Nursing Care Plan (NCP) for Enuresis / Bedwetting

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Outline

Pathophysiology

Urinary incontinence, known as enuresis, is normal for children under the age of 3, but as they grow, children gain more control of the bladder.  

  1. Nocturnal enuresis (bedwetting) – the most common and occurs when the child, who normally has bladder control, has episodes of wetting during the night.
  2. Diurnal enuresis (daytime) – when the child has wetting episodes during the day.
  3. Primary enuresis describes a child who is not fully toilet trained
  4. Secondary enuresis- when a toilet-trained child has episodes of wetting after periods of dryness.

Etiology

Unintentional wetting, or incontinence, may stem from many factors that include having a small bladder, developmental delays, persistent urinary tract infections or stress and anxiety. There may also be some hereditary factors as well, as it appears to run in families. Often, enuresis may occur if a child was forced to start toilet training too early or before they had full bladder control. Some children are just very heavy sleepers and don’t awaken enough to recognize the urge to void.

Desired Outcome

Patient will have optimal voiding pattern; patient will be free from infection; patient will understand and act on urge to void; patient will have decreased number of incontinent episodes

Enuresis / Bedwetting Nursing Care Plan

Subjective Data:

  • Repeat bedwetting
  • Wetting twice a week for 3 months or more
  • Anxiety
  • Pain with urination
  • Abdominal pain

Objective Data:

  • Small sized bladder
  • Blood or mucus in urine

Nursing Interventions and Rationales

  • Perform physical assessment, noting signs of rash or irritation of the genital area

 

Skin irritation may cause a child to hold urine if there is pain with voiding. Observe for signs of sexual abuse.

 

  • Obtain history from patient and parents/caregivers. Note any changes in home or social situation that may cause stress.

 

Help determine cause of symptoms: social or emotional stress and changes in family dynamics can cause children to have wetting accidents

 

  • Assess abdomen
    • Look for signs of distention
    • Listen – auscultate for bowel sounds
    • Feel- palpate for distended bladder or signs of constipation. Note presence of tenderness

 

Chronic constipation can be a factor in causing enuresis. A large mass of stool in the colon puts pressure on the bladder, which may lead to a diminished ability to control urine or a decreased capacity to hold urine.

 

  • Collect sample and monitor results for urinalysis

 

To determine if a urinary tract infection is the cause of symptoms

 

  • Administer medication as appropriate

 

  • Antibiotics may be given if the cause of enuresis is determined to be urinary tract infection.
  • The medication desmopressin may be given for low levels of vasopressin, a hormone that tells the kidneys to slow urine production.
  • Imipramine may be given to help stimulate vasopressin secretion and decrease REM sleep so patient wakes with urge to void.

 

  • Provide education and motivational interventions:
    • Keep a calendar of wet and dry days
    • Set a toileting schedule
    • Avoid caffeine or high-sugar drinks
    • Minimize fluid intake in the evening
    • Consider enuresis alarms

 

  • A calendar can help determine if there is a pattern to wetting and what may trigger the incidences.
  • Help the child train their body to void at appropriate times.
  • Sugar and caffeine can increase urgency and frequency of urination, especially at night.
  • Encourage fluid intake in the daytime hours, but limit fluid in the evenings to prevent overload during the night.
  • Alarms may be placed on the bed to alert or wake the child when they void.

 

  • Provide education and resources for parents

 

  • Encourage parents/caregivers to be patient with child.
  • Remind parents/caregivers that the child is not at fault and discourage punishments which can cause stress and worsen the situation.
  • Provide referrals as appropriate for behavioral health or urology specialists if necessary.

 

Writing a Nursing Care Plan (NCP) for Enuresis / Bedwetting

A Nursing Care Plan (NCP) for Enuresis / Bedwetting starts when at patient admission and documents all activities and changes in the patient’s condition. The goal of an NCP is to create a treatment plan that is specific to the patient. They should be anchored in evidence-based practices and accurately record existing data and identify potential needs or risks.


