Symptom: Urination, Increased

Initial Grading Reminder

Grade 1: Present
Grade 2: Limiting instrumental ADL; medical management

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had issues with frequent urination in the past? Are you on corticosteroids? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly?

Grade the symptom

Ask the patient:

How frequently are you urinating? Are you waking up at night to urinate? How much of an impact is it having on your life?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you also have any nausea or vomiting? Any abdominal (belly) pain; weakness; shortness of breath; confusion (feeling foggy)?

For patients with known diabetes:

Ask what their blood sugar level is and whether they have checked urine ketones.

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Patients with new onset moderate or worse (or worsening) increased urination should be seen.

    Patients with red-flag symptoms should be seen immediately.

    Patients with diabetes who are symptomatic and whose blood sugar and urine ketone levels are high should be seen. Patients should be instructed to go to the ED if blood glucose is >300 mg/dL and if there are multiple symptoms suggesting diabetic ketoacidosis.

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    Nursing Assessment of Potential Causes

    Type 1 Diabetes Mellitus - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear fatigued?
    • Does the patient appear dehydrated?
    • Does the breath have a sweet/fruity smell?
    • Is the patient tachycardic?
    • Frequent urination?
    • Increased thirst?
    • Increased hunger?
    • Increased fatigue?
    • Altered level of consciousness with advanced cases
    • Symptoms of diabetes
    • Serum glucose levels
    • Other immune-related toxicity
    • Infections

    Differential Diagnosis

    What do you suspect is the cause of increased urination?