Nocturia (Nursing)

by Prof. Lawes

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    00:00 Now let's look at this at nighttime because normally ADH is what our body puts out at nighttime so we can sleep and not have to get up to pee. That's a beautiful thing.

    00:11 Isn't it? Because once I am settled in and all comfortable, I do not want to have to get out of my bed. I mean you guys know what I'm talking about. Right? If you ever had that thought where you wake up and you think "Oh I have to pee. No, I think I can make it.

    00:25 I think I can make it til morning." Am I the only one that does that? Because yes when you're all warm and snugly I do not want to get out. But this is what ADH's job is.

    00:35 ADH's job is to allow me to get some good rest and we hang on to that fluid during the night. So here is how it goes down. When I'm younger, when I'm more like a young adult, I have more ADH than when I'm older. So, the kidneys know to reabsorb water and I have less urine and I can sleep peacefully through the night. We talked about young Jose, now let's compare old Jose. Remember, healthy, fit, normal aging of the kidneys.

    01:06 Let's talk about what his experience is like. Now remember his granddaughter was really concerned about how many times he got up during the night, nocturia, to use the restroom. Well, let me explain why that's normal. See, older Jose has less ADH, antidiuretic hormone. So since he has less of that hormone available, he is going to hang on to less water. Now let's make sure that's clear. Remember the role of ADH is to be against diuresing. When I'm against diuresing, I reabsorb that fluid back into my body instead of peeing it out. With less ADH available, then I'm going to pee out more than I normally would when I was younger. See, 2 things. You have less ADH as you age and your tubules are less responsive to the ADH you do have. So it's actually a double whammy. As you age, older Jose even though is healthy and fit, he has less ADH available and his tubules are less responsive to the ADH that he does have. That's why he ends up with the same urinary production or more than he normally would have at night because he doesn't have the same amount of ADH which normally allows him to sleep through the night without having to pee. He has less ADH, his tubules are less responsive to it and that's why he is ending up having to get up during the night to use the restroom or nocturia. Now, we looked at young Jose, we've looked at aging Jose, now I want to take a look and compare how Enrique's experience was so different. Now, Jose has nocturia having to urinate at night, but Enrique has nocturnal polyuria. Remember that word we introduced earlier. Poly means multiple times. So, Jose 3 times a night, Enrique like 6 times or more during the night. Now both of them have less ADH and both of their kidneys are less responsive to ADH, but Enrique again has had a different path. He has congestive heart failure, he has chronic kidney disease. So it's very common for people with congestive heart failure when they lay flat, it's easier for their heart to pump, they end up pushing out some of that extra fluid during the nighttime. So while both have less ADH, they're less responsive to ADH. Jose is a strong, healthy, aged successfully, elderly client. Enrique has had some big challenges and life events. So that is why he has nocturnal polyuria. He urinates more often during the night than the average elderly client. Now there are some other things that can also increase the risk for having polyuria. There are some medications like diuretics which is why we always encourage patients to take their diuretics early in the morning instead of at night. There is a loop diuretic called furosemide. You may know it as Lasix. But we would not want to give that to someone at nighttime because that will definitely help them experience nocturnal polyuria. So it's important in timing with medications that you take those medications earlier in the day so as you're going multiple times to the restroom, it's during the day and not during the night. Remember, these are elderly clients.

    04:40 We would prefer that we limit the number of times they have to get up during the night because of an increased risk for falls when you're kind of in a sleepy state. Now there are other medications, some antidepressants, some anti-seizure medications that will also increase the need to urinate. So keep that in mind, it's really important that you do a very clear assessment of the medications that your patients are on.

    05:05 So we're going to give you even more information about nocturia. We're going to look at healthy kidneys when Jose is 20 and when he is at 85. Now you're going to see a lot of numbers on the screen. The idea is not that you memorize these numbers, the idea is you look at the difference between young Jose and older Jose. So we're going to talk about them in the daytime and in the nighttime. Look at urine volume so you can see the difference in young Jose between his nighttime volume and his daytime volume.

    05:36 Look at old Jose. Wow. Now look at the difference between old and young. What pattern do you see? Now the biggest one is old Jose is literally putting out more urine at night than young Jose and that's why he is having to get up during the night. Now urine osmolality. That's looking at the concentration of the solutes in the solvent or in the urine. So you can look at the numbers there when you're young, usually 700 during the day about 8:30 at night for the young guy. But then look what we have here for older Jose. Look at that in the daytime, in the nighttime it's very different than what young Jose experienced. Now keep in mind, our older clients are at increased risk when they're being dehydrated or when they have fluid volume overload, but here's one of the reasons they have increased risk for dehydration. We're looking at ADH now. Now we have spent a lot of time talking about that. Antidiuretic hormone. Look at young Jose. You'll see that at nighttime he has almost twice as much ADH. Now slide on over to old Jose's column. Whoah, there's a big difference. Right? Compare old Jose's ADH at nighttime to young Jose's ADH at nighttime. That helps shed a lot of light unlike older Jose is having to get up more times during the night when he is in his 80s than when he did when he was in his 20s. Now, you notice that we're going over some of these concepts more than once. That's a good thing for you because we're helping you get things from your short-term memory to your working memory so we can eventually help you get them into your long-term memory. So that's why you're seeing some of these concepts more than once. We wanted you to have this summary slide so you can see everything all in one place and comparing the changes from a young man's kidney to Jose as an old man's kidney. Now this last one is probably new to you.

    07:51 Right? This may not be something that you feel incredibly familiar with, but know that ANH also increases nocturia. So, poor Jose. He's got less ADH, his tubules are less responsive to the ADH he does have, and if that's not enough now we're going to deal with ANH and that's also going to increase his nocturia. Now, let me break it down for you and we will explain why.

    About the Lecture

    The lecture Nocturia (Nursing) by Prof. Lawes is from the course Assessment of the Geriatric Patient: Renal System (Nursing).

    Included Quiz Questions

    1. Antidiuretic hormone
    2. Atrial natriuretic hormone
    3. Renin-angiotensin-aldosterone system
    4. Testosterone
    1. “This is, unfortunately, a normal part of aging, caused by decreased production of antidiuretic hormone.”
    2. “This is, unfortunately, a normal part of aging, caused by decreased production of atrial natriuretic hormone.”
    3. “This is not a part of normal aging and could be caused by abnormal production of atrial natriuretic hormone.”
    4. “This is not a part of normal aging and could be caused by abnormal production of antidiuretic hormone.”
    1. “What you’re experiencing is called nocturia, and it is completely normal to have to get up six or more times during the night as we age.”
    2. “As we age, our kidneys become less responsive to antidiuretic hormone, which contributes to having to get up to urinate during the night.”
    3. “I see that you’re on a diuretic. Do you take it at night or in the morning?”
    4. "Some medications, like certain antidepressants, can make you have to urinate more during the night."
    1. Urine osmolality decreases at night.
    2. Urine volume increases at night.
    3. Plasma ADH decreases at night.
    4. Plasma ADH increases at night.
    5. Urine osmolality increases at night.

    Author of lecture Nocturia (Nursing)

     Prof. Lawes

    Prof. Lawes

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