Chapter 31: Enuresis (Children) Flashcards
Enuresis
bedwetting
- involuntary discharge of urine
- voids normally and fully but not at the socially acceptable time
- genetic etiology; higher likelihood offspring with have it if parents have suffered from enuresis
Other Issues that may accompany enuresis
developmental delays in other areas such as speech, motor, and growth
Different Types of Enuresis
- Primary nocturnal enuresis (PNE)
- Primary
- Secondary
Primary Nocturnal Enuresis (PNE)
bedwetting during the night
Primary Enuresis
occurs when children have never been able to gain urinary control
-a child has never bee free of bedwetting for any extended period of time
Secondary enuresis
presence of enuresis after a child has achieved dryness for 6 to 12 months
-a child who started bed-wetting after development of urinary control
Children with enuresis are sought to have?
- small bladder capacity
- difficulty with arousing during the night to void
- low levels of antidiuretic hormone (ADH), which keeps people from voiding at night
- stress
- family disruptions such as new baby at home, school phobias, or parental divorce
Signs and Symptoms
- patterns of urinary urgency, crossed legs, jiggling behaviors, holding of genitals
- foul-smelling urine odor
- behavior problems, developmental delays, or possible ADHD
- encopresis (involuntary loss of stool after normal time of control)
- diabetes mellitus (polyuria, polydipsia, polyphagia, weight gain or loss)
- obstructive sleep apnea
- psychological stress
- signs of sexual abuse
Diagnosis
patient history and physical examination to rule out other medical conditions as the cause of enuresis
Prevention
- sometimes genetic, making prevention associated with awareness of familial incidence
- enuresis may be related to a variety of conditions, some of which can be prevented by medications or counseling
Nursing Care
- determine if primary or secondary enuresis
- not considered abnormal until outside the range of 5 or 6 years of age; parents need to be made aware and make them aware of developmental norms for toileting
Complementary Care: Enuresis
- 4 to 6 sessions of hypnotherapy can train a child to awaken when his/her bladder feels full
- bed alarms; a bell or buzzer is triggered when the child begins to void; eventually child learns to wake, may take up to 12 weeks of treatment
- acupressure or massage therapy may help in psychosocial-induced enuresis
- citrus foods, carbonated or caffeinated drinks, red dyes, and artificially colored candy may contribute to enuresis; elimination trials can be advised
- motivational therapy uses rewards where the child receives a star for dry nights or stays; taught to become more sensitive to body cues for voiding
Medical care
-in extreme cases of enuresis; use of medication to control the bladder
>may use this medication on special occasions like school functions and sleep overs; b/c many children embarrassed by this problem
-desmopressin (DDAVP)
Desmopressin (DDVAP)
used to control the bladder
- orally
- acts to lower nocturnal urinary production
- not used under age 6
- risk of hyponatremia; seizures
Education/Discharge
- explaining that sometimes enuresis is a result of the developmental stage of the child, or the child is a deep sleeper who does not feel the urge to void
- this may improve as the child grows, but should be monitored
- avoid fluid close to bedtime
- avoid diuretic beverages or substances (e.g. coffee, tea, chocolate, colas)
- use of reward charts
- commercial items to assist: mattress pads with alarms, watches with reminders to void, books on staying dry, and absorbent underwear
- use of a battery-operated bedwetting alarm; awakens child if the bedding becomes wet
