STUDENT ACTIVITY SHEET

Care of Mother and Child At-Risk or with Problems (Acute and Chronic) - Lecture

BS NURSING / SECOND YEAR Session # 46
LESSON TITLE: NURSING CARE OF A FAMILY WHEN A CHILD HAS NEUROLOGICAL ALTERATIONS
LEARNING OUTCOMES:
At the end of the lesson, the student nurse can:

  1. Define the common types of disorders in the nervous system that occur in children.
  2. Integrate the knowledge of the common types of disorders in the nervous system that occur in children and describe these disorders that occur in these classifications of children in formulating nursing care plan in giving quality maternal and child health nursing care.

Materials:

  • Book
  • Pen and notebook
  • Index card/class list
  • Speaker and LCD projector

Reference:
Pilliteri, Adele and Silbert-Flagg, JoAnne (2018). Maternal and Child Health Nursing, 8th Edition. USA: Lippincott Williams and Wilkins

## LESSON REVIEW/PREVIEW (5 minutes)

MAIN LESSON (50 minutes)

Please refer to Chapter 54: Nursing Care of a Child Has an Intellectual or Mental Health Disorder - Elimination Disorders p. 1553

ELIMINATION DISORDERS
ENCOPRESIS
  • Definition: In children ages 4 years and older, loss of feces is encopresis if there is repeated passage of feces at least once a month for at least 3 months in places not culturally appropriate for that purpose.
  • Prevalence: More common in boys than girls, considered primary if the child was never fully toilet trained and secondary if the problem began after effective training.

ASSESSMENT

  • Diagnosed only after ruling out medical causes (e.g., lactase deficiency, thyroid disease, hypercalcemia, Hirschsprung disease, infectious diarrhea).
  • Statistics: Between 1.5% and 7.5% of children ages 6 to 12 years have encopresis; 6 times as common in boys as in girls.
  • Requires knowledge of typical bowel evacuation habits, number of bowel accidents, timings of accidents.
  • Dietary history including fiber and fluid intake, recent changes or stress factors in the child’s environment is also important.
ENURESIS
  • Definition: Defined as repeated involuntary or intentional urination during the day or at night after an age when a child has attained control over bladder function, with no organic cause found.
  • Age Factor: Chronologic age (or developmental level) is at least 5 years; many cases have a positive family history.
  • Causes and Factors: Stress may be a factor, though primary causes are unknown.

ASSESSMENT

  • Most children outgrow the problem by adolescence; treatment important to minimize embarrassment for child and frustration for caregivers.
  • Serious effects on self-esteem, feelings of failure, and potential peer rejection.
  • Physical Exam: Including rectal examination is needed to assess anal sphincter control.; anal fissures might require investigation for possible maltreatment.
MANAGEMENT
Management of Encopresis
  • Therapeutic Regimen: Begins with a regimen to empty bowels of impacted stool; treatments include laxatives, enemas, or both.
  • Behavioral Interventions: Centered on habit relearning with routine evacuation periods (aim for morning and post-dinner).
    • Stool Softeners: Lactulose, high-fiber diets, mineral oil (1-6 tablespoons daily for 2-3 months to soften stools).
    • Vitamin Reminder: Children on long-term mineral oil also require water-soluble vitamins A, D, and K.
    • No punishment for encopresis; attention should be minimized to accidents, while providing praise for dry days.
Management of Enuresis
  • Focus: Behavioral management and positive reinforcement; enuresis alarms may be helpful but require intensive effort.
  • Pharmacological Management: Desmopressin (DDAVP), a synthetic analog of ADH for children over 5.
  • Use: Can be prescribed for short-term needs during excursions away from home (e.g., camps).

CHECK FOR UNDERSTANDING (30 minutes)

  • Quiz: Answer and rationalize this by pair; record as quiz. Each correct answer earns 1 point; correct rationale also earns 1 point. No superimpositions or erasures.

  1. Which of the following best describes encopresis?
    A. Leaking of stool in an inappropriate place
    B. Leaking of urine in an inappropriate place
    C. Inability to pass stool
    D. Inability to pass urine
    ANSWER: ________
    RATIO:_________________________________________________________________________________________

  2. What is the most common cause of encopresis?
    A. Emotional problems
    B. Bad conduct
    C. Chronic constipation
    D. Attention seeking behavior
    ANSWER: ________
    RATIO:_________________________________________________________________________________________

  3. Identify one method of preventing encopresis.
    A. Discipline the child
    B. Eat a diet high in fat
    C. Drink plenty of fluids
    D. Eat a diet high in salt
    ANSWER: ________
    RATIO:_________________________________________________________________________________________

  4. The following are management for Encopresis, EXCEPT:
    A. Treatment of encopresis begins with a therapeutic regimen to empty bowels
    B. Habit re-learning interventions
    C. Scheduled evacuation two times daily
    D. Child needing care for evaporation potential
    E. None of the above
    ANSWER: ________
    RATIO:_________________________________________________________________________________________

  5. TRUE OR FALSE: Enuresis happens only at night.
    A. True
    B. False
    ANSWER: ________
    RATIO:_________________________________________________________________________________________

  6. What is the minimum age at which a child can be considered to be suffering from enuresis?
    A. 2 years
    B. 3 years
    C. 4 years
    D. 5 years
    ANSWER: ________
    RATIO:_________________________________________________________________________________________

  7. Which method should not be used to treat enuresis in children?
    A. Behavior modification
    B. Enuresis Alarm
    C. Wearing a Diaper
    D. Punish the child after bedwetting
    ANSWER: ________

LESSON WRAP-UP (5 minutes)

  • Track your progress.
    PERIOD 1
    1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

PERIOD 2
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

PERIOD 3
32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

AL STRATEGY: CAT 3-2-1

3-2-1
  • Three things you learned:
    1. __________________________________________________
    2. __________________________________________________
    3. __________________________________________________
  • Two things that you’d like to learn more about:
    1. __________________________________________________
    2. __________________________________________________
  • One question you still have:
    1. __________________________________________________

Next session: Please refer to Chapter 54: Nursing Care of a Child Has an Intellectual or Mental Health Disorder - Elimination Disorders p. 1553

END OF NOTES