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Circumcision

Circumcision

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Published by: Dennis Nabor Muñoz, RN,RM on Jun 23, 2010
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01/26/2013

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CIRCUMCISION
Circumcision is a surgical procedure in which the prepuce (foreskin) of the penis isseparated from the glans, and a portion is excised. This elective procedure is performed in theUnited States based on parental choice for reasons related to hygiene, religion, tradition, socialnorms, and culture. It is usually performed at 12–24 hr of age or when the infant is consideredphysically stable. Frequency of this procedure has declined in recent years to approximately62%.
NEONATAL ASSESSMENT DATA BASECirculation
Vital signs WNL, no signs of cold stressAdministration of vitamin
Food/Fluid
Weight at least 2500 g (5 lb 8 oz)
Safety
 Temperature WNLFree of congenital anomalies; no family history of bleeding disorders or history of “proud flesh”scar formation (especially in black families)
Sexuality
Infant full-term (based on Dubowitz criteria)Genitalia normal, with no evidence of hypospadias or epispadias; testes descended, andscrotal sac free of hydrocele; prepuce, still developing at birth, normally nonretractable
DIAGNOSTIC STUDIES
CBC:
Rules out presence of anemia.
Clotting Studies:
Identify coagulation problems.
NURSING PRIORITIES
1.Provide parents with sufficient information to make an informed choice.2.Promote comfort and healing.3.Identify and minimize postoperative complications.4.Instruct parent(s) in proper care of circumcised infant.
DISCHARGE CRITERIA
1.Void appropriately past procedure.2.Free of complications.3.Parent(s) understand care needs and signs/symptoms requiring further evaluation.
NURSING DIAGNOSIS:KNOWLEDGE deficit [Learning Need], regardingsurgical procedure, prognosis,and treatmentMay Be Related To:
Lack of exposure, misinterpretation, unfamiliarity withinformation resources
Possibly Evidenced By:
Request for information, verbalization of concerns/misconceptions, inaccurate follow-through of instructions
 
DESIRED OUTCOMES/EVALUATION
Make informed decision.
CRITERIA—PARENT(S) WILL:
Demonstrate proper technique of care followingprocedure.Verbalize understanding of signs of complications.
ACTIONS/INTERVENTIONSRATIONALEIndependent
Ascertain parents’ understanding of the Provides a basis for discussion and identifies needprocedure. Determine cultural/religious influences.for further information. While cultural/religiousbeliefs may dictate circumcision be performed, somestudies have shown that many women do not knowthe meaning of the word or whether their husbandsare circumcised.Review information about the advantages and The routine practice of circumcision has beendisadvantages of circumcision.questioned, and the position of the AmericanAcademy of Pediatrics (1989) is that there are bothpotential medical benefits and advantages as well asdisadvantages and risks. Proponents believe thatcircumcision may reduce risk of cancer of the penisand prostate in men and of the cervix in women; that ithas prophylactic effects against a number of diseases,including herpes; that it facilitates hygiene; and that anuncircumcised boy may feel different from his peers.Opponents believe that the cancer link is not provedby scientific studies and that hygiene is more of afactor in cancer prevention than is circumcision; thatthe long-term effects of pain and stress are not known;and that complications are a significant concern.Discuss anticipated infant behaviors following Changes in sleep patterns, fussiness, and/orprocedure.refusal of feedings usually persist for 23 hrfollowing procedure. However, studies indicate thatelevated cortisol levels associated with stress of theprocedure can interfere with the newborn’s ability toregulate sleep-wake cycles for some time followingcircumcision.Note any special requests made by parents.Parents may want to be present during the procedureor may have specific religious or cultural preferences.Provide information about the healing process Prevents complications associated with infection;and proper care (e.g., cleaning, diapering, promotes infant’s comfort. Refer to ND: Painpositioning, use of petroleum gauze dressing or [acute]. Note: If plastic bell method is used tobacterial ointment). Discuss the need to check cover the glans, petroleum gauze is not needed.infant frequently to prevent gauze from dryingout and sticking to site of circumcision. Suggestsoaking gauze with warm, sterile water beforeremoving it.
 
Discuss potential complications, e.g., hemorrhage, Ensures prompt identifications and treatment of infection, or other signs warranting notification of problems.healthcare provider.
NURSING DIAGNOSIS:PAIN [acute]May Be Related To:
 Trauma to/edema of tender tissues
Possibly Evidenced By:
Crying, irritability, changes in sleep pattern, refusal toeat
DESIRED OUTCOMES/EVALUATION
Appear relaxed, appropriately consolable.
CRITERIA—NEONATE WILL:
Resume normal sleeping and eating patterns.
ACTIONS/INTERVENTIONSRATIONALEIndependent
Provide pacifier (dipped in sugar, if desired), Provides distraction and sense of reassurance tostroke lightly, and talk gently to infant soothe the infant.during procedure. Observe infant response.Remove infant from restraints immediately A sense of uneasiness occurs because of following procedure. Calm infant by holding, positioning and restraint. Acute pain occurs at thecuddling, dressing, and talking to him. time of surgical procedure, because the foreskinEncourage parents to feed and cuddle infant.contains numerous nerve endings. Change oposition, freedom of movement, and tactile activitiesrefocus infant’s attention and comfort infant. Feedingmay promote relaxation. Note: Infant’s turning headaway, increased restlessness, hiccuping suggestoverstimulation, which may further distress theinfant.Apply petroleum jelly and gauze dressing loosely Protects against adherence to diaper and directaround glans, as appropriate. Leave in place for contact with urine.at least 24 hr.Position infant on side or back, not on abdomen. Prevents friction or pressure on the penis. PlasticLoose diaper or use no diaper at all for 24–72 hr rim remains in place for 5–7 days. Plastic bell fallsfollowing procedure. Note continued placement off by itself when glans is healed. Note: Removalof plastic rim following circumcision with plastic of the bell by the healthcare provider may bebell.required.Avoid use of soaps on penis; clean with clear water.Soap may cause irritation, increasing discomfort, andmay cause plastic bell to fall off prematurely.Protect the surgical site from alcohol when caring Alcohol may cause stinging, adding to infant’sfor umbilicus.discomfort.

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