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MATURATIONAL ENURESIS Nursing Care Plan

      So what's the meaning of maturational enuresis? Maturational enuresis occurs in children during night. It is when a child experience involuntary voiding while sleeping and it is not pathologic in origin. Do not use this diagnosis when enuresis results from urinary tract infection, constipation, epilepsy and diabetes. Instead, you can use this when enuresis is from small bladder capacity, failure to perceive cues with a maturational issue such as new siblings or school pressures. We provided one sample of nursing care plan for maturational enuresis below.

ASSESSMENT:
Subjective:
"I always peed my bed every night," the boy said.

Objective:
(The boy is actually normal since this nursing diagnosis is not pathologic in nature.)


DIAGNOSIS:
Maturational enuresis related to voiding in bed every night as verbalized by the client.

PLANNING:
After 2 hours of nursing intervention the child and family will be able to list factors that decrease enuresis so that client will remain dry during sleep.

INTERVENTIONS:
- Determine contributing factors such as stressor-related like school or siblings, inattention to bladder cues, unfamiliar surroundings, small bladder capacity, and/or lack of motivation.

- Promote a positive parent-child relationship. Explain to both the parent and the child the physiologic development of bladder control. Offer reassurance to the child that other children do wet on bed at night and that is not bad or sinful.

- If there's small bladder capacity, encourage the child to postpone voiding after he drinks to help stretch the bladder.

- If the child is sound sleeper, encourage the child to void before sleeping. Restrict fluids in bedtime if necessary and if the child awaken later about 11pm at night, attempt to awaken him fully for positive reinforcement.

- If daytime wetting occurs, teach the child awareness of sensations that occur when it is time to void. Teach the child ability to control urination, let him start and stop the stream. Bladder retraining also help control dysfunctional voiding. Have a child keep a record on how is he doing and emphasize dry days and night on the calendar. If the child wets, let him note why he thinks it happened.

- In school-age child, assess if the child is using bathroom at school or do they get sufficient bathroom breaks?

- Initiate health teaching and referrals, as indicated.

EVALUATION:
After 2 hours of nursing intervention the child and family was able to list factors that decrease enuresis so that client will remain dry during sleep.

Note: Psychological problems usually are not the cause of enuresis but may result from lack of understanding or insensitivity to the problem. Interventions that punish or shame the child must be avoided. Involve the child in bed changing for nocturnal enuresis. Explain that the child cannot control bed-wetting but that bed-wetting can be controlled with intervention. According to Dr. N. Wolfish, Enuresis, although a common childhood concern, elicits great emotional turmoil for both the child and the care-giver alike. Many factors have been implicated in its genesis, but three fundamental processes have been identified in the etiology: spontaneous bladder contractions persisting well beyond the usual period for their disappearance; a reduced response to, or secretion of, anti-diuretic hormone (ADH); and an inability to arouse to the stimulus of a large or contracting bladder. These three mechanisms are maturational events in the developing child and are present with varying degrees of severity in any one individual. Thus, the clinical manifestations may vary from child to child, depending on the constellation of maturational lags that are present. In addition, the focus of our therapeutic approach may vary depending on the interplay of these factors. The normal processes of the maturation of bladder continence, the physiological alterations responsible for enuresis and the various clinical forms of enuresis are reviewed.

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