Bedwetting Causes & Treatment

Bed Wetting

• Nocturnal enuresis, also known as nighttime bedwetting, and daytime is diurnal enuresis
• Bedwetting is not typically considered normal after age 5, as children usually gain full bladder control between ages 4-6
• To be diagnosed, bedwetting must occur at least twice a week for three months
• Primary bedwetting is when a child has never been free from bedwetting
• Secondary bedwetting is when a child begins bedwetting again after having had full control
• Risks include family history, being male, bladder disorders, emotional factors, and constipation

Medications for Bedwetting

• Medications for bedwetting are usually titrated to find the correct dosage
• Desmopressin Acetate (DDMP) is an antidiuretic hormone reducing urine volume, the goal is at least 5 dry nights a week
  • Administer at bedtime, avoid evening fluids, and store the nasal spray in the refrigerator
• Imipramine hydrochloride are tricyclic antidepressants and they inhibit urination
  • Nursing considerations: administer 1 hour before bedtime with food, avoid sun exposure and OTC medications, monitor for suicidality for only 6-8 weeks
• Oxybutynin chloride are anticholinergics to reduce bladder contractions and must be weaned off
  • Nursing considerations: monitor for effectiveness

Discharge Teaching for UTIs

• Teach families to wipe from front to back for females
• "Double voiding" ensures the bladder adequately empties by urinating and then attempting to urinate again
• Emphasize wearing cotton, nonrestrictive underwear, and avoiding staying in wet clothes
• For uncircumcised males, demonstrate how to retract and clean the foreskin
• Avoid bubble baths, whirlpools, and hot tubs
• Ensure adequate fluid intake
• Sexually active individuals should void after sex
• Finish the entire prescribed antibiotic regimen

Glomerulonephritis

• Glomerulonephritis which can be acute or chronic, is most common in children aged 5-8 years old
• It is an inflammation of the glomeruli, which are bundles of tiny blood vessels inside the kidneys
• Glomeruli damage impairs their ability to filter waste and excess urine water, leading to tea-colored urine, increased blood pressure, periorbital edema, and sudden onset
• It is often a post-infectious disorder where the immune system overreacts to infections

Nephrotic Syndrome

• Minimal change nephrotic syndrome causes the kidneys to leak large amounts of protein into the urine
• This leads to swelling of body tissues and increases the risk of infection
• Under a microscope, the kidneys appear normal or nearly normal
• Albumin, 25%, is given because it increases plasma levels and decreases edema

Hemolytic Uremic Syndrome (HUS)

• Damaged red blood cells block the kidneys' filtering system, potentially causing kidney failure in children
• Often develops after a toxic strain of E. coli infection that is found in contaminated foods
• This infection can result in hemorrhagic enterocolitis within 2–12 days
• E. coli outbreaks are common in fast food restaurants (undercooked meats), daycare centers, and water parks, especially during summer and spring
• Triad of symptoms include microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury (AKI) after recent illness
• Risks include being 6 months-3 years old, ingesting shiga toxin that creates E. Coli, genetic disorders, and toxins in the bloodstream

Hydrocephalus

• Hydrocephalus can be congenital or acquired
• It is caused by an imbalance between the production and absorption of cerebrospinal fluid, leading to fluid accumulation in the brain ventricles
• Infant manifestations include a shrill, high-pitched cry, increased head circumference, a full or tight fontanel, lethargy, seizures, sunset eyes, irritability, a sluggish and unresponsive look, bradycardia, hypertension, apnea, and opisthotonos posturing
• Child manifestations include early morning headaches relieved by vomiting, increased projectile vomiting, swelling of the optic disc (papilledema), blurred or double vision, irritability, trouble walking or uncoordinated movement, urinary incontinence, hypertension, and tachycardia

Hypospadias/Epispadias

• The urethral opening is on the ventral (lower) aspect of the penis, as far as the scrotum for hypospadias
• The urethral opening is on the dorsal (top) aspect of the penis for epispadias

Nephrotic Syndrome Complications

• Complications from nephrotic syndrome include the following
  • Sepsis and infection
  • Circulation insufficiency
  • Thromboembolism

Hirschsprung Disease

• Hirschsprung Disease occurs when parasympathetic ganglion cells in the wall of the large intestine (colon) do not develop before birth
• Newborn manifestations include:
  • Delayed or absent meconium stool in the neonatal period (24-48 hours)
  • Vomiting bile
  • Refusal to eat
  • Abdominal distension
• Infant manifestations include:
  • Failure to thrive
  • Constipation
  • Vomiting
  • Episodes of vomiting and diarrhea
• Child manifestations include:
  • Foul-smelling ribbon-like or pellet-like stool
  • Undernourished, anemic appearance
  • Abdominal distension
  • Visible peristalsis
  • Palpable fecal mass
  • Constipation

Pyloric Stenosis

• Hypertrophic pyloric stenosis typically occurs between 3 weeks and 3 months of age
• Manifestations include:
  • Non-bilious vomiting
  • An olive-shaped mass in the right upper quadrant (RUQ) of the abdomen
  • Possible peristaltic wave that moves from left to right when lying supine
  • Failure to gain weight
  • Signs of dehydration
  • Hunger
• Pyloric stenosis can be diagnosed by ultrasound
• A surgical procedure called pyloromyotomy is used to treat pyloric stenosis

Necrotizing Enterocolitis (NEC)

• Necrotizing enterocolitis (NEC) is an infection that primarily affects the lower portion of the small intestine (ileum)
• Nursing interventions include:
  • Stop all feeds and administer IV or TPN instead
  • Use an NG tube to decompress the abdomen
  • Administer IV antibiotics
  • Carefully assess the abdomen and measure abdominal girth above the umbilicus every 4-8 hours
  • Conduct abdominal X-rays every 4-6 hours
  • Monitor vital signs
  • Facilitate bonding
• The possible surgery involves removing the necrotized portion of the bowel or creating a temporary colostomy

Priority Nursing Care for Burns

• The priority in burn care is to ensure the patient's ABCs (airway, breathing, and circulation)
• Provide oxygen and fluids quickly to prevent shock and death in major burns
• For minor burns:
  • Soak the burn in tepid water
  • Do not apply greasy lotion, ice, or butter on the burn
  • Do not break blisters
• For major burns:
  • Maintain airway and ventilation
  • Provide 100% oxygen
  • Monitor vital signs and IV access
  • Administer fluid replacement with Lactated Ringer's for the first 24 hours
  • Maintain urine output at 0.5 mL/kg/hr to 1 mL/kg/hr if the patient is under 30 kg

Post-Op Cheiloplasty

• During the post-op cheiloplasty (repair of cleft lip):
  • Position the head elevated or on the side
  • Apply elbow restraints
  • Clean the site with 0.9% NaCl or sterile water to dilute hydrogen peroxide, followed by an antibiotic ointment
  • No straws, pacifiers, or hard tip sippy cups
  • Gently suction secretions
  • Give analgesics and prevent crying