Jasmine Vorperian

What is Enuresis?

Enuresis, more commonly called bed-wetting, is a disorder of elimination that involves

the involuntary release of urine into bedding, clothing, or other inappropriate places. In
adults, loss of bladder control is often referred to as urinary incontinence rather than
enuresis.

Causes of Enuresis in Children

No one knows for sure what causes enuresis, but various factors may play a role as to
why children wet their beds. Firstly it may be physiological, whether the child has a small
bladder, and may not be large enough to hold the urine produced during the night. Or it
my be neurological, when the nerves that control the bladder are slow in maturing,
causing the inability to recognize a full bladder and not arousing the child from sleep

Causes of Enuresis in Adults

Enuresis or urinary incontinence in elderly adults may be caused by loss of independent

control of body functions resulting from dementia, bladder infections, uncontrolled
diabetes, side effects of medications, and weakened bladder muscles. Urinary
incontinence in adults is managed by treatment of the underlying medical condition, if
one is present.

Medical Management of Enuresis in Children

Most patients outgrow bed-wetting on their own. If there's a family history of bed-
wetting, the patient will probably stop bed-wetting around the age the parent stopped bed-
wetting.

Generally, the patients will direct the doctor's level of necessary treatment. If the patient
isn't especially bothered or embarrassed by an occasional wet night, less aggressive
treatments may be all that's needed. However, if the patient is worried about attending
social occasions, he/she may be more motivated to try additional treatments.

Moisture alarms

These small, battery-operated connect to a moisture-sensitive pad on the patients pajamas

or bedding. When the pad senses wetness, the alarm goes off. Ideally, the moisture alarm
sounds just as the patient begins to urinate, in time to help the patient awaken, stop the
urine stream and get to the toilet. If a moisture alarm is used, plenty of time most given
for it to begin working. It often takes at least two weeks to see any type of response and
up to 12 weeks to see dry nights. Moisture alarms are highly effective, carry a low risk of
relapse or side effects, and may provide a better long-term solution than medication does.
Jasmine Vorperian

Medication

If other techniques are not adequate in ceasing the enuresis, the doctor may prescribe
medication to stop it. Various types of medication can slow nighttime urine production,
change the patents sleep pattern and/or calm the bladder. Sometimes a combination of
medications are often most effective. Enuresis typically resumes when the medication is
stopped.

Nursing Interventions

Promote understanding of condition to patient and family..

Enhance self-esteem.
Assist client in achieving continence

What Are the Symptoms and Causes of Polyuria?

In general polyuria is a condition characterized by the passage of large amounts of urine

at least 1500 mL/24 hours. Polyuria is commonly caused by diabetes mellitus, that is
under poor control, or is not yet diagnosed or under treatment. Polyuria, also occurs in
some other conditions such as, diabetes insupidus, polycystic kidney disease and sick cell
disease. Polyuria, is usually corrected when the underlying medical condition is treated

Nursing interventions

Instruct patient regarding fluid restrictions.

Restrict sodium intake as prescribed.
Instruct patient to avoid medications that may cause fluid retention.

What Are the Symptoms and Causes of Urinary Retention?

Urinary retention is the inability to empty the bladder even though urine is present, it may
occur as a side effect of certain medications, post-operatively and numerous medical
conditions, such as prostate enlargement, bladder obstruction, urinary stones. Urinary
retention, can be corrected by different means, such as, managing and/or treating the
underlying medical condition, inserting urinary cauterization, prostatectomy.

Nursing Interventions

Encourage fluids. Unless medically contraindicated, fluid intake should be at least 1500
ml/24 hours.
Encourage patient to void at least every 4 hours.
Have patient listen to sound of running water, or place hands in warm water and/or pour
warm water over perineum.
Perform Credé’s method over bladder.
Jasmine Vorperian

Procedure and Purpose for Competent Catheter Care

There are several key nursing interventions that can be utilized, to provide patients with
knowledgeable catheter care, they are:

• The most important procedure that must be utilized every time that catheter care
is being provided, is handwashing, this the most important technique to prevent
infection.
• The urine collection bag should be emptied when 1/2 to 2/3 full or every 3 to 6
hours. This helps to prevent undue trauma/traction on the urethra due to the
weight of the bag.
• Secure the catheter to either the patient's thigh or the abdomen. This helps to
decrease the risk of bleeding, trauma, meatal necrosis, and bladder spasms from
pressure and traction.
• Maintain a closed system whenever possible, if a leg bag is changed from a larger
overnight bag, careful handwashing must be preformed and cleaning the contact
ports with an antiseptic must be completed, to prevent the introduction infection
into the catheter system.

Relieving Urinary Retention

To help a patient suffering from urinary retention a nurse may implement the following
techniques to relieve symptoms. Some of these procedures include:

• Have the patient listen to sound of running water, or place hands in warm water
and/or pour warm water over the perineum (this stimulates urination). Encourage
the patient to drink at least 1500 mL/24 hrs, while also having the patient try to
void every 4 hours.
• The nurse may also perform Credé’s method over the bladder. Credé’s method is
the process of pressing down over the bladder with the hands, which increases
bladder pressure, and this in turn may stimulate relaxation of sphincter to allow
voiding.
• The nurse may also encourage the use of bethanechol (Urecholine) as ordered, if
the above mentioned procedures have not worked in relieving the urinary
retention. Urecholine is a cholinergic agent, which release acetylcholine at nerve
endings and to increase tone and strength of contractions of smooth muscles of
the urinary bladder.
• And lastly a nurse may catheterize a patient with urinary retention, to relieve the
symptoms.