1229 Exam 5: Extrophy of the bladder

Question 1

What is Phimosis?

Answer 1

Tight foreskin that does not retract. A narrowing of the foreskin or prepuce that cannot be retracted behind the glans

Question 2

What is the treatment for Phimosis?

Answer 2

Mild cases: manual retraction of the foreskin

Severe Cases: Certical division and transverse suturing of the foreskin, circumcision

Question 3

Nursing care of Phimosis:

Answer 3

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.

Question 4

Nursing diagnosis for Phimosis:

Answer 4

Risk for impared urinary elimination
risk for infection
Deficient knowledge

Question 5

Paraphimosis:

Answer 5

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!

Question 6

What is Hypospadias:

Answer 6

Penile anomaly that is associated with abnormal location of turinary meatus that opens below the glans penis.

Failure of urethral canalization during fetal development.

Question 7

What causes Hypospadias?

Answer 7

Its unknown, but suspected to be associated with the use of hair dyes during pregnancy.

Question 8

How do you classify Hypospadias?

Answer 8

According to location of urinary meatus.

Presence or absence of chordee

Question 9

What is chordee?

Answer 9

Ventral curvature of the penis that usually accompanies the more severe forms of hypospadias

Question 10

Nursing assessment for Hyposadias:

Answer 10

Assess urinary system function, voiding, other congenital defects.
Chordee may impair sexual function later in life due to causing decreased sensation.

Question 11

How is hyposadias diagnosed:

Answer 11

renal ultrasound, IVP, voiding cystourethography

Question 12

Treatment of Hypospadias:

Answer 12

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.

Question 13

Goal of Hypospadias surgery:

Answer 13

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.

Question 14

Pre op care for Hypospadias

Answer 14

Support for parents and infant

prepare for surgery

Question 15

Post Op care for Hypospadias:

Answer 15

Pain management 
Nerve Block
Tylenol
Monitor for infection
assess voiding
urethral stent

Question 16

What is Epispadias?

Answer 16

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

Question 17

Episadias in female infants:

Answer 17

involves a widened urethra and a bifid or divided clitoris

Question 18

Diagnosis of Episadias:

Answer 18

Is at birth or shortly thereafter: 
fetal ultrasound
physical exam after birth
CBC
electrolytes
pelvic x-ray
IVP
urogenital ultrasound

Question 19

Treatment for Epispadias:

Answer 19

Mild cases may require no intervention or surgery done for cosmetic purposes only.
Surgical correction involving 1-2 reconstructive surgeries.

Question 20

Pre Op Episadias:

Answer 20

Support for parents and infant

prepare for surgery

Question 21

Post Surgical Care Epispadias:

Answer 21

Pain management
Tylenol
Monitor for bleeding or infection
No tub baths
Assess urinary functions/stents

Question 22

Hypospadias and Epispadias Nursing Diagnoses:

Answer 22

Impaired urinary elimination
acute pain
interrupted family processes
Risk for infection
risk for disturbed body image
Risk for sexual dysfunction

Question 23

What is Exstrophy of the bladder?

Answer 23

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.

Question 24

Treatment of Extrophy of the Bladder:

Answer 24

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.

Question 25

Pre op for Exstrophy of the Bladder:

Answer 25

Protect bladder/skin (prevent excoriation)
diapers under infant-urine seeps from bladder; position baby on back or side
hydrate and prevent constipation.

Question 26

Post Op for Exstrophy of the Bladder:

Answer 26

Hydrate and prevent constipation
monitor for bleeding and infection
assess urinary output
consider psychosocial needs

Question 27

Nursing Care for Exstrophy:

Answer 27

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

Question 28

Nursing diagnoses for Extrophy of Bladder:

Answer 28

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

Question 29

Psychosocial concerns of Exstrophy of bladder:

Answer 29

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.