Episodic Visit: Gastrointestinal or Genitourinary Condition Focused Notes
Walden university
NURS 6541- Primary Care of Adolescents and Children
Episodic visit: Genitourinary Focused Note
Patient Information:
Initials: D.S Age: 7 y/o Sex: Female Race: African American
Date of service-10/18/2021.
S.
CC: “She has a problem with wetting on herself even at wake hours”
HPI: D.S is a 7-year-old female African American brought to the clinic by her mother who was
concerns that her daughter bed wets at night as well during the day. The mother mentioned that,
the child was toilet trained at two years old, but still encounters night time bed wetting about 1-2
times during the week. The child has had periodic nighttime bedwetting for five years, which at
some point ceased for a couple of months without any treatment, and then started back in July,
2021. This time around, the child bed wets during wake-time hours at home and in school, and it
has been more frequent for about 2-3 times per week. Everything has been normal both at home,
and school except for the coming of the grandmother who currently lives at home with them
since last Christmas. The child reported that, she usually feels the need to urinate, however, she
can’t control her bladder, and sometimes is not aware when she starts urinating. The child also
, reported a burning sensation during urination about three days ago, as well as a foul-smelling
urine. There is no sleeping issues or history of urinary tract infection, and the mother has not
attempted to treat the condition with any form of medications. The mother denies the presence of
fever, lower abdominal pain, vaginal discharge, or any change in urine color. There hasn’t been
any change in thirst or increased fluid intake. The child has a significant weight gain of about 18
lbs from the last visit in 2020.
Walden university
NURS 6541- Primary Care of Adolescents and Children
Episodic visit: Genitourinary Focused Note
Patient Information:
Initials: D.S Age: 7 y/o Sex: Female Race: African American
Date of service-10/18/2021.
S.
CC: “She has a problem with wetting on herself even at wake hours”
HPI: D.S is a 7-year-old female African American brought to the clinic by her mother who was
concerns that her daughter bed wets at night as well during the day. The mother mentioned that,
the child was toilet trained at two years old, but still encounters night time bed wetting about 1-2
times during the week. The child has had periodic nighttime bedwetting for five years, which at
some point ceased for a couple of months without any treatment, and then started back in July,
2021. This time around, the child bed wets during wake-time hours at home and in school, and it
has been more frequent for about 2-3 times per week. Everything has been normal both at home,
and school except for the coming of the grandmother who currently lives at home with them
since last Christmas. The child reported that, she usually feels the need to urinate, however, she
can’t control her bladder, and sometimes is not aware when she starts urinating. The child also
, reported a burning sensation during urination about three days ago, as well as a foul-smelling
urine. There is no sleeping issues or history of urinary tract infection, and the mother has not
attempted to treat the condition with any form of medications. The mother denies the presence of
fever, lower abdominal pain, vaginal discharge, or any change in urine color. There hasn’t been
any change in thirst or increased fluid intake. The child has a significant weight gain of about 18
lbs from the last visit in 2020.
