Patient Care and Monitoring UI

1. Assess the patient's symptoms to determine if patient-directed therapy is appropriate or whether or not the patient should be evaluated by a physician. Assessment includes the types and severities of symptoms and the presence or absence of exacerbating factors. Does the patient have any UI-related complications?

2. Review any available diagnostic data to determine disease status.

3. Obtain a thorough medication history, including use of prescription, nonprescription, and complementary and alternative drug products. Determine which, if any, treatments in the past had been helpful as judged by the patient. Could any of the patient's current medications be contributing to UI?

4. Educate the patient on lifestyle modifications that may improve symptoms, including but not limited to, smoking cessation (for patients with cough-induced SUI), weight reduction for those patients with SUI and UUI, prevention of constipation in patients at risk, caffeine reduction, and modification of diet and fluid intake (e.g., timing and quantity of fluid intake and avoidance of foods or beverages that worsen UI).

5. Is the patient taking the appropriate drug(s) for his or her type(s) of UI? Are the dose(s) appropriate? If no (to either question), why?

6. Develop a plan to assess efficacy after a minimum of 4 weeks.

7. Assess changes in quality of life (physical, psychological, social functioning, and well-being).

8. Evaluate the patient for drug-related adverse events, allergies, and interactions (drug-drug and drug-disease).

9. In cognitively intact elderly patients, focus communications to elicit the preferences of the patient, not those of potential proxies.

10. Stress the importance of adherence with the prescribed regimen, including lifestyle modifications. Recommend the most "patient-friendly" treatment regimen possible.

11. Provide patient education regarding the disease state, lifestyle modifications, and drug therapy:

• Causes of UI and what things to avoid (see 3 and 4 above)

• Possible UI complications

• Timing of medication intake

• Potential adverse events (limit to most frequent and/or clinically relevant)

• Potential drug-drug interactions

Enuresis is not a benign disorder that children will just "grow out of." Emotional and/or physical abuse of the child by adult caregivers lead to secondary problems such as chronic anxiety, low self-esteem, and delayed developmental milestones such as attending camp or going on "sleepovers" at the homes of friends. The emotional and developmental damage produced by enuresis may be more significant to the child than the enuresis itself.

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