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classification Urine Incontinence
urge: associated with strong perceived need to void
reflex: associated with spinal cord lesion-> no sensory awareness of need to void
stress: coughing, sneezing-> weakend perineal muscles permit leakage
functional: intact urinary physiology, but mobility impairement, cognitive problems, cannot reach toilet in time
total: no control because of physiologic or psychological impairement
Painful or difficult urination.
- Dysuria has many causes, including urinary tract infections or sexually transmitted infections (such as cystitis or urethritis); urethral strictures; diseases of the prostate gland; prolapse of the uterus, metritis, cervical diseases; dysmenorrhea; bladder irritants (such as caffeine or some artificial sweeteners); and medications that obstruct the bladder outlet (such as anticholinergics or opiates).
- SYMPTOMS AND SIGNS
- Commonly reported symptoms include a burning sensation with urination, bladder or pelvic fullness, urinary hesitancy, or urinary frequency. Patients with infectious dysuria may have fever. Patients with kidney stones may pass blood, gravel, sand, or grit in the urine and have associated pain in the flanks.
Diagnosis of the disease is based on its signs and symptoms and urinalysis. Imaging studies are occasionally used (plain x-rays or abdominal CT) to identify structural abnormalities, stones, or infections in the urinary tract.
- Phenazopyridine hydrochloride may be given orally for symptomatic relief. Antibiotics are given for infections. Antifungals may be given for vaginal yeast infections, and antivirals for herpes simplex infection.
The patient with dysuria should be taught how to obtain a midstream, clean-catch urine specimen for culture and sensitivity. Additional diagnostic testing (such as urethral swabs or pelvic examinations) may be required based on patient history and physical examination. Unless fluids are restricted as a result of heart or kidney failure, the patient with dysuria may benefit from drinking fluids liberally to dilute the urine and reduce irritation. If phenazopyridine HCl is prescribed as a urinary analgesic/antiseptic, the patient should be advised to take the drug with meals to minimize gastric distress and be reminded that the drug colors urine, saliva, and tears red or orange and may stain fabrics and contact lenses. SEE: urinary tract infection
blood in the urine
- Blood may appear in the urine as a result of many conditions, including contamination during menstruation or the puerperium; internal trauma or kidney stones; vigorous exercise; urinary tract infections or systemic infections with renal involvement; some cases of glomerulonephritis; vascular anomalies of the urinary tract; or cancers of the urethra, bladder, prostate, ureters, or kidneys.
- The clinical history may help determine the cause of hematuria. Kidney stones often cause hematuria associated with intense flank pain that radiates into the groin. Hematuria in a child with recent sore throat, new edema, and hypertension may reflect a poststreptococcal glomerulonephritis. Urinary bleeding in a patient with abdominal pain and an enlarged or prosthetic aorta may have a fistulous connection to a ureter, a true surgical emergency. In the laboratory, microscopic examination of the urine also provides clues to the cause of bleeding. Red blood cells from the upper urinary tract are often deformed or misshapen whereas those from the urethra or bladder have a normal microscopic appearance. The urine may appear tea-colored, slightly smoky, reddish, or frankly bloody.
- PATIENT CARE
- In patients over the age of 35 who have persistent microscopic hematuria without obvious cause, the American Urological Association recommends cystoscopy (followed by upper urinary tract imaging if cystoscopy does not reveal a cause
Excessive or frequent urination after going to bed, typically caused by excessive fluid intake, congestive heart failure, uncontrolled diabetes mellitus, urinary tract infections, diseases of the prostate, impaired renal function, or the use of diuretics. Less often, diabetes insipidus is the cause. SYN: nycturia
- PATIENT CARE
- Patients may find that they can reduce the need to void at night by limiting fluid intake during the evening. Safety is emphasized for patients who need to get up to go to the bathroom at night because they may not be fully awake or alert. Specific recommendations include use of night lights and removal of objects blocking the route from the bedroom to the bathroom. The patient should be assessed for cause and treatment instituted to resolve the problem if possible.
decreased urine production
Involuntary discharge of urine after the age at which bladder control should have been established. In children, voluntary control of urination is usually present by 5 years of age. Nevertheless, nocturnal enuresis is present in about 10% of otherwise healthy 5-year-old children and in 1% of normal 15-year-old children. Enuresis is slightly more common in boys than in girls and occurs more frequently in first-born children. This condition has a distinct family tendency. SEE: nocturnal enuresis; bladder drill
- When no organic disease is present, the use of imipramine as a temporary adjunct may be helpful. This is usually given in a dose of 10 to 50 mg orally at bedtime, but the effectiveness may decrease with continued administration. The bladder may be trained to hold larger amounts of urine. This procedure has decreased the occurrence rate of enuresis. No matter what the cause, the child should not be made to feel guilty or ashamed, and the family and the child should regard enuresis as they would any other condition that lends itself to appropriate therapy. If the child tries too hard to control the condition, it may worsen. Conditioning devices that sound an alarm when bed-wetting occurs should not be used unless prescribed by a health care professional familiar with the treatment of enuresis.
