HYPERrventilation
 Results From:
 Hyperventilation due to fear, anxiety, intracerebral
trauma, salicylate toxicity, or excessive mechanical
ventilation
 Results in:
 Decreased CO2
 Increased pH
 S&S
 Vitals: Tachypnea
 Inability to concentrate, numbness, tingling, tinnitus, and
possible loss of consciousness
 Tachycardia, ventricular and atrial dysrhythmias
 Rapid, deep respirations
o Metabolic Acidosis
 Results From:
 Excess production of hydrogen ions
 Diabetic Ketoacidosis (DKA)
 Lactic Acidosis
 Heavy exercise
 Seizure Activity
 Hypoxia
 Excess intake of acids
 Ethyl alcohol
 Methyl alcohol

 Acetylsalicylic acid (Aspirin)
 Inadequate elimination of hydrogen ions
 Kidney Failure
 Severe Lung problems
 Inadequate production of bicarbonate HCO3
 Kidney Failure
 Pancreatitis
 Results in:
 Decreased HCO3
 Decreased pH
 S&S:
 Dysrhythmias
 Vitals: Bradycardia, weak peripheral pulses,
hypotension, tachypnea
 Headache, drowsiness, confusion
