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Ian Wilson
Ian Wilson

Mature Lady Must Pee



There is no easy answer and each case must be treated individually. Help by family, friends, services providers, APS, or health care interventions can be offered but the person has to accept that help.




mature lady must pee



Second, children need to learn how to use the toilet. Children must be able to understand instructions and follow them. For instance, they have to be able to sit or stand comfortably. They have to be able to pull down their pants and underpants, as well as pull them back up.


Delivery is the only cure for preeclampsia. Patients with preeclampsia without severe features are often induced after 37 weeks' gestation. Before this, the patient is usually hospitalized and monitored carefully for the development of worsening preeclampsia or complications of preeclampsia, and the immature fetus is treated with expectant management with corticosteroids to accelerate lung maturity in preparation for early delivery.


In patients with preeclampsia with severe features, induction of delivery should be considered after 34 weeks' gestation. In these cases, the severity of disease must be weighed against the risks of infant prematurity. In the emergency setting, control of BP and seizures should be priorities.


An estimated 2-8% of pregnancies are complicated by preeclampsia, with associated maternofetal morbidity and mortality. [14] In the fetus, preeclampsia can lead to ischemic encephalopathy, growth retardation, and the various sequelae of premature birth.


Hypertension is diagnosed when two BP readings of 140/90 mm Hg or greater are noted 4 hours apart within a 1-week period. Measuring BP with an appropriate-sized cuff placed on the right arm at the same level as the heart is important. The patient must be sitting and, ideally, have had a chance to rest for at least 10 minutes before the BP measurement. She should not be lying down in a lateral decubitus position, as the arm often used to measure the pressure in this position will be above the right atrium.


The Korotkoff V sound should be used for the diastolic pressure. In cases in which the Korotkoff V sound is not present, the Korotkoff IV sound may be used, but it should be noted as such. The difference between the Korotkoff IV and V sounds may be as much as 10 mm Hg. When an automated cuff is used, it must be able to record the Korotkoff V sound. When serial readings are obtained during an observational period, the higher values should be used to make the diagnosis.


During diagnosis, preeclampsia must be differentiated from gestational hypertension. Although gestational hypertension is more common and may present with symptoms similar to those of preeclampsia, including epigastric discomfort or thrombocytopenia, it is which is not characterized by proteinuria. (See Classification and Characteristics of Hypertensive Disorders.)


The presence of schistocytes, burr cells, or echinocytes on peripheral smears, or elevated indirect bilirubin and low serum heptoglobin levels, may be used as evidence of hemolysis in diagnosing HELLP syndrome. The differential diagnosis for HELLP syndrome must include various causes for thrombocytopenia and liver failure such as acute fatty liver of pregnancy, hemolytic uremic syndrome, acute pancreatitis, fulminant hepatitis, systemic lupus erythematosus, cholecystitis, and thrombotic thrombocytopenic purpura.


The optimal management of a woman with preeclampsia depends on gestational age and disease severity. Because delivery is the only cure for preeclampsia, clinicians must try to minimize maternal risk while maximizing fetal maturity. The primary objective is the safety of the mother and then the delivery of a healthy newborn. Obstetric consultation should be sought early to coordinate transfer to an obstetric floor, as appropriate. [61]


Patients with preeclampsia without severe features are often induced after 37 weeks' gestation. Before this, the immature fetus is treated with expectant management with corticosteroids to accelerate lung maturity in preparation for early delivery.


In patients with preeclampsia with severe features, induction of delivery should be considered after 34 weeks' gestation. In these cases, the severity of disease must be weighed against the risks of infant prematurity. In the emergency setting, control of BP and seizures should be priorities. In general, the further the pregnancy is from term, the greater the impetus to manage the patient medically.


If a patient presents with preeclampsia with severe features before 34 weeks' gestation but appears to be stable, and if the fetal condition is reassuring, expectant management may be considered, provided that the patient meets the strict criteria set by Sibai et al (see Laboratory values for preeclampsia and HELLP syndrome). [66] This type of management should be considered only in a tertiary center. In addition, because delivery is always appropriate for the mother, some authorities consider delivery as the definitive treatment regardless of gestational age. However, delivery may not be optimal for a fetus that is extremely premature. Therefore, in a carefully chosen population, expectant management may benefit the fetus without greatly compromising maternal health.


All of these patients must be evaluated in a labor and delivery unit for 24 hours before a decision for expectant management can be made. During this period, maternal and fetal evaluation must show that the fetus does not have severe growth restriction or fetal distress. In addition, maternal urine output must be adequate. The woman must have essentially normal laboratory values (with the exclusive exception of mildly elevated liver function test results that are less than twice the normal value) and hypertension that can be controlled.


Fetal monitoring should include daily nonstress testing and ultrasonography performed to monitor for the development of oligohydramnios and decreased fetal movement. In addition, fetal growth determination at 2-week intervals must be performed to document adequate fetal growth. A 24-hour urine collection for protein may be repeated. Corticosteroids for fetal lung maturity should be administered prior to 34 weeks.


Preeclampsia resolves after delivery. However, patients may still have an elevated BP postpartum. Liver function tests and platelet counts must be performed to document decreasing values prior to hospital discharge. In addition, one third of seizures occur in the postpartum period, most within 24 hours of delivery, and almost all within 48 hours. [73] Therefore, magnesium sulfate seizure prophylaxis is continued for 24 hours postpartum. (See Seizure Treatment and Prophylaxis With Magnesium Sulfate.)


Rarely, a patient may have elevated liver enzymes, thrombocytopenia, and renal insufficiency more than 72 hours after delivery. In these cases, the possibility of hemolytic uremic syndrome (HUS) or thrombotic thrombocytopenic purpura (TTP) must be considered. In such situations, plasmapheresis, along with corticosteroid therapy, may be of some benefit to such patients and must be discussed with renal and hematology consultants.


Hi Preston,I am sorry your senior girl is having these urinary issues. I know how worrisome it must be facing this unknown path ahead. I am glad the article was helpful and will offer guidance for the conversation with your vet. Your dog is lucky to have you in her life advocating for her health and well-being. Hoping for answers and an effective treatment. Wishing you and your sweet girl the best.


Normal bowel function requires healthy muscles and nerves in the rectum and pelvis. The large intestine (also called the colon) must be able to form and store the stool until you can get to the bathroom. The sphincter muscles of the anus must be strong enough to stay closed until you need to pass stool or gas.


Krystn is a passionate pet nutrition enthusiast. She has worked in the pet industry for over a decade and loves to share her passion for animal welfare with others. She loves all animals but is currently channeling some crazy cat lady vibes with her four lovable, but rebellious cats. 041b061a72


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