1229 Exam 5: Extrophy of the bladder Flashcards
What is Phimosis?
Tight foreskin that does not retract. A narrowing of the foreskin or prepuce that cannot be retracted behind the glans
What is the treatment for Phimosis?
Mild cases: manual retraction of the foreskin
Severe Cases: Certical division and transverse suturing of the foreskin, circumcision
Nursing care of Phimosis:
proper cleansing of area.
monitor for bleeding, infection, dysuria
no tub bath for at least one week after surgery if circumcision is done or incision is made.
Nursing diagnosis for Phimosis:
Risk for impared urinary elimination
risk for infection
Deficient knowledge
Paraphimosis:
occurs when the foreskin of the penis is pulled back over the glans penis and can not return back to the original location.
*May occur after sexual activity, erection, or penile injury.
**Cuts off blood supply to the glans penis
MEDICAL EMERGENCY, CAUSES SERIOUS COMPLICATIONS IF LEFT UNTREATED!
What is Hypospadias:
Penile anomaly that is associated with abnormal location of turinary meatus that opens below the glans penis.
Failure of urethral canalization during fetal development.
What causes Hypospadias?
Its unknown, but suspected to be associated with the use of hair dyes during pregnancy.
How do you classify Hypospadias?
According to location of urinary meatus.
Presence or absence of chordee
What is chordee?
Ventral curvature of the penis that usually accompanies the more severe forms of hypospadias
Nursing assessment for Hyposadias:
Assess urinary system function, voiding, other congenital defects.
Chordee may impair sexual function later in life due to causing decreased sensation.
How is hyposadias diagnosed:
renal ultrasound, IVP, voiding cystourethography
Treatment of Hypospadias:
Sirgoca; re[aor ear;u om 1st year of life (8-12 months) or as soon after first year if possible. PREFERABLY BEFORE TOILET TRAINING.
Goal of Hypospadias surgery:
improved appearance of genitalia
allow male child to urinate in a standing position
provide a sexually adequate organ
DO NOT CIRCUMCISE INFANT BEFORE UROLOGY CONSULT.
Pre op care for Hypospadias
Support for parents and infant
prepare for surgery
Post Op care for Hypospadias:
Pain management Nerve Block Tylenol Monitor for infection assess voiding urethral stent
What is Epispadias?
Anomaly of urethral meatus that opens on dorsal surface/top of the penis, penis may be broad spade-like and not completely formed, presenting with widened pubic symphysis and urethral meatus on dorsal surface
Patho: failure of urethral canalization to form normally some association with virus or cold during pregnancy
Episadias in female infants:
involves a widened urethra and a bifid or divided clitoris
Diagnosis of Episadias:
Is at birth or shortly thereafter: fetal ultrasound physical exam after birth CBC electrolytes pelvic x-ray IVP urogenital ultrasound
Treatment for Epispadias:
Mild cases may require no intervention or surgery done for cosmetic purposes only.
Surgical correction involving 1-2 reconstructive surgeries.
Pre Op Episadias:
Support for parents and infant
prepare for surgery
Post Surgical Care Epispadias:
Pain management Tylenol Monitor for bleeding or infection No tub baths Assess urinary functions/stents
Hypospadias and Epispadias Nursing Diagnoses:
Impaired urinary elimination acute pain interrupted family processes Risk for infection risk for disturbed body image Risk for sexual dysfunction
What is Exstrophy of the bladder?
Most common anomaly of bladder & bladder, urethra, and urethral orifices to are exposed
-more common in males and often occurs with epispadias
**abnormal fetal development of bladder, abdominal wall, and symphysis pubis
IT IS NOT INHERITED.
Treatment of Extrophy of the Bladder:
Cover exposed organs after birth using sterile, non-adherent dressing to protect them until the site is closed
low dose of antibiotics
surgery. (may be started as a neonate on 1-2 day of life. optimal outcome is complete closure and contruction of normal urethral tract but this may take several surgeries to accomplish.
Pre op for Exstrophy of the Bladder:
Protect bladder/skin (prevent excoriation)
diapers under infant-urine seeps from bladder; position baby on back or side
hydrate and prevent constipation.
Post Op for Exstrophy of the Bladder:
Hydrate and prevent constipation
monitor for bleeding and infection
assess urinary output
consider psychosocial needs
Nursing Care for Exstrophy:
Teach for catherters and stomas keep site clean and dry monitor urinary output monitor for obstruction (sediment, clots, kinks in tubing) monitor for infection protect from damage prevent infection catheter care/stoma care NO TUB BATHS promote hydration psychological support
Nursing diagnoses for Extrophy of Bladder:
Risk for fluid volume deficit Impaired skin integrity Risk for infection Impaired urinary elimination acute pain risk for perioperative positioning injury risk for disturbed body image
Psychosocial concerns of Exstrophy of bladder:
interrupted family processes risk for impaired attachment caregiver role strain parents have major concerns: care of child financial cost of surgeries genital appearance organ size potential to procreate rejection by peers.
