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RENAL DYSFUNCTION ENURESIS (PG 1007-1008) PATHOPHYSIOLOGY Urine control is related to maturity of CNS. By age 5 most children are aware of bladder fullness and are able to control voiding. Daytime control is usually 1 st followed by nighttime dryness. Girls master earlier than boys. Nocturnal enuresis may indicate delayed maturation of CNS. Night time wetting may run in families. Not concerning until >6yo Secondary nocturnal enuresis or issues with daytime enuresis may need further evaluation to r/o other conditions such as Bladder infections/UTI’s Diabetes Bladder contractions/over active bladder/urgency Anatomic abnormalities MANAGEMENT Reduce fluids after supper Set alarms Bladder training- set times to use bathroom Voiding just before bed and waking child during the night to urinate. Avoid sugar and caffeine Train using imagery- picturing waking to use bathroom Reward systems do not work- assumes bed wetting is voluntary. Place pads on bed Desmopressin acetate (DDAVP)- antidiuretic (not recommended in children under 6. Anticholinergics(oxybutynin chloride) to relax smooth muscles in blader.(over active or spastic bladder) NURSING CARE Situational low self-esteem- embarrassed. Impaired social interactions- does not go to parties, sleep overs or play dates. Risk for impaired skin integrity Provide correct information Encourage follow up Support URINARY TRACT INFECTIONS: UTI (PG 1008-1009)
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Results in significant morbidity in infants and children. One of the most
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  • Fall '17
  • Julie Gwin

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Christopher Reinemann
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