A nurse is caring for a debilitated female patient with nocturia. Which nursing intervention is the priority when planning to meet this patient’s needs?
A. Encouraging the use of bladder training exercises.
B. Providing assistance with toileting every four hours.
C. Positioning a bedside commode near the bed.
D. Teaching the avoidance of fluid after 5 PM.
Correct Answer: C. Positioning a bedside commode near the bed.
The use of a commode requires less energy than using a bedpan and is safer than walking to the bathroom. Sitting on the commode uses gravity to empty the bladder fully and thus prevent urinary stasis. Nocturia is defined as the need for a patient to get up at night on a regular basis to urinate. A period of sleep must precede and follow the urinary episode to count as a nocturnal void. This means the first-morning void is not considered when determining nocturia episodes. Use of a bedside commode or urinal can minimize the bother, if not the frequency, of nocturia and may reduce the risk of falls. Remove any obstacles, loose rugs, or furniture between the bed and the nearest commode to reduce fall risk further. Consider using nightlights to help illuminate the passage to the bathroom.
Option A: Although bladder training exercises should be done, it is not the priority. Behavioral therapy, which includes pelvic floor muscle training, urge-suppression techniques, delayed voiding, fluid management, sleep hygiene, Kegel exercises, and peripheral edema management, has been shown to be reasonably efficacious both when used alone or together with pharmacological therapy in controlling nocturia.
Option B: Assisting with toileting may be too often or not often enough for the patient. Care should be individualized for the patient. In particular, older adults with nocturia who make multiple nocturnal trips to the bathroom are at a substantially increased risk of potentially serious falls. A quarter of all the falls that occur in older individuals happen overnight. Of these, 25% are directly related to nocturia. Patients who make at least 2 or more nocturnal bathroom visits a night, have more than double the risk of fractures and fall-related traumas.
Option D: Fluids may be decreased during the last two hours before bedtime, but they should not be avoided completely after 5 PM (opt4). Some fluid intake is necessary for adequate renal perfusion. Drinking large amounts of fluids shortly before going to bed and ingesting caffeine or alcohol late in the day and before bed is likely to contribute to nocturia as well. Be aware that some elderly patients may already be somewhat dehydrated and might require extra fluid intake earlier in the day before they can safely do any evening fluid restriction before bedtime.