Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PNP1 Exam 3 > GU- Enuresis > Flashcards

GU- Enuresis Flashcards

1
Q

vol or invol urination into clothes at the age when toilet training should be complete

A

“enuresis” per text

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

incontinence durine sleep

A

nocturnal enuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

enuresis during waking hours

A

diurnal emuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

night time wetting with no daytime concerns

A

monosymptomatic nocturnal emuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

nocturnal enuresis plus some type of bowel or bladder dysfunction

A

non-monosymptomatic enuresis (NMNE)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

enuresis in child who has never had urinary control

A

primary enuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

enuresis in a child has previously been dry 6-12 months then begins wetting

A

secondary enuresis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

DSM-V diagnostic criteria

A

minimum age 5 years old

at least one episode per month for at least 3 months

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

ICCS infrequent enuresis

A

4 or less times per month

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

ICCS frequent enuresis

A

four of more times per week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

causes of enuresis

A

has definitive cause, not due to bad behavior or attention seeking

familial disposition- many found to be due to constipation

developmental comorbidities- strong collelation with adhd

always consider trauma or abuse

constipation, neuro dev delay, small bladder. sleep disorders, stress/family disruption, polyurina, inappropriate toilet training

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

palpate abd for signs of fecal impaction

A

hard mass in LLQ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

indication of full bladder

A

abd tenderness over suprapubic area midline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

testing UA and diff dx

A

UA- should be normal, looking for organic causes enuresis such as UTI- most common cause

DM, sickle cell-increased intake = increase output

CRF- inablilty to concentrate urine

hypercalciurea, neurogenic bladder, obstr uropathy, vaginitis, sleep apnea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

differential dx pollakiuria

A

self limiting and benign

“daytime extraordinary urinary frequency”

8-12 times day, often as Q15-30 min

doesnt respond to meds, typically lasts 6 months but can last years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

treatment should focus on daytime issue first if present then focus on night time

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment - urotherapy

A

non pharmocologic therapy

not as effective as alarm therapy and meds- good starting point

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

urotherapy education

A

Education-how bladder works, minimize embarassment/scolding, reinforce positives and childs wanting to be dry

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

urotherapy - bladder training

A

bladder training-void Q2hrs during day, awakning and prior to bed, proper sitting and emptying

20
Q

urotherapy diet and fluids

A

adequate water between bfast and lunch to avoid evening thirst- eliminate carb beverages, citus juices and caff

no dairy 4 hours before bedtime

no fluids 2 hours before bedtime

NEVER takes prescidence over adequate hyrdration

21
Q

urotherapy - monitor progress and manage constipation

A

keep voiding diary

manage constipation issues

22
Q

How long should we try urotherapy before medication and enuresis alarm?

A

3 months

use of alarms and desmopressin are also first line treatment, choice of urotherapy vs alarm/meds is up to family

23
Q

how do alarms reduce nocturnal enuresis?

A

increasing nocturnal bladder capacity or by enhanced arousal

does not reduce nocturnal output

24
Q

how is alarm worn and when to follow up and d/c

A

worn with undrpants, parents should awaken child if he/she doesnt awake

nightly for2-4 (3) months and until after patient is dry for at least 1 month (14 days min)

follow up is biweekly or monthly

25
Q

Drug therapy for monosymptomatic nocturnal enuresis -first, second and third

A

desmopressin acetate (DDAVP)-first line

imipramine (tofranil) - only thrid line therpy at tertiary care facilities- third line

26
Q

desmopressin dose

A

0.2-0.4mg daily at bedtime

120mcg melt daily at bedtime up to 240 as equivalent dosage

27
Q

desmopressin info- reduces nighttime urine production

A

effective in kids with nocturnal polyuria and normal bladder volume

take on empty stomach, no caff/choc/nutrasweet/carb bev

30 min before bed then wake to void within 10hrs

kids at least 6 years old

do not use with nasal spray

caution in HTN, CF (hyponatremia) any lyte imbalances

use least amount effective

can use daily or intermittantly

d/c in 6 months to check for relapse, 80-100% will relapse with d/c

28
Q

oxybutynin dose

A

anticholenergic - second line

5 mg once daily at bedtime,

increase by 5mg

MAX DOSE 20MG/DAY

29
Q

oxybutynin notes

A

relaxes smooth mosclus of bladder to increase capacity, has antispasmotic and analgesic properties

effective for daytime enuresis

kids at least 5 years old

30
Q

concerns for referral

A

weak or interrupted stream

need to use abd pressure to urinate

daytime incont and nocturnal enuresis combined

31
Q

ectopic ureter results in

A

costant leakage

32
Q

no response

A

less than 50% reduction in enuresis

33
Q

partial response

A

50-99% reduction

34
Q

complete response

A

100% reduction

35
Q

relapse

A

more than one symptom relapse per month

36
Q

continued success

A

no sympt at 6 months

37
Q

complete success

A

no symptoms for 2 years

38
Q

what age can treatment start?

A

6 years old

39
Q

What do we do for 3-5 year olds?

A

benign neglect in the face of accidents

for older children, more aggressive treatments are warranted, rarely indicates disease

40
Q

Drug therapy for monosymptomatic nocturnal enuresis -second line

A

Anticholenergics

oxybutynin (ditropan)

Tolterodine (detrol)

41
Q

Drug therapy for monosymptomatic nocturnal enuresis -third line

A

tricyclic antidepressant

imipramine (tofranil)

only thrid line therpy at tertiary care facilities- third line

42
Q

Detrol notes

A

anticholinergic- second line treatment

kids 12 and up

43
Q

detrol dosage

A
44
Q

anticholenergic s/e and warnings

A

detrol (tolterodine) and ditropan (oxybutynin)

no not admin with fever, sweating is anticholinergic effect

caution in kids who play vigerously, exericse, hot days

s/e: dry mouth, blurred vision, facial flushing, CONSTIPATION, poor bladder emptying, mood changes

45
Q

imipramine dose

A
46
Q
A
46
Q

imepramine notes

A

TCA- thrid line treatment

has anticholenergis s/e as well as a CNS stimulant

allows children to awaken to sensation of full bladder

use with caution can cause seizures or cardiac arrythimas with OD

PNP1 Exam 3 (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions