NR 602 FINAL EXAM REVIEW STUDY NOTES
◉ urine culture should be done when.
Answer: urine sample positive for nitrites or leukocyte esterase if
the child has symptoms of UTI, the risk criteria for UTIs are met, or
the child has a high fever without a source
◉ enuresis diagnosis.
Answer: According to the ICCS a diagnosis of enuresis requires a
minimum age of 5 years old, and one episode a month for a duration
of 3 months.
◉ before treating nocturnal enuresis:.
Answer: • Constipation: It cannot be overemphasized how
important it is to determine if constipation or impaction exists
before treating nocturnal enuresis.
◉ causes of enuresis.
Answer: • Familial disposition
• Neurologic developmental delay.
• ADHD, mental health disorders
• Functional small bladder capacity
,• Sleep disorders: Obstructive sleep apnea and disordered sleep
patterns result in increased nocturnal enuresis incidence
• Stress and family disruptions
• Polyuria: This can be caused by nocturnal drinking as well as
caffeine intake
• Inappropriate toilet training: This is especially common when
parents are overly demanding or punitive of the child.
◉ history questions enuresis.
Answer: • Urgency, dysuria, or dribbling
• Are there voiding or stooling postponement behaviors?
• Number of voids per day: is nocturia present?
• Cluster voiding: for example, is the child waiting until after school?
• Frequency of wetting—day and night
• Type of urinary stream
◉ referral warranted for enuresis.
Answer: • Weak or interrupted urinary stream
• Need to use abdominal pressure to urinate
• Combined daytime incontinence and nocturnal enuresis
◉ physical exam enuresis.
,Answer: • Assess the external genitalia for signs of irritation,
infection, labial fusion, and/or meatal stenosis.
• Examine the abdomen for masses, especially at the suprapubic
midline and in the left lower quadrant.
• Examine the lower back for dimples and hair tufts.
• Assess for neurologic function and deep tendon reflexes.
◉ treatment enuresis in children >6 yrs old.
Answer: • Urotherapy
• Enuresis alarms
• Drug therapy: Drug therapy can be combined with urotherapy
and/or alarm therapy, but it is not curative.
◉ drug therapy for enuresis.
Answer: Desmopression
Effective in children with nocturnal polyuria and normal bladder
volume.
Short-term treatment only (4-8 weeks).
Not recommended in children younger than 6 years.
Not recommended to use nasal spray.
Caution must be used with patients who are hypertensive or have a
potential for fluid-electrolyte imbalance (e.g., children with cystic
fibrosis susceptible to hyponatremia).
, Use least amount effective.
Take on empty stomach; avoid caffeine, chocolate, NutraSweet, and
carbonated beverages.
Wake children to urinate within 10 h of taking the medication.
◉ family education pediatric UTIs.
Answer: • Clear explanation of the cause, potential complications,
and overall treatment plan, including short- and long-term plans.
• Frequent and complete voiding and increased fluid intake,
especially water. Scheduled voiding times, voiding with knees spread
apart, or double voiding (voiding and then immediately attempting
to void again) is helpful.
• Proper hygiene and avoiding irritants, such as bubble baths, sitting
in soapy water, and perfumed soaps. Avoid wearing tight pants,
especially spandex pants. Wear cotton underwear. Treat perineal
inflammation to help prevent UTI.
• Treat constipation, pinworms.
• Encourage sexually active females to drink water before
intercourse and void immediately afterward.
• Decrease intake of bladder irritants, such as the "four Cs" (caffeine,
carbonated beverages, chocolate, citrus), aspartame (NutraSweet),
alcohol, and spicy foods.
• Seek prompt medical attention with recurrence of fever and/or
duration of fever for more than 48 hours, especially if younger than
24 months old.
◉ urine culture should be done when.
Answer: urine sample positive for nitrites or leukocyte esterase if
the child has symptoms of UTI, the risk criteria for UTIs are met, or
the child has a high fever without a source
◉ enuresis diagnosis.
Answer: According to the ICCS a diagnosis of enuresis requires a
minimum age of 5 years old, and one episode a month for a duration
of 3 months.
◉ before treating nocturnal enuresis:.
Answer: • Constipation: It cannot be overemphasized how
important it is to determine if constipation or impaction exists
before treating nocturnal enuresis.
◉ causes of enuresis.
Answer: • Familial disposition
• Neurologic developmental delay.
• ADHD, mental health disorders
• Functional small bladder capacity
,• Sleep disorders: Obstructive sleep apnea and disordered sleep
patterns result in increased nocturnal enuresis incidence
• Stress and family disruptions
• Polyuria: This can be caused by nocturnal drinking as well as
caffeine intake
• Inappropriate toilet training: This is especially common when
parents are overly demanding or punitive of the child.
◉ history questions enuresis.
Answer: • Urgency, dysuria, or dribbling
• Are there voiding or stooling postponement behaviors?
• Number of voids per day: is nocturia present?
• Cluster voiding: for example, is the child waiting until after school?
• Frequency of wetting—day and night
• Type of urinary stream
◉ referral warranted for enuresis.
Answer: • Weak or interrupted urinary stream
• Need to use abdominal pressure to urinate
• Combined daytime incontinence and nocturnal enuresis
◉ physical exam enuresis.
,Answer: • Assess the external genitalia for signs of irritation,
infection, labial fusion, and/or meatal stenosis.
• Examine the abdomen for masses, especially at the suprapubic
midline and in the left lower quadrant.
• Examine the lower back for dimples and hair tufts.
• Assess for neurologic function and deep tendon reflexes.
◉ treatment enuresis in children >6 yrs old.
Answer: • Urotherapy
• Enuresis alarms
• Drug therapy: Drug therapy can be combined with urotherapy
and/or alarm therapy, but it is not curative.
◉ drug therapy for enuresis.
Answer: Desmopression
Effective in children with nocturnal polyuria and normal bladder
volume.
Short-term treatment only (4-8 weeks).
Not recommended in children younger than 6 years.
Not recommended to use nasal spray.
Caution must be used with patients who are hypertensive or have a
potential for fluid-electrolyte imbalance (e.g., children with cystic
fibrosis susceptible to hyponatremia).
, Use least amount effective.
Take on empty stomach; avoid caffeine, chocolate, NutraSweet, and
carbonated beverages.
Wake children to urinate within 10 h of taking the medication.
◉ family education pediatric UTIs.
Answer: • Clear explanation of the cause, potential complications,
and overall treatment plan, including short- and long-term plans.
• Frequent and complete voiding and increased fluid intake,
especially water. Scheduled voiding times, voiding with knees spread
apart, or double voiding (voiding and then immediately attempting
to void again) is helpful.
• Proper hygiene and avoiding irritants, such as bubble baths, sitting
in soapy water, and perfumed soaps. Avoid wearing tight pants,
especially spandex pants. Wear cotton underwear. Treat perineal
inflammation to help prevent UTI.
• Treat constipation, pinworms.
• Encourage sexually active females to drink water before
intercourse and void immediately afterward.
• Decrease intake of bladder irritants, such as the "four Cs" (caffeine,
carbonated beverages, chocolate, citrus), aspartame (NutraSweet),
alcohol, and spicy foods.
• Seek prompt medical attention with recurrence of fever and/or
duration of fever for more than 48 hours, especially if younger than
24 months old.
