Nocturia

When the nurse is administering any of the miscellaneous drugs, the nurse monitors die patient for a reduction in the symptoms obtained in die preadministration assessment such as dysuria, urinary frequency, urgency, nocturia, and relief of any pain associated widi irritation of die lower genitourinary tract. 

Hot flushes, hypertension, dizziness, paresthesia, insomnia, rash, constipation, nausea, diarrhea, nocturia, hematuria, peripheral edema, bone pain, dyspnea, general pain, back pain, asthenia, infection... 

Hypoperfusion of skeletal muscles leads to fatigue, weakness, and exercise intolerance. Decreased perfusion of the central nervous system (CNS) is related to confusion, hallucinations, insomnia, and lethargy. Peripheral vasoconstriction due to SNS activity causes pallor, cool extremities, and cyanosis of the digits. Tachycardia is also common in these patients and may reflect increased SNS activity. Patients will often exhibit polyuria and nocturia. Polyuria is a result of increased release of natriuretic peptides caused by volume overload. Nocturia occurs due to increased renal perfusion as a consequence of reduced SNS renal vasoconstrictive effects at night. In chronic severe HF, unintentional weight loss can occur which leads to a syndrome of cardiac cachexia. This results from several factors, including loss of appetite, malabsorption due to gastrointestinal edema, elevated metabolic rate, and elevated levels of proinflammatory cytokines. 

Morning, nocturnal, or spontaneous erections suitable for intercourse (-) nocturia, urgency, symptoms of prostatitis (+) significant life stressors (+) mild pain in feet... 

AA is a 65-year-old male patient with an AUA symptom score of 1 9, urinary hesitancy, a slow urinary stream, urinary frequency, and nocturia. He wakes up three times every night to void. A digital rectal exam reveals an enlarged prostate of approximately 40 g (1.4 oz). His PSA is 4 ng/mL (4 mcg/L). 

To reduce nocturia, patients should be instructed to stop drinking fluids several hours before going to bed, and then voiding before going to sleep. During the day, patients should avoid excessive caffeine intake, as this may cause urinary frequency. In addition, toilet mapping (knowing the location of toilets on the way to and from various destinations) may help reassure the patient that he can still continue with many of his routine daily activities. 

Note The AUA Symptom Score focuses on seven items (incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia) and asks that the patient quantify the severity of his complaints on a scale of 0 to 5. Thus, the score can range from 0 to 35. 

Urinary incontinence (UI) is defined as the complaint of involuntary leakage of urine.1 It is often associated with other bothersome lower urinary tract symptoms such as urgency, increased daytime frequency, and nocturia. Despite its prevalence across the lifespan and in both sexes, it remains an underdetected and underreported health problem that can have significant negative consequences for the individual s quality of life. Patients with UI may be depressed due to a... 

In UUI, the detrusor (bladder) muscle is overactive and contracts inappropriately during the filling phase. The amount of urine lost per episode can be as large as the entire contents of the bladder may empty. Sleep may be disrupted by nocturia and enuresis. 

Urine leakage with physical activity (volume is proportional to activity level). No Ul with physical inactivity, especially when supine (no nocturia). May develop urgency and frequency as a compensatory mechanism (or as a separate component of bladder overactivity). 

Urinary frequency (greater than 8 micturitions/day), urgency with or without urge incontinence nocturia (greater than or equal to 2 micturitions/night) and enuresis may be present as well. 

Recurrent coughing, urinary incontinence, dyspareunia, vaginal itching, multiple UTIs (-) nocturia, enuresis, urgency, dysuria, frequency, lower abdominal fullness, decreased force of stream... 

Reduction of the number of UI episodes (daytime and nighttime) and frequency of nocturia... 

Symptoms of lower UTIs include dysuria, urgency, frequency, nocturia, and suprapubic heaviness. 

Dysuria, suprapubic heaviness, gross hematuria, urinary frequency, and nocturia... 

Fluid overload can result in pulmonary congestion and peripheral edema. Nonspecific symptoms may include fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloating, ascites, poor appetite, ascites, mental status changes, and weight gain. 

Other outcomes include improvement in exercise tolerance and fatigue, decreased nocturia, and a decrease in heart rate. 

Lethargy, polyuria, nocturia, and polydipsia can be present on diagnosis significant weight loss is less common. 

Acute bacterial prostatitis High fever, chills, malaise, myalgia, localized pain (perineal, rectal, sacrococcygeal), frequency, urgency, dysuria, nocturia, and retention Chronic bacterial prostatitis Voiding difficulties (frequency, urgency, dysuria), low back pain, and perineal and suprapubic discomfort Physical examination... 

Muscle weakness and transient lethargy occur in about 30% of patients. Polydipsia with polyuria and nocturia occurs in up to 70% of patients and is managed by changing to once-daily dosing at bedtime. 

Hypercalcemia of malignancy develops quickly and is associated with anorexia, nausea and vomiting, constipation, polyuria, polydipsia, and nocturia. Hypercalcemic crisis is characterized by acute elevation of serum calcium to greater than 15 mg/dL, acute renal failure, and obtundation. Untreated hypercalcemic crisis can progress to oliguric renal failure, coma, and life-threatening ventricular arrhythmias. 

Nocturia (waking to pass urine at night) Usually Seldom... 

Sleep disturbances are common in the elderly. These disturbances are often secondary to medical illness and/or medication use (Martin et al. 2000). Illnesses could be anxiety disorders or any illness that may disturb sleep due to pain or nocturia. Medications that may cause sleep disturbances are e.g. beta-blockers, corticosteroids and SSRIs. If the sleep disturbance is secondary the treatment should be focused on the underlying cause. If there is no such cause the sleep disturbance is said to be primary. First-line treatment should then be improvement of sleep hygiene (Box 4.1). 

Gil Sexual dysfunction impotence or decreased libido dysuria nocturia urinary retention or frequency. 

For the symptomatic relief of dysuria, urgency, nocturia, suprapubic pain, frequency, and incontinence as may occur in cystitis, prostatitis, urethritis, urethrocystitis/urethrotrigonitis. 

Renal Urinary tract infection (flurbiprofen, meloxicam) elevated BUN (ketoprofen) hematuria cystitis azotemia nocturia proteinuria polyuria dysuria urinary frequency pyuria oliguria anuria. 

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