Enuresis & UTIs - PEDs

Define Enuresis (2)

• Uncontrolled or unintentional urination that occurs after a child is beyond an age at which bladder control is achieved

• Inappropriate urination during day or night at least twice a week for at least 3 months

Define Primary Enuresis

A child has never been free of bed-wetting for any extended periods of time.

Define Secondary Enuresis

A child who started bed-wetting after development of urinary control.

Risk Factors - Enuresis (6)

• Family history of enuresis

• Twin siblings

• Disorders associated with bladder dysfunction

• Males

• Emotional events (new sibling, divorce)

• Behavioral disorders

Enuresis - Expected Findings (4)

• History of alterations in toilet training

• History of chronic or acute illness (UTI, diabetes, sickle cell disease, neurologic deficits)

• Fluid intake, especially in the evening

• Restlessness, urinary frequency & urgency

Enuresis - Diagnostics

Functional bladder screening

Nursing Care - Enuresis (5)

• Have the child urinate prior to bedtime.

• Restrict fluids at least 2 hr prior to bedtime.

• Avoid caffeinated drinks in the afternoon.

• Allow the child to assist with changing the bed linens

• Wake the child up at scheduled intervals during the night to void.

Meds - Enuresis (3)

• Antidiuretic Hormone - Desmopressin, decreases urine volume

• Tricyclic Antidepressants - Imipramine hydrochloride, inhibits urination.

• Anticholinergics - Oxybutynin chloride reduces bladder contractions.

Define UTI (3)

• Infection in any portion of the urinary tract

• E. coli is most common causes

• Bacteriuria - bacteria in urine (C&S to determine organism)

UTI Expected Findings < 2 y/o (7)

• Often have nonspecific findings​​​​​​​

• Newborn - jaundice, tachypnea, cyanosis, hypothermia, fever

• Poor feeding

• Vomiting & diarrhea

• Irritability & lethargy

• Frequent urination

• Fever

UTI Expected Findings > 2 y/o (7)

• Vomiting

• Enuresis, frequent urination, dysuria

• Blood in the urine

• Constipation

• Fever & chills

• Malodorous urine

• Abdominal or flank pain

Labs - UTI (4)

• Uranalysis & urine C&S

• Leukocytes: positive

• Nitrites: positive

• RBC: positive

Diagnostics - UTI (3)

• Determine anatomic defects

• Ultrasonography

• Voiding cystourethrogram (VCUG)

UTI Nursing Care (6)

• Encourage frequent voiding & complete emptying of the bladder.

• Encourage fluids.

• Monitor urine output.

• Prepare child for diagnostic tests.

• Administer a mild analgesic (acetaminophen) for pain management.

• Antibiotics based on findings of urine culture and sensitivity testing

Client Education - UTI (8)

1. Wipe the perineal area from front to back.

2. For uncircumcised clients, ensure foreskin is retracted prior to performing hygiene and replaced afterward.

3. Change infant’s diapers frequently.

4. Use cotton underwear.

5. Maintain adequate hydration with caffeine-free beverages.

6. Avoid bubble baths.

7. Void frequently & empty bladder completely, void after sex

8. History of recurrent UTIs, child needs repeat urinalysis 7 days after treatment.​​​​​​​