| Course | DNP 643 Developmentally Based Care of the Well Child |
|---|---|
| Module | Module 4 |
| Paper type | Case study response with peer reply |
| Length | About 563 words |
| Format | Discussion post with APA 7 citations |
| School | Arizona State University |
| Program | Doctor of Nursing Practice |
| Updated | October 2026 |
Free sample paper for DNP 643 Module 4
Case Study 4: Seven and Still Wet at Night
Seven and Still Wet at Night: Evaluating and Treating Monosymptomatic Enuresis Before a School-Age Boy's First Sleepover
The Case
J., a 7-year-old boy, is brought by his mother because he wets the bed four or five nights a week and has never had a dry stretch longer than a few days. He is dry during the day. He has a sleepover with his soccer team in six weeks and is embarrassed. His father wet the bed until age 9. J. has a bowel movement every two to three days. He snores occasionally. Growth and development are normal, and his examination, including the abdomen, spine and genitalia, is normal.
Case Study Response
Assessment
J. has primary monosymptomatic nocturnal enuresis: bedwetting in a child aged 5 or older who has never had a sustained dry period, with no daytime symptoms (Neveus et al., 2020). It is common, affecting about 5% to 10% of 7-year-olds (Kliegman et al., 2024), and the family history is typical, since enuresis runs strongly in families. The underlying mechanisms are nighttime overproduction of urine, reduced bladder capacity at night and difficulty waking to the full-bladder signal.
Ruling Out Other Causes
A urinalysis is the only routine test: glucose would suggest diabetes, and specific gravity, infection or protein would change the picture. Red flags that call for further evaluation include daytime wetting, a weak stream, new onset after a dry period, increased thirst, weight loss and abnormal findings on the spine examination. J. has none. Two contributors deserve attention. His stool pattern suggests constipation, which presses on the bladder and worsens enuresis; treating it can help on its own. Snoring raises the question of obstructive sleep apnea, which is associated with enuresis, so I would ask about pauses, gasping and daytime sleepiness.
Plan
First, basic urotherapy: regular daytime voiding, voiding before bed, good daytime fluid intake with less in the evening, and treatment of constipation. A diary of wet and dry nights helps track progress. Two first-line treatments are supported by evidence (Neveus et al., 2020). The enuresis alarm works best for motivated families who can get up at night and has the lower relapse rate, but it takes several weeks to work. Desmopressin, taken an hour before bed with fluid limited afterward, works quickly but relapse after stopping is common. With the sleepover in six weeks, a sensible plan is to start the alarm now and offer desmopressin for the sleepover night if he is not yet dry, with a practice night at home first. Fluid must be restricted from an hour before the dose until morning to avoid low sodium.
Talking With the Child
I would tell J. that bedwetting is common, is nobody's fault and gets better, and that his father had the same problem. Wet nights should never be punished. Involving him in the diary and the plan increases motivation, in keeping with the Bright Futures emphasis on a school-age child's growing responsibility for his own health (Hagan et al., 2017).
Reply to a Classmate (On Punishment)
Kelsey, in your case the father planned to take away screen time after wet nights. I would explain that enuresis happens during sleep and is not under the child's control, so punishment adds shame without helping, while praise for steps he can control, such as voiding before bed, supports progress. How would you approach a parent who sees it as laziness?
References
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (Eds.). (2017). Bright Futures: Guidelines for health supervision of infants, children, and adolescents (4th ed.). American Academy of Pediatrics.
Kliegman, R. M., St. Geme, J. W., Blum, N. J., Tasker, R. C., Wilson, K. M., Schuh, A. M., & Mack, C. L. (Eds.). (2024). Nelson textbook of pediatrics (22nd ed.). Elsevier.
Neveus, T., Fonseca, E., Franco, I., Kawauchi, A., Kovacevic, L., Nieuwhof-Leppink, A., Raes, A., Tekgul, S., Yang, S. S., Rittig, S., & International Children's Continence Society. (2020). Management and treatment of nocturnal enuresis: An updated standardization document from the International Children's Continence Society. Journal of Pediatric Urology, 16(1), 10-19. https://doi.org/10.1016/j.jpurol.2019.12.020
Reading the DNP 643 Module 4 assignment instructions
Week 8 covers the school-aged child from 6 to 11 and coincides with the second immersion, OSCEs and the developmental and behavioral presentation. Case Study 4 keeps the course's weekly rhythm, a posted case at the start of the week, a cited answer by midweek and a peer response by its end. School-age cases often involve a concern that affects the child's daily life and self-esteem, such as bedwetting, school performance or behavior. A complete answer covers the clinical assessment and also how you talk with the child and family, since the child is now old enough to take part in the plan. Expect questions about red flags, about what tests are needed and about how to choose between treatments, so plan a short section for each.
How the DNP 643 Module 4 example is put together
After a short case summary, the sample answers under four headings. The assessment names the condition using the international definition, gives its prevalence and explains the three mechanisms behind it. The section on ruling out other causes limits testing to a urinalysis, lists red flags and identifies constipation and sleep apnea as contributors worth checking. The plan begins with urotherapy, compares the alarm and desmopressin on speed and relapse and fits the choice to the family's six-week deadline, with the safety rule for fluid restriction. The last section covers how to speak with the child. A reply to a classmate addresses a parent's plan to punish wet nights with a reason and an alternative. Three sources support the response.
DNP 643 Module 4 rubric: what earns full marks
Case Study 4 counts for 10 points. Faculty usually credit a diagnosis grounded in a recognized definition, testing limited to what the presentation calls for, attention to contributing conditions, a plan that compares evidence-based options and helps the family choose, medication safety information and counseling that a child would hear as supportive. APA references and a reply that adds something complete the expectations. Deductions follow from unnecessary tests, from treatment options listed without trade-offs and from counseling that implies the child is to blame. Since the cases together carry 30% of the grade, a consistent effort each week adds up. A response that ties its choice of treatment to the family's own goal, such as a sleepover, shows the judgment faculty look for.
DNP 643 Module 4 help: mistakes that cost marks
Start with the basics before medication: daily habits and constipation often matter as much as any drug. When you present the alarm and desmopressin, help the family choose by matching each to their goals and timeline. Include the fluid restriction rule with desmopressin. Use the international standardization document as your main source. Speak to the child directly in your counseling section, and make sure no one punishes wet nights. Keep the reply to a classmate focused on one helpful point. If you would like a review of your plan against the case questions, share the posted case with the desk.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Arizona State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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DNP 643 Module 4 questions, answered
Where can I find a free DNP 643 Module 4 sample paper?
The DNP 643 Module 4 sample here is a full school-age case study response on primary nocturnal enuresis in a 7-year-old, with treatment choices and a classmate reply.
What is monosymptomatic enuresis?
Bedwetting in a child aged 5 or older with no daytime urinary symptoms; it is primary if the child has never had a sustained dry period.
Which is better for bedwetting, the alarm or desmopressin?
The alarm has lower relapse but takes weeks to work; desmopressin works quickly but relapse after stopping is common. Family goals guide the choice.
What tests are needed for bedwetting?
Usually only a urinalysis, unless red flags such as daytime wetting, increased thirst, weight loss or an abnormal spine exam suggest another cause.
What does Week 8 of DNP 643 include?
Care of the school-aged child, the second immersion with OSCEs, Case Study 4 and the developmental and behavioral health concern presentation.