In NU569's Unit 4 write-up, functional constipation explains a composite first-grader's new daytime wetting, documented from history to plan with Rome IV criteria and bracketed dosing. Searches like "nu 569 unit 4 assignment example", "nu569 unit 4 sample" and "nu569 unit 4 example" land here.
Pediatric Case Write-Up: Daytime Wetting and a Left Lower Quadrant Mass in a 6-Year-Old, Read as Functional Constipation
[Student Name]
Purdue University Global
NU569: FNP I Clinical - Lifespan Health Focus
Unit 4 Pediatric Case Write-Up
[Instructor Name]
[Date]
The child is a composite; values, percentiles and amounts are bracketed, and no amount here is a dose for any real child.
Identification
Composite, [6] years old, girl, brought by her father. Reason for visit: daytime wetting for three weeks.
Subjective
History of present illness. [Ella] was dry by day at [3] years and at night by [4]. For three weeks, her underwear has been damp by afternoon, and she has had two small accidents at school. She started at a new school this fall and says she does not like the bathrooms there, so she waits until she gets home. Her father notes hard stools about twice a week that are large enough to block the toilet, and that she sometimes crosses her legs or stands on tiptoe when she needs to go. No blood in stools, no vomiting, no abdominal swelling, no fever, no pain on urination, no increased thirst.
Birth and early history. Term birth; meconium passed on the first day. No constipation in infancy.
Diet. About [four] cups of milk a day; little fruit or vegetables; drinks little water at school.
Development and family. Normal development; no family history of bowel disorders or thyroid disease.
Objective
Growth: weight [21] kg, [55th] percentile; height [116] cm, [50th] percentile on the CDC chart; tracking along her curves. Abdomen: soft, nondistended; firm, movable, nontender mass in the left lower quadrant, consistent with stool. Back: lumbosacral spine without dimple, hair tuft, pigmented patch or asymmetric gluteal cleft. Neurologic: lower limb strength, tone and reflexes normal and symmetric; gait normal. Perianal: normal anal position; no fissure; perianal sensation intact. Digital rectal examination deferred, since the history and abdominal findings are sufficient. Urinalysis: [negative for nitrite and leukocyte esterase; no glucose].
Assessment
Functional constipation, with secondary daytime urinary incontinence as bladder and bowel dysfunction.
Rome IV criteria for functional constipation in children 4 and older require at least two of the following for at least one month (Hyams et al., 2016):
1. Two or fewer defecations a week: met.
2. At least one episode of fecal incontinence a week: not met.
3. Retentive posturing or stool withholding: met, legs crossed, tiptoe, avoiding school bathrooms.
4. Painful or hard bowel movements: met.
5. A large fecal mass in the rectum: met by the abdominal mass.
6. Large-diameter stools that may obstruct the toilet: met.
Five met where two suffice, for more than a month.
Red flags checked and absent: delayed meconium, onset in infancy, poor growth, abdominal distension, vomiting, blood in stools, spinal or neurologic abnormalities. Hirschsprung disease is unlikely with meconium on day one and onset at six. Hypothyroidism is unlikely with normal growth and no other signs. Urinary infection is excluded by the urinalysis.
A rectum loaded with stool presses on the bladder, reducing its capacity and triggering overactive contractions, so the wetting is likely to improve when the constipation is treated. That link is recognized in the terminology of bladder and bowel dysfunction in children (Austin et al., 2016).
Routine blood tests and abdominal radiography are not ordered, since the guideline advises against them in children without alarm features (Tabbers et al., 2014). The urinalysis is the exception, because of the wetting.
