Nocturnal Enuresis

• Nocturnal enuresis is also known as wetting the bed
• Daytime is known as diurnal enuresis

When Wetting the Bed is Not Normal

• Full bladder control is typically gained between ages 4-6
• Bed wetting after age 5 is not considered normal
• Must occur twice a week for 3 months to be diagnosed
• Primary bedwetting means the individual has never been free from bedwetting
• Secondary bedwetting happens once having full control was established
• Risks include family history, being male, having a bladder disorder, emotional factors, and constipation issues.

Medications to Help Bedwetters

• Medications are usually titrated
• Antidiuretic hormone (Desmopressin Acetate) DDMP reduces the volume of urine (goal is 5 of 7 dry days)
  • Give at HS (bedtime), no fluids in evening, keep nasal spray in refrigerator
• Tricyclic antidepressants (Imipramine hydrochloride) inhibits urination
  • Give 1 hour prior to bedtime with food, avoid sun exposure and OTCs; monitor for suicidality and only give for 6-8 weeks
• Anticholinergics (Oxybutynin chloride) reduce bladder contraction, must be weaned off and monitored for effectiveness

Discharge Teaching for UTIs

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

Common Cause of Glomerulonephritis

• Glomerulonephritis is most common in children ages 5-8 and can be acute or chronic
• It is an inflammation of the glomeruli, bundles of tiny vessels inside the kidneys
• Glomeruli damage prevents effective filtering of waste products and excess urine water from the bloodstream
• Symptoms of glomerulonephritis include tea-colored urine, increased blood pressure, periorbital edema, and sudden onset
• It is a post-infectious disorder associated with the immune system overreacting to pneumococcal, streptococcal, and viral infections
• Most cases are post-strep

Why Albumin for Minimal Change Nephrotic Syndrome

• In minimal change nephrotic syndrome, kidneys leak a large amount of protein into the urine
• This causes swelling of body tissues and greater infection chances
• Kidneys appear normal or nearly normal under a microscope
• Albumin is given 25% to increase plasma and decrease edema

Hemolytic Uremic Syndrome (HUS)

• HUS happens when damaged red blood cells block the kidneys' filtering system, which leads to kidney failure in children
• Develops after infection with toxic E. Coli bacteria
• E. Coli is found in contaminated foods like meats and dairy or undercooked meat, 2–12-day onset of hemorrhagic enterocolitis
• E. Coli leads to outbreaks in fast food (undercooked meats), daycare centers, water parks, common in summer and spring due to pools
• Unknown etiology with triad of symptoms
  • Microangiopathic hemolytic anemia, thrombocytopenia, and AKI (acute kidney injury) after recent illness
• The risk age group is 6 months-3 years old
• HUS is caused by ingestion of Shiga toxin that creates E. Coli, genetic disorders, and toxins in the bloodstream killing red blood cells

Signs of Hydrocephalus

• Hydrocephalus can be congenital or acquired
• It is Imbalance between the production and absorption of cerebral spinal fluid causing accumulation of fluid in the ventricles

Infant Manifestations of Hydrocephalus

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

Child Manifestations of Hydrocephalus

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

Hypospadias and Epispadias

• Hypospadias means the urethral opening is on the ventral (lower) aspect of the penis, near the scrotum
• Epispadias means the urethral opening is on the Dorsal (top) aspect of the penis

Complication of Nephrotic Syndrome

• Complications include sepsis and infection, circulation insufficiency, and thromboembolism

Symptoms of Hirschsprung Disease

• Hirschsprung Disease is when parasympathetic ganglion cells in the wall of the large intestine (colon) do not develop before birth

Newborn Manifestations of Hirschsprung Disease

• Delayed or absence of meconium stool in the neonatal period of 24-48 hours is a cardinal sign
• Other manifestations are vomiting bile, refusing to eat, and abdominal distension

Infant Manifestations of Hirschsprung Disease

• Failure to thrive, constipation, vomiting, and episodes of vomiting/diarrhea

Child Manifestations of Hirschsprung Disease

• Foul-smelling ribbon-like or pellet-like stool is a sign
• Other signs include being undernourished and anemic, abdominal distension, visible peristalsis, a palpable fecal mass, and constipation

Symptoms of Pyloric Stenosis

• Hypertrophic Pyloric Stenosis usually occurs at 3 weeks-3 months of age

Manifestations of Pyloric Stenosis

• Signs are non-bilious vomiting
• Olive-shaped mass in the RUQ of the abdomen, possible peristaltic wave that moves L to R when lying supine
• Failure to gain weight along with signs of dehydration and constant hunger (ALWAYS lose weight!)
• Diagnosis- Ultrasound and treated with surgical procedure called pyloromyotomy

Nursing Interventions for Necrotizing Enterocolitis (NEC)

• Necrotizing Enterocolitis (NEC) is an infection most commonly affecting the lower portion of the small intestine (ileum)

Nursing Interventions NEC

• Stop ALL feeds, use IV or TPN instead
• Perform Nasogastric (NG) decompression of the abdomen
• Administer IV antibiotics
• Measure abdominal girth above the umbilicus every 4-8 hours
• Perform Abdominal X-rays every 4-6 hours
• Monitor V/S and facilitate bonding
• Possible surgery involves removal of the necrotic portion of the bowel or temporary colostomy

Priority Nursing Care for Burns

• Prioritize ABCs!
• Provide oxygen and fluids quickly to prevent shock and death, especially with major burns

Minor Burns

• For superficial burns, soak in tepid water
• Avoid greasy lotion, ice, or butter on burns
• If partial thickness burns have blisters, soak in tepid water but do not break blisters

Major Burns

• Maintain airway and ventilation
• Provide 100% oxygen
• Monitor V/S, IV access
• Perform a 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