MATURATIONAL ENURESIS Nursing Care Plan

Don’t be ashamed if your child has maturational enuresis. It is only natural among children, like this kid, named Zion, a 7 year old boy who often experienced wetting in bed while sleeping at night. Zion seems to have no problem but is he? There are a lot of factors that causes voiding in bed at night, from physical, physiological, emotional, to psychosocial. Identifying the cause of maturational enuresis will surely solve Zion's problem. The challenge to the nurse is the boy's participation through the courses of nursing care. Note that the boy may deny that he didn't do voiding during the night and rejects any actions or intervention. Below is a nursing care plan sample of maturational enuresis of Boy Zion, 7 years old, smart kid in school. 

ASSESSMENT:

Subjective:
"I always pee 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:

- Find out Zion’s contributing factors such as stress-related in school or his siblings, unable to have attention to bladder cues, unfamiliar surroundings, small bladder capacity, or lack of motivation. Zion might have encountered problem in school, this kind of stressors may cause maturational enuresis to the boy. Is the boy getting bullied in school? Did one of his teachers scold him? Did one of his exams failed? Did he do something that made him embarrassed? Confirm if he has siblings, sibling fights are very common but they mostly ended easily, however for some, it can very stressful especially if cannot handle properly. You may ask the parent or the guardian of how long they are living in their home. If it is too recent, the boy may experience stress because of unfamiliar surroundings.

- You need to increase parent-child relationship. Both Zion and his parent must know the physiologic development of bladder control so explain them properly and make sure they understand the discussion. Zion must understand that other children at his age also experience voiding in bed and it is not bad.

- If there's small bladder capacity, encourage the child to postpone voiding after he drinks to help stretch the bladder. This will need a parent’s guidance since most children did not want to delay their needs to void.

- Tell the parent to encourage their child to void before going to bed, this technique really work to decrease enuresis especially if Zion is a sound sleeper. Tell the parent to avoid giving their son any kind of fluids during bedtime and if the child awakens later about 11pm at night, attempt to awaken him fully for positive reinforcement.

- Ask the parent if Zion voids during daytime. Teach the child about controlling urination by practicing "start and stop" during the steam of urination. Bladder retraining also helps control dysfunctional voiding. Have the parent keep a record on how is their son doing and note for dry days and nights on the calendar. Every time the child wets, ask him what he thinks why it happen.

- 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.