The 48-year-old client with diabetes mellitus is being treated for her third episode of acute pyelonephritis in the past year. She asks what she could do to help prevent these infections. What is the nurse's best response?
A. "Test your urine daily for the presence of ketone bodies and proteins."
B. "Use tampons rather than sanitary napkins during your menstrual period."
C. "Drink more water and try to empty your bladder at least every 2 to 3 hours while you are awake."
D. "Inject your insulin in larger doses or more frequently to keep your blood sugar lower so the microorganisms have fewer nutrients for growth."
C
Clients with long-standing diabetes mellitus are at risk for pyelonephritis for many reasons. Chronically elevated blood glucose levels spill glucose into the urine, changing the pH and pro-viding a favorable climate for bacterial growth. The neuropathy associated with diabetes reduces bladder tone and reduces the client's sensation of bladder fullness. Thus, even with large amounts of urine, the client voids less frequently, allowing stasis and overgrowth of microorganisms. In-creasing fluid intake (specifically water) and voiding frequently prevent stasis and bacterial overgrowth.
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