Plan
Phase 1, clearance: [polyethylene glycol 3350] [composite amount, weight-based, for 3 to 6 days] until stools are soft and passing easily, following the guideline's first-line recommendation for fecal disimpaction (Tabbers et al., 2014). Phase 2, maintenance: [polyethylene glycol 3350] [composite lower daily amount], adjusted to one or two soft stools a day, continued for at least [two] months and for at least one month after symptoms resolve. Behavior: toilet sitting for [5] minutes after breakfast and dinner, with feet supported on a stool; a sticker chart for sitting, not for results. Diet: milk reduced to [two] cups a day; fruit, vegetables and water increased; a water bottle at school. School: a note asking that she be allowed to use the bathroom whenever she needs to, and to use the nurse's bathroom if she prefers. Stool diary: frequency and consistency on a picture chart. Follow-up: phone check in [one] week; visit in [four] weeks. Return sooner for abdominal pain, vomiting, blood in stools or no stool for [three] days on the plan. Teaching: constipation is common, no one's fault, and treatment usually takes months; stopping too early is the most common reason it returns.
References
Austin, P. F., Bauer, S. B., Bower, W., Chase, J., Franco, I., Hoebeke, P., Rittig, S., Vande Walle, J., von Gontard, A., Wright, A., Yang, S. S., & Nevéus, T. (2016). The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the standardization committee of the International Children's Continence Society. Neurourology and Urodynamics, 35(4), 471-481. https://doi.org/10.1002/nau.22751
Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Childhood functional gastrointestinal disorders: Child/adolescent. Gastroenterology, 150(6), 1456-1468. https://doi.org/10.1053/j.gastro.2016.02.015
Tabbers, M. M., DiLorenzo, C., Berger, M. Y., Faure, C., Langendam, M. W., Nurko, S., Staiano, A., Vandenplas, Y., & Benninga, M. A. (2014). Evaluation and treatment of functional constipation in infants and children: Evidence-based recommendations from ESPGHAN and NASPGHAN. Journal of Pediatric Gastroenterology and Nutrition, 58(2), 258-274. https://doi.org/10.1097/MPG.0000000000000266
How this NU569 Unit 4 example is structured
Each SOAP section answers a question the next one needs. The history establishes onset after infancy and a likely trigger, supporting a functional cause. The exam then checks what would make the cause organic: spinal signs, reflexes, growth and anal position, each stated as a finding. The assessment counts Rome IV criteria one by one, five met where two suffice, for over a month, and gives the differential its due: Hirschsprung disease, hypothyroidism and urinary infection each receive a sentence and a reason. Routine blood tests are deliberately not ordered, as the 2014 NASPGHAN and ESPGHAN guideline advises without alarm features; a urinalysis is the exception because of the wetting. The plan runs in two phases, clearance with [polyethylene glycol 3350] and then maintenance, every amount bracketed, with toilet sitting after meals, a stool diary and a school bathroom note.
Get an NU569 Unit 4 example written to your instructions
Which age group does your section assign for the Unit 4 write-up, and in what format? Send that along with the prompt and the rubric. We build a composite child in the right age band, document the visit in your course's format, and bracket every dose for a prescriber. First one free, turned around in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
NU569 Unit 4 questions, answered
Does the pediatric write-up have to be a sick visit?
Not always. Some sections want a well-child visit covering growth, development and anticipatory guidance, and others want an acute or chronic problem. The prompt usually says which. When it leaves the choice open, a problem visit shows diagnostic reasoning, while a well visit shows age-specific prevention. Tell us which your section expects and the sample will follow it.
How are doses shown in a sample case?
In brackets, with the source of the dosing named, such as a weight-based range from a pediatric reference. The brackets mark every amount as illustrative, because dosing belongs to the prescriber and the specific child. Graders generally want to see a calculation by weight and a check against a maximum; the sample shows that layout without presenting any number as advice.
Why does the write-up discuss tests that were not ordered?
Because declining a test is a decision, and graders reward decisions that are explained. Saying which tests a guideline advises against without alarm features, and why the case has none, shows judgment. Leaving tests out silently looks the same as never thinking of them, and ordering everything looks like guessing. The sample puts that reasoning in two sentences.