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Pediatric Elimination Disorders

Pediatric Elimination Disorders. NPN 200 Medical Surgical I. 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 .

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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

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