ATI children Ch. 24 Enuresis and UTI’s – Flashcards
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Enuresis
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uncontrolled or unintentional urination that occurs after a child is beyond an age at which bladder control is acheived
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UTI
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infection in any portion of the urinary tract
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Enuresis: Primary: secondary:
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* inappropriate urination must occur at least 2 times a week for at least 3 months and at least 5 years old before diagnosing * Primary: child has never been free of bed wetting for any extended period of time * secondary: Child developed after development of urinary control
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Risk factors for enuresis
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no clear etiology but may be related to: * family history of enuresis * disorders associated with bladder dysfunction * males * emotional factors
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Assessment findings
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* alterations in toilet training, voiding behaviors, and BM habits * Hx of chronic or acute illnesses * emotional stress or family disruptions * family Hx of enuresis * increased intake at night
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Nursing care to prevent enuresis
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* have child empty bladder at HS * encourage fluids during day and restrict in evening * avoid fruit,fruit drinks, and caffeinated drinks after 1600 * wear regular PJ and not diapers *positively reinforce * have child change bed linen after accident * avoid constipation, ^ fiber * wake up during night to void
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Desmopressin acetate
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Antiduiretic hormone - reduces urine volume * given PO or nasal (nasal needs to be refrigerated) * Give at HS *restrict intake after dinner
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Imipramine hydrochloride
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tricyclic antidepressant * inhibits urination * monitor for ^ suicidality * length of Tx. 6-8 weeks then plan gradual withdrawal *Give with food * Give 1 hr before bed * avoid sun exposure * DO NOT use any OTC meds
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oxybutynin chloride
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anticholinergic * reduces bladder contractions
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pyelonephritis
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inflammation of the upper urinary tract and the kidneys
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Urosepsis
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bacterial infection
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Risk factors for UTI's
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* urinary stasis * urinary tract anomalies * reflux within the urinary tract * constipation * onset of toilet training * uncircumcised male( not cleaned well) * females (urethra too close to rectum) * synthetic, tight underwear and wet bathing suits * sexual activity
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S&S in infants of a UTI
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* increased irritability * screaming with urination * Poor feeding, vomiting, or failure to gain wt. * ^ thirst * frequent urination * straining with urination * foul smelling urine * fever *diaper rash * dehydration * seizure * pallor
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S&S in children with UTI
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* ABD or back pain * pain with urination * poor appetite * vomiting * slowed growth * ^ thirst * enuresis, frequent urination *swelling of face * seizures *pallor * blood in urine * edema * HTN * tetany
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Best methods for collecting UA in children < 2
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sterile catheterization and suprapubic aspiration( need a consent signed for this one)
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Nursing actions for UTI diagnosis
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* consent signed for suprapubic * DO NOT have kid drink large amount of fluid, will dilute bacteria * send to lab STAT
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If UA is + for UTI, UA will look like what?
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* pH weak acid or neutral alkaline * protein, glucose, ketones, leukocytes and nitrates will be positive
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diagnostic testing: IV pyelogram (IVP) Dimercaptosuccinic acid scan
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* check allergy to iodine * sedate infants and young kids if required * NPO for cystoscopy and IVP *IVP requires bowel prep * may need to catheterize
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Patient care for UTI's
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* encourage frequent voiding and complete emptying * encourage fluids * monitor output * tylenol for pain or other mild analgesic
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ATB used for UTI's
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Depends on C&S PCN sulfonamides cephalosporins nitrofuratoin
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pt teaching
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* educate on signs of reoccurring UTI's: dysuria, frequency, urgency * retract and clean foreskin *cotton underwear * keep diaper and underwear dry * maintain adequate hydration * NO bubble baths * encourage frequent voiding, and completely emptying of bladder using double voiding (void wait 5 min, then void again) *avoid sexual activity * void STAT after sex
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complications of UTI's
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progressive kidney injury
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A nurse is assessing an infant who has a suspected UTI. Which of the following are anticipated findings? Select all a. increase in hunger b. irritability c. decrease urination d. vomiting e. fever
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B,D,E Urine would be increased if pt has UTI
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A nurse is assessing a child who has a UTI. Which of the following are clinical manifestations of a UTI? Select all a. night sweats b. swelling of the face c. pallor d. pale colored urine e. fatigue
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B,C,E swelling in face pallor fatigue
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A nurse is teaching a parent of a child who has a UTI. Which of the following should the nurse include in the teaching? Select all a. wear nylon underpants b. avoid bubble baths c. empty bladder completely with each void d. provide information about clinical manifestations of infection e. wipe back to front
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B,C,D avoid bubble baths empty bladder provide info about infections
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A nurse is planning care of a child who has a UTI. Which of the following should the nurse include? a. administer antidiuretic b. restrict fluids c. evaluate the child's self esteem d. encourage frequent voiding
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D- encourage frequent voiding
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A nurse is caring for a child with enuresis. Which of the following is a complication of enuresis? a. UTI's b. emotional problems c. urosepsis d. progressive kidney disease
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B- emotional problems