Imipramine is not recommended for children under 6 years of age. Blood counts should be taken at least monthly during therapy to detect the possible onset of agranulocytosis.
- Excessive secretion and discharge of urine; specifically, urination in excess of 50mL/kg of body weight per day.. The urine generally does not contain abnormal constituents. Several liters in excess of normal may be voided each day.
- The urine is virtually colorless.
- Specific gravity is 1.000 to 1.002 (higher in diabetes mellitus). Polyuria occurs in diabetes insipidus, diabetes mellitus, chronic nephritis, nephrosclerosis, hyperthyroidism, following edematous states (esp. those induced by heart failure treated with diuretics), and following excessive intake of liquids.
Urinary output of less than 400 mL/day. Oliguria results in renal failure if it is not reversed.
- Diminished urinary output may result from inadequate perfusion of the kidneys (e.g., in shock or dehydration), from intrarenal diseases (e.g., acute tubular necrosis), or from obstruction to renal outflow (as in bilateral hydronephrosis). oliguric, adj.
A reduction in the mass of circulating red blood cells. People are considered anemic when their hemoglobin levels are more than two standard deviations below the mean level in their hospital's laboratory. The diagnosis of anemia is influenced by variables such as the patient's age (neonates are anemic at levels of hemoglobin that would be considered polycythemic in some adults), gender (men have higher hemoglobin levels than women), pregnancy status (hemodilution in pregnancy lowers measured hemoglobin), residential altitude, and ethnic or racial background. anemic (ă-nē′mik), adj. anemically (ă-nē′mi-k(ă-)lē), adv. Symptomatic anemia exists when hemoglobin content is less than that required to meet the oxygen-carrying demands of the body.
If anemia develops slowly, however, there may be no functional impairment even though the hemoglobin is less than 7 g/100/dL of blood.Anemia is not a disease but rather a symptom of other illnesses. It is classified on the basis of mean corpuscular volume as microcytic (80), normocytic (80-94), and macrocytic (>94); on the basis of mean corpuscular hemoglobin as hypochromic (27), normochromic (27-32), and hyperchromic (>32); and on the basis of etiological factors.
- Anemia may be caused by bleeding, e.g., from the gastrointestinal tract or the uterus; vitamin or mineral deficiencies, esp. vitamin B12, folate, or iron; decreases in red blood cell production, e.g., bone marrow suppression in kidney failure or bone marrow failure in myelodysplastic syndromes; increases in red blood cell destruction as in hemolysis due to sickle cell anemia; or increases in red blood cell sequestration by the spleen (as in portal hypertension), or administration of toxic drugs (as in cancer chemotherapy).
- Anemic patients may experience weakness, fatigue, lightheadedness, breathlessness, palpitations, angina pectoris, and headache. Signs of anemia may include a rapid pulse or rapid breathing if blood loss occurs rapidly. The chronically anemic may have pale skin, mucous membranes, or nail beds and fissures at the corners of the mouth.
- Treatment of anemia must be specific for the cause. The prognosis for recovery from anemia is excellent if the underlying cause is treatable.
Anemia due to excessive blood loss: For acute blood loss, immediate measures should be taken to stop the bleeding, to restore blood volume by transfusion, and to combat shock.
Chronic blood loss usually produces iron-deficiency anemia.
Anemia due to excessive blood cell destruction: The specific hemolytic disorder should be treated.
Anemia due to decreased blood cell formation: For deficiency states, replacement therapy is used to combat the specific deficiency, e.g., iron, vitamin B12, folic acid, ascorbic acid. For bone marrow disorders, if anemia is due to a toxic state, removal of the toxic agent may result in spontaneous recovery.
Anemia due to renal failure, cancer chemotherapy, HIV, and other chronic diseases: Erythropoietin injections are helpful.
- PATIENT CARE
- The patient is evaluated for signs and symptoms, and the results of laboratory studies are reviewed for evidence of inadequate erythropoiesis or premature erythrocyte destruction. Prescribed diagnostic studies are scheduled and carried out. Rest: The patient is evaluated for fatigue; care and activities are planned and regular rest periods are scheduled. Mouth care: The patient's mouth is inspected daily for glossitis, mouth lesions, or ulcers. A sponge stick is recommended for oral care, and alkaline mouthwashes are suggested if mouth ulcers are present. A dental consultation may be required. Diet: The patient is encouraged to eat small portions at frequent intervals. Mouth care is provided before meals. The nurse or a nutritionist provides counseling based on type of anemia. Medications: Health care professionals teach the patient about medication actions, desired effects, adverse reactions, and correct dosing and administration. Patient education: The cause of the anemia and the rationale for prescribed treatment are explained to the patient and family. Teaching should cover the prescribed rest and activity regimen, diet, prevention of infection, including the need for frequent temperature checks, and the continuing need for periodic blood testing and medical evaluation.
An outpouching of the walls of a canal or organ. diverticular