References

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Transcript

This is the nursing care plan for enuresis or bedwetting. So urinary incontinence also known as any enuresis is normal for children under the age of three, but as they grow children gain more control of the bladder, nocturnal enuresis or bedwetting is the most common. And it occurs when the child who normally has bladder control has episodes of wetting during the night, nocturnal enuresis or daytime is when the child is having episodes of wetting during the day there’s primary enuresis that describes the child who is not yet fully potty trained. And there are secondary reasons when the child is toilet trained, but still has episodes of wetting after periods of dryness. So some nursing considerations. So we want to do a good skin assessment. We want to make sure that we’re checking for rash or break down. We want to collect a urine analysis. We want to do an abdominal assessment. We want to provide education and resources for parents and patients regarding enuresis. And we want to administer any medications as ordered. The desired outcome for this patient is that this patient is going to have an optimal voiding pattern. The patient is going to be free from infection. The patient is going to understand and act on the urge to void, and the patient is going to have a decreased number of incontinent episodes. 

So when this patient comes in, there’s going to be a few things that are subjective, that the patient’s going to report to us, or the parent is going to report to us. So the first thing about any reason that we want to know is they are going to tell us that there is a repeat bedwetting. So that’s going to be the first thing there’s going to be a repeat bedwetting. The next thing that they are going to want to tell us is that they are wetting once or twice a week, for three months or more. Okay, there is going to be some anxiety. So the patient is going to have some anxiety. There may be some pain with urination. So pain. There may also be some abdominal pain. When we assess the patient, we’re going to cover some objective data. We may notice that there is a small bladder and we’ll do that by palpation or by imaging, or we may notice blood or mucus in the urine. This can give us some good information to indicate a few things. So the nursing interventions that we can do, the first thing is we want to assess, we’re going to assess, we’re going to do a physical assessment. We’re going to know any signs of rash or irritation to the genital area. Remember that skin irritation may cause a child to hold it in. And if there’s any pain while voiding, we want to observe also for signs of sexual abuse. 

The next thing we want to do is we want to collect a sample. So we want to do a urinalysis. So UA, and the reason why we want to do that is sometimes patients tend to hold onto urine, or it’s difficult to urinate if there is a urinary tract infection. So they may not want to go when it’s time to go, because it’s just very painful. So this is for a U T I, the next thing we want to do is we want to assess the abdomen. So we want to assess the abdomen. The reason why we want to assess the abdomen is because we want to check to see if there’s any constipation. Remember chronic constipation can be a factor in causing enuresis. A large mass of stool in the colon puts a lot of pressure on the bladder and it makes it diminished to be able to control the urine or a decreased capacity to hold urine. 

So that bladder space is decreased. We have decreased space in the bladder, maybe because of constipation. We want to provide some education and resources for the patients. So we want to encourage patients to be patient with the child, remind them that the child is not at fault and discourage punishments, which can cause stress and worse than that situation. Oftentimes parents may be angry or frustrated because the child is wetting the bed, but we want to assure them that it is not the child’s fault. Also, we want to make sure that we can provide any type of referrals as appropriate for any behavioral health issues. Or we may want to consult a urologist if necessary. So consult, urologist or psych. 

Finally, we want to administer any medications as appropriate. So we want to give some medicine; some meds that may be ordered are antibiotics. If it is a UTI if we can; what else can we or we offer desmopressin that’s given for low levels of vasopressin and that’s the hormone that tells the kidneys to slow your production. We may also give a medication to stimulate vasopressin secretion. some pathophysiology here. So remember, any reason is normal for a child under the age of three, but as they grow children gain more control of the bladder, subjective data. Remember, repeat bedwetting twice a week, repeat bedwetting for twice a week. And that’s going to be over a course of three months. There’s going to be some anxiety, abdominal pain. We may observe a small bladder. 

There may be blood or mucus in the urine. A skin assessment is the first thing we want to do. We want to do a good skin assessment because this patient is at risk for skin breakdown. And there may be some irritation that will cause the patient to not void on time. We want to do a urinalysis. Remember one cause of bedwetting is a urinary tract infection. We want to collect a sample and we want to send that sample to the lab because then we can intervene with any antibiotic therapy. We love you guys; go out and be your best self today. And, as always, happy nursing.

 

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