Care of Mother and Child At-Risk or with

STUDENT ACTIVITY SHEET Problems (Acute and Chronic)-Lecture

BS NURSING / SECOND YEAR
Session # 46

LESSON TITLE: NURSING CARE OF A FAMILY WHEN A

CHILD HAS NEUROLOGICAL ALTERATIONS
LEARNING OUTCOMES: Materials:
At the end of the lesson, the student nurse can: Book, pen and notebook, index card/class list,
speaker and LCD projector
1. Define the common types of disorders in the nervous
system that occur in children. Reference:
2. Integrate the knowledge of the common types of disorders in Pilliteri, Adele and Silbert-Flagg, JoAnne (2018)
the nervous system that occur in children and describe these Maternal and Child Health Nursing, 8th Edition.
disorders that occur in these classifications of children in USA: Lippincott Williams and Wilkins
formulating nursing care plan in giving quality maternal and
child health nursing care

LESSON REVIEW/PREVIEW (5 minutes)

MAIN LESSON (50 minutes)

Please refer to Chapter 54: Nursing Care of a Child Has an Intellectual or Mental Health Disorder- Elimination Disorders p.
1553

ELIMINATION DISORDERS
ENCOPRESIS ENURESIS
 In children ages 4 years and older, loss of feces is  Enuresis is defined as repeated involuntary or
encopresis if there is repeated passage of feces intentional urination during the day or at night after
at least once a month for at least 3 months in an age at which a child has attained or should
places not culturally appropriate for that purpose. have attained control over bladder function, when
 It is more common in boys than in girls and no organic cause for the problem can be found.
considered primary if the child was never fully  Chronologic age (or developmental level) is at
toilet trained and secondary if the problem began least 5 years and there is a positive family history
after effective training. in many instances.
 Although stress may be a factor in occurrences of
ASSESSMENT enuresis,
 It is diagnosed only after medical causes such as  its primary cause is unknown.
lactase deficiency, thyroid disease,
hypercalcemia, Hirschsprung disease, and ASSESSMENT
infectious diarrhea have been ruled out.  Most children outgrow the problem by
 Between 1.5% and 7.5% of children ages 6 to 12 adolescence.
years old have encopresis, and it is 6 times as  It is important to treat enuresis to minimize
common in boys as in girls embarrassment and anxiety of the child and
 history of usual bowel evacuation habits, the frustration experienced by parents and/or
number of bowel accidents, and the times at caregivers.
which they occur.  The most serious result of enuresis is related to
 Additionally, a dietary history including fiber and the child’s feelings of failure with each occurrence
fluid intake is important. Investigate any recent and associated rejection by peers.
changes or stress factors in the child’s  All this contributes to a lowered sense of self-
environment. esteem.

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PHINMA Education (Department of Nursing) 1 of 5
  A physical examination that includes a rectal MANAGEMENT
examination should be done to establish whether  Treatment focuses on behavioral management
there is proper anal sphincter control. and positive reinforcement.
 If anal fissures are present, the possibility of child  Enuresis alarms can be beneficial in the short and
maltreatment needs to be investigated, although long term; however, their use can be labor
encopresis alone does not substantiate sexual intensive and time-consuming.
abuse.  Success is more likely with strong family support
and a positive attitude.
MANAGEMENT  A medication such as desmopressin (DDAVP), a
 the treatment of encopresis begins with a synthetic analogue of antidiuretic hormone (ADH),
therapeutic regimen to empty the bowels of is a first-line pharmacologic agent used in children
impacted stool, most often with laxatives, enemas, over the age of 5 years.
or a combination of both  It can be used for short-term treatment for children
 Behavior interventions are centered on habit hesitant to be away from home overnight, for
relearning. example, at a slumber party or overnight camp.
 Reserving time in a busy household for children to
evacuate their bowels about two times daily (in
the morning and after dinner) may create new
“habit” periods for them.
 It is especially advantageous if they are able to
evacuate their bowels before they leave for school
in the morning because then they are less likely to
experience encopresis and embarrassment in
school.
 The administration of a stool softener such as
lactulose, a high-fiber diet, or 1 to 6 tablespoons
of mineral oil daily for 2 or 3 months often softens
stools so bowel movements are not painful.
 Remind parents that children receiving long-term
mineral oil therapy also need to take water-soluble
forms of vitamins A, D, and K because these
vitamins tend to be removed from the
gastrointestinal tract with the mineral oil.
 Emphasize to parents that children should not be
punished for encopresis.
 Encourage them to pay as little attention as
possible to bowel accidents and to give praise for
days when encopresis does not occur.
CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by pair. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct ratio. Superimpositions or erasures in you answer/ratio is not allowed.

Multiple Choice

1. Which of the following best describes encopresis?

A. Leaking of stool in an inappropriate place
B. Leaking of urine in an inappropriate place
C. Inability to pass stool
D. Inability to pass urine

ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

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 2. What is the most common cause of encopresis?
A. Emotional problems
B. Bad conduct
C. Chronic constipation
D. Attention seeking behavior
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

3. Identify one method of preventing encopresis.

A. Discipline the child
B. Eat a diet high in fat
C. Drink plenty of fluids
D. Eat a diet high in salt
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

4. The following are management for Encopresis, EXCEPT:

A. The treatment of encopresis begins with a therapeutic regimen to empty the bowels of impacted stool, most often
with laxatives, enemas, or a combination of both
B. Behavior interventions are centered on habit re-learning.
C. Reserving time in a busy household for children to evacuate their bowels about two times daily
D. Child is able to evacuate their bowels before they leave for school in the morning because then they are less
likely to experience encopresis and embarrassment in school.
E. None of the above
ANSWER: ________
RATIO:___________________________________________________________________________________________
_____________________________________________________________________________________________ ____
_____________________________________________________________

5. TRUE OR FALSE: Enuresis happens only at night.

A. True
B. False
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

6. What is the minimum age at which a child can be considered to be suffering from enuresis?
A. 2 years
B. 3 years
C. 4 years
D. 5 years
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

7. Which method should not be used to treat enuresis in children?

A. Behavior modification
B. Enuresis Alarm
C. Wearing a Diaper
D. Punish the child in the morning following bedwetting
ANSWER: ________

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RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

8. Who is more likely to have the habit of bedwetting?

A. Girls
B. Boys
C. Both
D. Neither
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

9. Which of the following best describes enuresis?

A. The inability to control stool in a person that is already toilet trained
B. The inability to control urine in a person that is already toilet trained
C. Frequent urination
D. Painful urination
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

10. Which of the following is a possible cause of enuresis?

A. Urinary tract infection
B. Diaper rash
C. Skin infection
D. Too many Kegel exercises
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_____________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among
yourselves. Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
RATIO:_______________________________________________________________________________________
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3. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
4. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________
5. ANSWER: ________

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 RATIO:_______________________________________________________________________________________
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_____________________________________________________________________
6. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
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7. ANSWER: ________
RATIO:_______________________________________________________________________________________
______________________________________________________________________________ _______________
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8. ANSWER: ________
RATIO:_______________________________________________________________________________________
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9. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
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10. ANSWER: ________
RATIO:_______________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________

LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.
PERIOD 1
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
PERIOD 2
17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
PERIOD 3
32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

AL STRATEGY: CAT 3-2-1

3-2-1
Three things you learned:
1. __________________________________________________
2. __________________________________________________
3. __________________________________________________

Two things that you’d like to learn more about:

1. __________________________________________________
2. __________________________________________________

One question you still have:

1. __________________________________________________

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