An elderly resident of a long-term care facility frequently wakes up to urinate during the night. What physiological change associated with normal aging could be the cause of this?

Choice A rationale:
Administering pre-operative medications does not address the client's expressed desire regarding resuscitation. It is a necessary step in preparing the client for surgery, but it does not directly relate to their preferences for end-of-life care.
Fulfilling this task does not ensure that the client's wishes are communicated to the appropriate healthcare providers, potentially leading to unwanted resuscitative efforts if the client's condition deteriorates during surgery.
It is crucial for the nurse to prioritize the client's autonomy and right to self-determination regarding their healthcare choices.
Choice B rationale:
Informing the physician after the surgery is complete is not timely and could result in the client's wishes not being respected.
The physician needs to be aware of the client's resuscitation preferences before the procedure begins to ensure that care aligns with their wishes.
Delaying communication could lead to ethical and legal dilemmas if resuscitation is attempted against the client's expressed desires.
Choice C rationale:
This is the most appropriate action because it directly addresses the client's concerns and ensures that their wishes are documented and communicated effectively.
Having a clear conversation with the client allows for exploration of their understanding of resuscitation and any potential concerns or questions they may have.
Recording the client's wishes in their medical record provides a clear record for all healthcare providers involved in their care, promoting consistency and respect for their autonomy.
Choice D rationale:
While verbally communicating the client's wishes to the operating room supervisor is important, it is not sufficient on its own.
Written documentation in the medical record is essential to ensure that the information is accurately conveyed to all members of the healthcare team and accessible throughout the client's care journey.

Urinary retention is the inability to completely empty the bladder. It is a common symptom of BPH, as the enlarged prostate can press on the urethra and obstruct the flow of urine. This can lead to several characteristic symptoms, including:

Feeling of incomplete bladder emptying: Patients often feel as though they haven't fully emptied their bladder, even after urinating.

Straining to urinate: It may take extra effort to initiate and maintain a urine stream.

Weak urine stream: The force of the urine stream may be noticeably reduced.

Intermittent urine stream: The flow of urine may start and stop repeatedly.

Post-void dribbling: Urine may continue to drip after urination has seemingly ended.

Urinary frequency: The need to urinate frequently, often at night (nocturia).

Urgency: A sudden, compelling need to urinate that may be difficult to postpone.

Bladder pain or discomfort: Pressure or pain in the lower abdomen, often associated with a full bladder. Pathophysiology:

Bladder outlet obstruction: The enlarged prostate physically compresses the urethra, the tube that carries urine from the bladder to the outside of the body. This obstruction makes it difficult for urine to flow freely, leading to incomplete bladder emptying.

Detrusor muscle dysfunction: The detrusor muscle, which forms the bladder wall, may become weakened or overactive due to the constant strain of trying to empty against resistance. This can further impair bladder emptying.

Neurological factors: In some cases, nerve damage or dysfunction may contribute to urinary retention, particularly in men with diabetes or neurological conditions.

Additional insights:

Chronic urinary retention can result in serious complications, such as bladder stones, urinary tract infections, and kidney damage.

Acute urinary retention is a medical emergency that requires immediate catheterization to relieve the bladder and prevent further complications.

Treatment for urinary retention typically involves medications to relax the prostate and bladder muscles, as well as lifestyle modifications such as limiting fluid intake before bedtime. In some cases, surgical intervention may be necessary to reduce the size of the prostate or widen the urethra.