NATURAL AGING CHANGES WITH THE
ELDERLY
• Decreased kidney size-- less ability to get rid of waste
• Loss of smooth muscle tone--incontinence
• Decreased blood flow—less ability for kidneys to filter
• Difficulty emptying bladder—prone to UTIs
• What implications do these changes have on the elderly resident? What might you anticipate with the elderly?

1. Increase risk of infection
2. Incontinence
3. UTI

• 1. Remove waste through urine
• 2. Maintain fluid & electrolyte balance
• 3. Manage and balance chemistry of blood

Ureters- Connect kidney to bladder; 10-12 inches long, carry urine
Bladder- Stores urine
Urethra- Tube that carries urine from bladder to outside of body. females: 1 ½ inches males: 6-8 inches
Urinary meatus- outside of body; where urine is excreted out
Kidneys- Filtering organs that produce urine

WHO IS MORE AT RISK FOR INFECTION?
Think about this in terms of UTI for elderly…who is more at risk???
Male or Female???

• Kidneys: Bean shaped organs located in
RETROPERITONEAL cavity. Filtering organs that produce urine.

Nephron-Functional unit of kidney, more than a million in each kidney, filters blood and removes waste. Located in cortex of kidney
Glomerulus-Coil of capillaries w/in nephron. Lies w/in
Bowman’s capsule
Bowman’s Capsule-Encloses glomerulus; site of filtration

Urine is secreted by the kidneys, stored in the bladder, and excreted through the urethra.
Urine formation is the complex process that cleans the blood of unnecessary substances while selectively
reabsorbing other essential material.
What are the essential materials?

Normal urine is acidic and pale to deep yellow
Dilute urine has more water and fewer dissolved substances, so it is colorless to pale yellow
Concentrated urine has less water and more dissolved substances, so it is darker in color and has a stronger odor

Let’s learn the medical word for urinating….

Body’s attempt to keep its internal environment (temp, BP, fluid balance) stable or in balance. The urinary system determines the content of tissue fluid
(watery environment around the cell).
Specifically, waste products are removed, and fluids, electrolytes, blood pressure and pH (acid balance) are regulated to help the body maintain its normal state. The urinary system is responsible to maintain the fluid homeostasis of the body.

WHAT COLOR URINE WOULD YOU
EXPECT TO SEE WITH……

FLUID BALANCE AND FLUID
IMBALANCE
Fluid Balance- same amount of fluid is taken in by the body that is excreted by the body
Fluid Imbalance- occurs when the body
Keeps or retains too much fluid OR
When the body loses too much fluid.

DEHYDRATION
A decrease in the amount of water in the tissues. Occurs when fluid output exceeds input or intake.
Fluid can be lost by:
Vomiting, bleeding, diarrhea, too much urination (polyuria)
EDEMA
Abnormal swelling of a body part caused by fluid collecting in that area; usually extremities

DEHYDRATION
Causes:
Fever, decreased fluid intake, abnormal loss of fluid/blood, disease
S&S: dry membranes, coated tongue, low
BP, low UO, wt. loss
EDEMA
Causes:
Heart disease, CHF, kidney disease, infections, immobility, burns, increased salt
S&S: edema, SOB, wt. gain, low UO

DEHYDRATION
Water @ bedside
Accurate I&O
Offer fluids
Check weight
Check VS
EDEMA
Avoid tight shoes
Elevate legs
Check extremities
Accurate I&O
Check weight
Check VS

Step 1: Glomerular Filtration:
• Urine formation starts. Filtering of blood. The filtrate contains essential and nonessential materials. These waste products, helpful products, and water are filtered through the capillary walls of the glomerulus into Bowman’s capsule, forming a liquid called FILTRATE.
Step 2: Tubular Reabsorption:
• Taking back water and essential materials that the body needs. Moves it out of the filtrate and into the blood. 99% is reabsorbed back into the blood.
Step 3: Tubular Secretion:
• Moves non essential material out of blood and into filtrate for excretion out of the kidneys. The urine, containing wastes, is now passed out of the kidney and into the ureter.