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Pediatric Elimination Disorders

Pediatric Elimination Disorders

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Pediatric Elimination Disorders

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  1. Pediatric Elimination Disorders NPN 200 Medical Surgical I

  2. External Defects • Serious conditions because psychological effects • Surgical correction is usually successful and is carried out as early as possible • Major anomalies • Inguinal hernia • Hydrocele • Phimosis • Hypospadias • Epispadias

  3. Defects • Inguinal hernia • Protrusion of abdominal contents through the inguinal canal into the scrotum • Usually painless and repaired by surgery • Hydrocele • Fluid in the scrotum • May resolve spontaneous, but if not in 1 year will repair • Phimosis • Narrowing ot stenosis or the opening in the foreskin • May need circumcision if severe

  4. Defects, cont. • Hypospadias • Urethral opening located behind the glans penis or anywhere along the ventral surface of the penis • Repair allows child to void in the standing position and direct stream in usual manner • Improves physical appearance and produce a sexually adequate organ

  5. Defects, cont. • Epispadias • Meatal opening located on the dorsal surface of the penis • Correction involves penile and urethral lengthening and bladder neck reconstruction

  6. Defects, cont. • Cryptorchidism • Undescended testicles • Detected by inability to palpate testes • If older child may give human chorionic gonadotropin • Orchiopexy • Must prevent damage to testicles • Avoid trauma

  7. Defects, cont. • Nursing considerations • Child may develop a distorted body image • Usually , if accomplished between 6-15 months, may avoid problems • After surgery, the usual post-op care for pediatric client is performed

  8. Megacolon (Hirschsprung Disease) • Congential • Mechanical obstruction caused by inadequate motility of part of the intestines • Lack of nerve innervation to segments of colon • Accounts for ¼ of all neonatal obstructions • Can be acute, life threatening and fatal • Almost always includes the anus and rectum • Bowel becomes distended and ischemia can occur • Death may occur from enterocolitis (inflammation of the small bowel and colon) • Diagnosed by age and symptoms

  9. Megacolon (Hirschsprung Disease) • Management • Removal of diseased portion • Usually done in 2 stages – colostomy and then wait until child weighs 20 lbs and anastomose the colon together • May have anal stricture and incontinence post procedure • Nursing care • Assist parents • Diet management – low fiber, high calorie, high protein

  10. Anorectal Malformations • Imperforate anus • Encompasses many forms of malformation • No obvious anal opening • May have fistula from distal rectum to the perineum or GU system • Diagnosed at birth • Abdominal ultrasound further determines extent of problem • Treated with reconstruction if possible • Post-op care is challenging • Challenge for family to care for

  11. Pilonidal Sinus • Pilonidal sinus is a small tract under the skin between the buttocks and the sacrococcygeal area • Can communicate with the spinal tract • In an infant, may indicate spina bifida • May be covered by a tuft of hair • The area is moist and warm and the wiry hair can penetrate the skin and cause an infection, which is called a “pilonidal cyst or abscess” • Treatment of cyst • Incision and drainage • Warm moist compresses • Sitz baths • Antibiotics