Assignment: Urinary frequency, nocturia, incontinence

Assignment: Urinary frequency, nocturia, incontinence

Assignment: Urinary frequency, nocturia, incontinence

Third Trimester Common Discomforts

Your patient is in the third trimester and has had all routine prenatal care elements so far. All results have been normal.

The patient reports : Urinary frequency, nocturia, incontinence
Please respond to the following questions based on the common discomfort this patient has reported. Keep the patient’s gestational age in mind. 3rd trimester

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Question 1: Briefly and in patient-centered, non-medical language, how would you explain to the patient the physiologic cause for this discomfort of pregnancy? [worth 2 of 10 points for this exam] Include only the level of detail that is appropriate for patients; patients can get overwhelmed with information. Your response does not need to demonstrate to faculty all that you know about the topic. Your response should be no more than about 3 bullet points.

Question 2: What are the most important HISTORY OF PRESENT ILLNESS (HPI) elements that you would assess that would align with this common discomfort? Don’t include a list of questions you WOULD ask. Instead, list the HPI FINDINGS that would RULE IN a normal concern of pregnancy and are reassuringly supportive that this is the identified common discomfort, rather than something more serious.

Question 3: What are the most important CHART REVIEW elements that you would assess that would align with this common discomfort? Please list the FINDINGS FROM THE CHART that would RULE IN a normal concern of pregnancy and are reassuringly supportive that this is the identified common discomfort, rather than something more serious.

Question 4: Assuming that the HPI and chart review findings are benign, do you need OBJECTIVE DATA elements to be reassured that this is a common discomfort? [ Choose between the following options:

-No objective data is needed, assuming that the HPI and chart review findings are benign.
-Yes, I need objective data to be reassured that this is a common discomfort even if the HPI and chart review findings are benign.

Question 5: What is your rationale for your decision about objective data being needed or not? If you indicated that no objective data is needed, provide a brief reason for that decision. If you indicated that objective data is needed, include the FINDINGS that would RULE IN a normal concern of pregnancy, rather than indicating what you WOULD order/assess.

Question 6: What are the most important treatments or relief strategies you would suggest to the patient to manage this common discomfort (after eliciting their needs and values)? Limit to no more than 3-4 strategies.

I am looking for brief responses that answer the question in a concise, prioritized way.

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Urinary Frequency, Nocturia and Incontinence
I would explain to her that her urinary frequency, nocturia, and incontinence are common in pregnancy. They arise from the pressure that the fetus exerts on the bladder. As a result, she develops difficulties in controlling bladder functions, leading to urinary frequency, nocturia, and incontinence. The additional causes include hormonal changes, increased renal excretion of excess fluids, and increased blood volume during pregnancy (Kalkan et al., 2022).
The HPI findings that would RULE IN a normal concern include the lack of burning sensation during urination, polydipsia, glucose in urine, foul smelling urine, passing of blood stained or pus stained urine, and painful urination.
The most important CHART REVIEW elements that would RULE IN a normal concern of pregnancy include absence of dysuria, polydipsia, burning on urination, foul smelling urine, blood, or pus stained urine, and glucose in urine. The other element is the absence of proteins or ketones in urine, which would indicate pre-eclampsia and dehydration (Poudel et al., 2021).
No. No objective data is needed since the HPI and chart review findings are benign.
No objective data is needed for the patient in this case study. The complaints are attributed to the physiological changes that occur during pregnancy. The growing fetus places pressure on the bladder. The hormonal changes and increased urinary excretion of fluids also cause nocturia. Therefore, there is no need for additional objective data since HPI and chart review elements are assuring.
The most important relief strategies that I would suggest to the patient to manage her discomforts include pelvic floor muscle strengthening exercises, passing urine at intervals to prevent incontinence, and use of clean panty liners to catch any urine leaks.

References
Kalkan, Ü., Yassa, M., Sevi̇m, B., Buran, A., Bi̇rol, P., Teki̇n, A., & Tug, N. (2022). Changes in pelvic floor mobility in uncomplicated pregnant women over 28 gestational week and its relation with subjective urinary incontinence complaints. Journal of Experimental and Clinical Medicine, 39(1), Article 1.
Poudel, A., Dangal, G., & Shrestha, M. (2021). Urinary Incontinence among Pregnant Women in Third Trimester of Pregnancy in a Tertiary Care Center: A Descriptive Cross-sectional Study. JNMA: Journal of the Nepal Medical Association, 59(240), 752–756. https://doi.org/10.31729/jnma.6914