Nocturnal Enuresis and Medications

• This is a worksheet for Test 3

Bed Wetting

• Bed wetting is also known as nocturnal enuresis, daytime enuresis is diurnal enuresis
• Bed wetting is not considered normal after age 5 when children typically gain full bladder control
• Bed wetting must occur 2x/week for 3 months to be diagnosed
• Primary bed wetting means a child has never been free from bedwetting

Medications for Bed Wetting

• Medications for bed wetting are usually titrated
• Desmopressin Acetate (DDMP) is an antidiuretic hormone that reduces urine volume
• The goal is at least 5 dry days out of 7
• Give at HS (bedtime), no fluids in evening, nasal spray in refrigerator
• Imipramine hydrochloride comprises tricyclic antidepressants
• Medication inhibits urination
• Give 1 hour before bedtime with food, avoid sun exposure and OTC, monitor for suicidality, give only for 6-8 weeks
• Oxybutynin chloride comprises anticholinergics
• Reduces bladder contraction, must be weaned off
• Monitor for effectiveness

Discharge Instructions for UTIs

• Teach females to wipe front to back
• "Double voiding" ensures adequate bladder emptying
• Urinate, stop, and attempt to urinate again
• Wear cotton underwear, nonrestrictive underwear, and avoid staying in wet clothes
• Demonstrate how to retract and clean foreskin if uncircumcised
• Avoid bubble baths, whirlpools, or hot tubs
• Ensure adequate fluid intake
• Sexually active individuals should void after sex
• Complete the entire prescribed antibiotic regimen

Glomerulonephritis

• Glomerulonephritis is an inflammation of the glomeruli
• Acute or chronic, it is most common in 5-8 year olds
• Glomeruli damage results in ineffective filtering of waste and excess water, leading to tea-colored urine, increased BP, periorbital edema, and sudden onset
• Glomerulonephritis is a post-infectious disorder associated with an overreaction of the immune system to pneumococcal, streptococcal, and viral infections (most commonly post-strep)

Minimal Change Nephrotic Syndrome & Albumin

• Kidneys leak significant amounts of protein into the urine, causing swelling and increasing infection risk
• Kidneys appear normal/nearly normal under a microscope, and the cause is usually unknown
• 25% albumin is administered to increase plasma and reduce edema

Hemolytic Uremic Syndrome (HUS)

• HUS occurs when damaged red blood cells obstruct the kidneys' filtering system, leading to kidney failure
• Usually develops after an infection with a toxic strain of E. Coli bacteria
• E. Coli is found in contaminated/dairy/meat that is undercooked
• 2-12 day onset of hemorrhagic enterocolitis
• E. Coli outbreaks occur in fast food (undercooked meats), daycare centers, and water parks, common in summer/spring
• Triad of Symptoms:
  • Microangiopathic hemolytic anemia
  • Thrombocytopenia
  • AKI (acute kidney injury) after recent illness
• Risk factors include being 6 months-3 years old, ingesting shiga toxin that creates E. Coli, genetic disorders, or toxins in the bloodstream

Hydrocephalus

• Hydrocephalus can be congenital or acquired
• It involves an imbalance between the production and absorption of cerebral spinal fluid, leading to fluid accumulation in the brain ventricles

Manifestations of Hydrocephalus in Infants

• Shrill, high-pitched cry
• Increased head circumference
• Full or tight fontanel
• Lethargy
• Seizures
• Sun set eyes
• Irritability
• Sluggish and unresponsive eyes
• Bradycardia
• Hypertension
• Apnea
• Opisthotonos posturing (rigid arched back and hyperextended neck)

Manifestations of Hydrocephalus in Children

• Early morning headache relieved by vomiting
• Increased vomiting that becomes projectile
• Swelling of the optic disc (papilledema)
• Blurred or double vision
• Irritability
• Trouble walking or uncoordinated movement
• Urinary incontinence
• Hypertension
• Initial bradycardia, followed by tachycardia as ICP worsens

Hypospadias

• The urethral opening is on the ventral (lower) aspect of the penis, as far as the scrotum

Epispadias

• The urethral opening is on the dorsal (top) aspect of the penis

Nephrotic Syndrome Complications

• Sepsis
• Infection
• Circulation insufficiency
• Thromboembolism

Hirschsprung Disease

• Absence of parasympathetic ganglion cells in the large intestine wall before birth

Hirschsprung Disease Manifestations in Newborns

• Delayed or absence of meconium stool within 24-48 hours is a cardinal sign
• Newborn vomits bile
• Refusal to eat
• Abdominal distension

Hirschsprung Disease Manifestations in Infants

• Failure to thrive
• Constipation
• Vomiting
• Episodes of vomiting/diarrhea

Hirschsprung Disease Manifestations in Children

• Foul-smelling ribbon-like or pellet-like stool
• Undernourished, anemic appearance
• Abdominal distension
• Visible peristalsis
• Palpable fecal mass
• Constipation

Pyloric Stenosis

• Usually presents in infants 3 weeks-3 months old

Pyloric Stenosis Manifestations

• Projectile non-bilious vomiting
• Olive-shaped mass in the RUQ of the abdomen
• Possible peristaltic wave that moves from left to right when lying supine
• Failure to gain weight, signs of dehydration (always lose weight)
• Hunger

Diagnosis & Treatment of Pyloric Stenosis

• Diagnosis via ultrasound
• Treated with surgical pyloromyotomy

Necrotizing Enterocolitis (NEC)

• NEC is an infection that most commonly affects the lower portion of the small intestine (ileum)

Nursing Interventions for NEC

• Stop ALL feeds (instead provide IV or TPN)
• Use NG tube to decompress the abdomen
• Administer IV antibiotics
• Perform careful abdominal assessments, measuring abdominal girth above the umbilicus every 4-8 hours
• Obtain abdominal X-rays every 4-6 hours
• Monitor vital signs
• Facilitate bonding

Burns Priority

• Focus on ABCs

Burns: Oxygenation & Fluids

• Provide oxygen and fluids quickly to prevent shock and death in major burns

Minor Burns Treatment

• Superficial burns- soak in tepid water
• Avoid greasy lotion, ice, or butter on burns
• Partial-thickness burns with blisters- soak in tepid water, do not break blisters

Major Burns Treatment

• Maintain airway and ventilation
• Provide 100% oxygen
• Monitor vital signs, IV access
• Initiate fluid replacement with Lactated Ringer’s over the first 24 hours
• Maintain urine output at 0.5 mL/kg/hr to 1 mL/kg/hr if <30 kg

Nursing Care for Cheiloplasty (Cleft Lip Repair)

• 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 antibiotic ointment
• Avoid straws, pacifiers, or hard tip sippy cups
• Gently suction secretions
• Give analgesics and prevent crying