On completion of this chapter the reader will be able to: • Outline a plan of care for the child with an elimination problem. • Describe the most common causes of physical growth or maturation failure in later childhood. • Demonstrate an understanding of common disorders of the male and female reproductive systems. • Demonstrate an understanding of health problems related to adolescent sexuality. • Outline a plan for discussing sexuality issues with adolescents. • Outline a plan of care for the adolescent with an eating disorder. • Discuss the manifestations and nursing management of selected emotional or behavioral problems in school children and adolescents. http://evolve.elsevier.com/wong/essentials Animation—Pelvic Inflammatory Disease Case Studies—Attention-Deficit/Hyperactivity Disorder; Obesity; Teen Smoking Enuresis is more common in boys; nocturnal bedwetting usually ceases between 6 and 8 years of age. Enuresis can also be defined as primary (bedwetting in children who have never been dry for extended periods) or secondary (the onset of wetting after a period of established urinary continence). The passage of urine may occur only during nighttime sleep with the child remaining dry during the day (monosymptomatic), or it may be polysymptomatic, wherein the child has daytime urinary urgency and an occasional daytime accident in conjunction with other conditions such as sleep apnea, urinary tract infection, neurologic impairment, constipation, or emotional stressors (Berry, 2006; Katz and DeMaso, 2011). The nocturnal, monosymptomatic type is most common. The condition may be particularly distressing to adolescents, who may refuse therapy. Although enuresis may occur during the daytime, the following discussion primarily focuses on nocturnal enuresis. Before psychogenic factors are considered, organic causes that may be related to enuresis should be ruled out. These include structural disorders of the urinary tract; urinary tract infection; neurologic deficits; disorders that increase the normal output of urine, such as diabetes; and disorders that impair the concentrating ability of the kidneys, such as chronic renal failure or sickle cell disease. A bladder volume of 300 to 350 ml (10–12 oz) is sufficient to hold a night’s urine. Normal bladder capacity (in ounces) is the child’s age plus 2 (up to age 14 years). In other cases, enuresis is influenced by emotional factors, although it is doubtful that they are causative factors. Parents report that these children sleep more soundly than other children; however, the depth of sleep has not been identified as the cause of nocturnal enuresis (Berry, 2006; Elder, 2011). Nocturnal enuresis has a strong familial tendency. These drugs are considered second-line management, and parents should be cautioned not to think that these agents will cure the condition; parents are also advised of the drug’s side effects (Katz and DeMaso, 2011; Sethi, Bhargava, and Shipra, 2005). No matter what techniques are used, the nurse can help both children and parents understand the problem of enuresis, the treatment plan, and the difficulties they may encounter in the process. Essential to the success of any method is the supportive management of parents and their children. Both need encouragement and patience. The problem is discussed with both the parent and the child because all treatments involve and require the child’s active participation. In some treatment interventions, the child is in charge of the intervention; therefore, parents must learn to support the child rather than intervene themselves. For example, children can strip their wet linens, limit fluids, and use the toilet before bedtime. Parents should encourage the child to maintain a regular bowel evacuation regimen; constipation can contribute to nocturnal enuresis (Katz and DeMaso, 2011). A calendar with wet and dry nights may be helpful to motivate the child to stay dry and maintain a positive perspective on the problem; positive rewards are also helpful (Box 17-1). Normally, children and adolescents have one or two soft-formed stools per day. Children with soiling problems tend to form large-bore stools, which are painful to excrete. Therefore, they tend to avoid defecation and withhold stooling. Stool held in the rectum and sigmoid colon loses water and progressively hardens, which causes successively more painful bowel movements and a stretched rectal vault. Over time, the child will lose the urge to defecate on his or her own (Montgomery, 2008). A pain–retention–pain cycle is established. Many children have diarrhea or loose leakage in their clothing and pass small amounts of hard stool, which suggests leakage around an impaction. Therapeutic management consists of determining the cause of the soiling and using appropriate interventions to correct the problem. To determine the cause, perform a complete physical examination, including a rectal examination. Abdominal radiography may be done to determine the severity of impaction. Dietary modifications, stool softeners, and a toilet ritual that encourages the child to establish normal defecation are used. Fecal impaction is relieved by lubricants such as mineral oil; osmotic laxatives such as lactulose, sorbitol, or polyethylene glycol (PEG or MiraLax); and magnesium hydroxide. Customary dosages are usually insufficient. Mineral oil should be avoided in children who have dysphagia or vomiting to prevent aspiration. Dietary changes may be helpful, including elimination of milk and dairy products and consumption of increased amounts of high-fiber foods, such as fruits, vegetables, and cereals, as well as increased fluids (see Chapter 24). Behavior therapy may be indicated to eliminate any fear that has developed as a result of painful defecation. Psychotherapeutic intervention with the child and the family may become necessary.
Health Problems of School-Age Children and Adolescents
Health Problems of School-Age Children
Problems Related to Elimination
Enuresis
Nursing Care Management
Encopresis
Health Problems of School-Age Children and Adolescents
Family-Centered Care
