A middle-aged client with diabetes mellitus is being treated for the third episode of acute pyelonephritis in the past year and asks what can be done to help prevent these infections. Which is the nurse's best response?

Question

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 empty your blad-der every 2 to 3 hours during the day."
d. "Keep your hemoglobin A1c under 9% by keeping your blood sugar controlled."

Answer 1

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 microorgan-isms. Increasing fluid intake (specifically water) and voiding frequently prevent stasis and bac-terial overgrowth. Testing urine and wearing tampons will not help prevent pyelonephritis. A hemoglobin A1c of 9% is too high.