STUDY - Technical - New Dacian's Medicine
Nocturia
(Classical / Allopathic Medicine)
Nocturia -
excessive urination at night - may result from disruption of
the normal diurnal pattern of urine concentration or from
overstimulation of the nerves and muscles that control
urination. Normally, more urine is concentrated during the
night than during the day. As a result, most persons excrete
three to four times more urine during the day and can sleep
for 6 to 8 hours during the night without being awakened. With
nocturia, the patient may awaken one or more times during the
night to empty his bladder and may excrete 700 ml or more of
urine.
Although nocturia
usually results from a renal or lower urinary tract disorder,
it may also result from a cardiovascular, endocrine, or
metabolic disorder. This common sign may also result from the
use of a drug that induces diuresis - particularly if it's
taken at night - or from ingestion of large quantities of
fluids, especially caffeinated beverages or alcohol, at
bedtime.
HISTORY:
Ask the patient when the nocturia began and how often it occurs.
Ask the patient if he can identify a specific pattern or precipitating factors, such as a change in his usual pattern or in the volume of his fluid intake.
Ask the patient to estimate the volume of urine voided.
Ask the patient about changes in the color, odor, or consistency of his urine.
Ask the patient about associated signs and symptoms, such as pain or burning on urination, difficulty initiating a urine stream, costovertebral angle tenderness, and flank, upper abdominal, or suprapubic pain.
Review the patient's medical history, noting especially renal or urinary tract disorders and endocrine or metabolic disease, particularly diabetes.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, noting especially drugs that increase urine output, such as diuretics, cardiac glycosides, and antihypertensives. Also, ask the patient about alcohol intake.
Ask the patient when the nocturia began and how often it occurs.
Ask the patient if he can identify a specific pattern or precipitating factors, such as a change in his usual pattern or in the volume of his fluid intake.
Ask the patient to estimate the volume of urine voided.
Ask the patient about changes in the color, odor, or consistency of his urine.
Ask the patient about associated signs and symptoms, such as pain or burning on urination, difficulty initiating a urine stream, costovertebral angle tenderness, and flank, upper abdominal, or suprapubic pain.
Review the patient's medical history, noting especially renal or urinary tract disorders and endocrine or metabolic disease, particularly diabetes.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs, noting especially drugs that increase urine output, such as diuretics, cardiac glycosides, and antihypertensives. Also, ask the patient about alcohol intake.
PHYSICAL
ASSESSMENT:
Palpate and percuss the kidneys, the costovertebral angle, and the bladder.
Carefully inspect the urinary meatus.
Inspect a urine specimen for color, odor, and the presence of sediment.
Palpate and percuss the kidneys, the costovertebral angle, and the bladder.
Carefully inspect the urinary meatus.
Inspect a urine specimen for color, odor, and the presence of sediment.
SPECIAL
CONSIDERATIONS:
Monitor vital signs, intake and output, and daily weight; document the frequency of nocturia, amount, and specific gravity.
Monitor vital signs, intake and output, and daily weight; document the frequency of nocturia, amount, and specific gravity.
PEDIATRIC
POINTERS:
In children, nocturia may be voluntary or involuntary. The latter is commonly known as enuresis or bedwetting.
With the exception of prostate disorders, causes of nocturia are generally the same for children and adults. However, children with pyelonephritis are more susceptible to sepsis; signs and symptoms include fever, irritability, and poor skin perfusion. In addition, girls may experience vaginal discharge and vulvar soreness or pruritus.
In children, nocturia may be voluntary or involuntary. The latter is commonly known as enuresis or bedwetting.
With the exception of prostate disorders, causes of nocturia are generally the same for children and adults. However, children with pyelonephritis are more susceptible to sepsis; signs and symptoms include fever, irritability, and poor skin perfusion. In addition, girls may experience vaginal discharge and vulvar soreness or pruritus.
AGING ISSUES:
Postmenopausal women have decreased bladder elasticity, but urine output remains constant, resulting in nocturia.
Postmenopausal women have decreased bladder elasticity, but urine output remains constant, resulting in nocturia.
PATIENT
COUNSELING:
Advise the patient to plan the administration of a diuretic for daytime hours, if possible. Recommend the patient reduce fluid intake (especially of caffeinated beverages) before bedtime.
Advise the patient to plan the administration of a diuretic for daytime hours, if possible. Recommend the patient reduce fluid intake (especially of caffeinated beverages) before bedtime.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common symptoms,
Edition V, McGraw - Hill, 2002.