hypospadias – Flashcards
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care of child after repair
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use the double diapering technique to protect the stent, don not bathe the child in the tub until the stent or catheter is removed, force fluids, antibiotics, signs of infection, urine will be blood tinged for several days, restrict the infant or toddler from activities, avoid holding infant straddled on the hip, limit activity for 2 weeks
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cryptorchidism
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undescended testicles
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pathophysiology
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failure of one or both testes to descend normally through the inguinal canal. ( sometimes will wait till school age to do surgery)
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diagnosis
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inability to palpate testes within scrotuim, US,
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management
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prevent damage to undescended testicle, decrease incidence of malignancy, prevent cosmetic and psychological disability. 75% will descend by age 1, may attempt descent by administration of HCG, orchiopexy between age 1and 3
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phimosis
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narrowing of stenosis of preputial opening of foreskin,
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mild cases ( phimosis )
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manual retraction of foreskin & proper cleansing.
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severe cases ( phimosis)
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circumcision, vertical division and transverse suturing of foreskin.
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chordee
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ventral curvature of the penis. often associated with hypospadiasis. sometimes referred to as cobra head penis. surgical release of fibrous band
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patent urachus
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fistula between bladder & umbilicus that forms as the result of the urachus to close late in embryonic life
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symptoms & management
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presence of patent urachus on sonogram, urine leaking from cord remnant. management - surgical closure in inmediate neonatal period via small umbilical incision
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hydrocele
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fluid filled mass that occurs when the process vaginalis fails to close at birth thus allowing peritoneal fluid to enter the scrotum. often associated with an inguinal hernia. often close & reabsorb by age 1. surgical repair.
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prune-belly syndrome (eagle-barett syndrome)
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congenital defect. failure of the abdominal musculature to develop. urinary tract anomalies: poor ureteral peristalsis, enlarged bladder, UTI, VUR, 30%end stage renal disease in children
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associated abnormalities prune belly
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respiratory: pulmonary hypoplasia-(under development of tissue organ or body) cardias: atrial septal defect, patent ductus arterious, tetralogy of fallot, ventricular septal defect. GI: malnutrition. musculoskeltal:club foot, congenital hip dysplasia, curvature of the spine.
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obstructive uropathy
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obstruction on the normal flow of urine. can occur at any level of the upper or lower urinary tract.
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pathophysiology uropathy
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structural or functional abnormalities that interfere with urine flow and if uncorrected result in hydronephrosis leading to: cessation of glomerulofiltration, metabolic acidosis, polydipsia % polyuria, urinary stasis favoring UTI, renal failure.
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vesicoureteral reflux (VUR)
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backflow of urine from the bladder into the kidneys. reservoir for bacterial growth. cause: incomplete development of the ureterovesicular junction, genetic componet.
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treatment of VUR
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surgery to reimplant the ureters. nursing care: iv at a higher rate than usual, monitor I and O, medications antibiotics and antispasmodics oxybutynin due to spasm. teaching: signs and symptoms of infections, high fiber diet, prophylactic antibiotics.
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hydronephrosis
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when pressure in the kidney pelvis equals the filtration pressure in the glomerular capillaries, glomerular filtration stops. - b/p increases, cell death. metabolic acidosis- distal nephrons unable to secrete H+ impairment of the kidney's ability to concentrate urine- polydysia and polyuria.
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hydronephrosis
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urinary stasis-growth of bacteria. obstructive nephropathy-chronic renal failure. 30% diagnosed in infancy develop end stage renal disease in childhood.
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nursing diagnosis for hydronephrosis
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impaired urinary elimination related to obstructive outflow, risk for infection related to urinary retention, parental anxiety related to infant's potential for progressive renal failure, acute pain related to surgical procedure.
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enuresis
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repeated involuntary voiding by a child old enough for bladder control to be expected.
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primary enuresis
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child has never had a dry night: attributed to maturational delay and small functional bladder; not associated with stress or psychiatric cause.
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intermittent enuresis
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child has occasional nights or periods of dryness
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secondary enuresis
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child begins bedwetting who has been reliably dry for 6 to 12 months; associated with stress, infections, and sleep disorders.
