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INTRODUCTION
The study focuses on the actual case of a 4 year old boy with hypospadias. In line with this, the group aims to identify and analyze the occurrence, the signs and symptoms, as well as its etiologic and pathologic factors and the diagnostics and interventions needed for this kind of condition. Hypospadias is a birth defect of the urethra in the male that involves an abnormally placed urinary meatus (the opening, or male external urethral orifice). Instead of opening at the tip of the glans of the penis, a hypospadic urethra opens anywhere along a line running from the tip along the of the shaft to the junction of the penis and scrotum or perineum
INTRODUCTION cont.
A distal hypospadias may be suspected even in an uncircumcised boy from an abnormally formed foreskin and downward tilt of the glans. Hypospadias repair is, however, controversial because it is genital surgery. Some people regard it as unnecessary interference with a child's body and a traumatic experience with psychological consequences extending into adult life. Others maintain that boys with untreated hypospadias are far more likely than those who have had surgery to develop fears about intimate relationships and sexuality.
INTRODUCTION cont.
Hypospadias is one of the most common birth defects of the male genitalia but widely varying incidences have been reported from different countries, from as low as 1 in 4000 to as high as 1 in 125 boys. The incidence of hypospadias around the world has been increasing in recent decades. Two surveillance studies reported that the incidence had increased from about 1 in 500 total births (1 in 250 boys) in the 1970s to 1 in 250 total births (1 in 125 boys) in the 1990s. Although a slight worldwide increase in hypospadias was reported in the 1980 - 2005, studies in different countries and regions have yielded conflicting results and some registries have reported decreases. The availability and cooperation of the client and its relatives help us come up choosing the case.
OBJECTIVES
To describe the congenital defect process of hypospadias. To illustrate the pathophysiology of hypospadias. To determine the importance of the treatment and management of the congenital defect. To formulate specific and appropriate nursing care plan. To evaluate the effectiveness of the interventions and detect any progress of the clients condition.
I.
Personal Data
Name: Patient X Age: 4 years old Birthday: March 31, 2007 Religion: Roman Catholic Weight: 23kg Date of Admission: July 13, 2011 Diagnosis: Hypospadias Operation: Repair of Hypospadias; Circumcision, Urethroplasty and Glanuloplasty Date of Operation: July 14, 2011 Date of Discharge: July 18, 2011 Source of Data: Mother
II.
Chief Complaint: Abnormal Urination When the child was at 4 months of age, his mother noticed an abnormal direction of the urine every time he void. The mother seeks for medical assistance and immediately went to Jose R. Reyes Memorial Medical Center; the physician explained the condition and advised to comeback after 3 years for surgery.
Hypertension Asthma
FATHER X
MOTHER O
Patient
2ND
V.
According to the mother, the patient has initiative to study, eat, play and the like. The mother verbalized mahilig yan maglaro, madami syang friends. The parents are aware of the abnormal location of urethral orifice of their child thus, the patient has regular micturation.
Date Assessed: July 19, 2011 Time: 10:00 AM General Survey: The patient is post operative, conscious and afebrile. PR: 98 RR: 28 T: 36.4
A.
Physical Assessment
Normal Findings Equally distributed Actual Findings Equally distributed Thick, silky and resilient hair White sclera, no White sclera, no discharge, lids close symmetrically, pupil Eyes constricts when illuminated, both eyes move in unison Symmetrical, pinna Ears recoils after it is folded, No aural discharges, Symmetrical, pinna recoils after it is folded, No discharges, Within normal range discharge, lids close symmetrically, pupil constricts when illuminated, both eyes move in unison Within normal range Interpretation Within normal range
Category
Head
A.
Nose
Physical Assessment
Symmetric and straight, no nasal discharges Uniform pink color Uniform pink color lips, Uniform pink color lips, Within normal range Symmetric and straight, Within normal range
Mouth
moist mucous membrane Muscles equal in size; head centered; no neck vein
moist mucous membrane Muscles equal in size; head centered; no neck vein engorgement, No palpable lymph nodes Within normal range
Neck
Skin
A.
Physical Assessment
Intact, With suprapubic tube cystoscopy on hypogastric region Urethral meatus is Surgical incision site
No enlargement or tenderness,
Size is relative to body penile Genital size, Urethral meatus positioned at the tip of the penis Various to some degree with the Extremities person s physical activity, Intact With IV catheter on the left hand With urethra stent in the Hypospadias
IV fluid replacement
B.
Developmental Theory
tube cystoscopy, with filler at Analysis: Stage 3 - Initiative vs. Guilt Children who are successful at this stage feel the urethra.) capable and able to lead others. Those who fail to acquire these skills are left with a sense of guilt, self-doubt and lack of initiative. Reference: http://psychology.about.com/od/psychosocialt heories/a/psychosocial_2.htm
B.
Developmental Theory
B.
Developmental Theory
Nagpapakitang gilas
B.
Developmental Theory
Masunurin
kasi takot yan sa tatay nya. there s a procedure to Analysis: The first level of moral thinking is that generally Disiplinado kasi yun . be done. found at the elementary school level. In the first stage of this level, people behave according to socially acceptable norms because they are told to do so by some authority figure (e.g., parent or teacher). This obedience is compelled by the threat or application of punishment. Reference: http://www.csudh.edu/dearhabermas/kohlberg01bk.htm
VIII. Pathophysiology:
HYPOSPADIAS
The term, hypospadias, means under [hypo] the rent [spadon]. Hypospadias can occur anywhere along the urethral groove. In mild forms, the urethra opens just under the corona glandis. This is called coronal hypospadias
Types:
Pathophysiology:
Increased Maternal Age Cause is unknown Family History
Penis
The genitals develop a masculine phenotype primarily under the testosterone As the phallus grow, the open urethral groove extends from its base to the level of the corona
Urethral opening
Penile/Coronal
HYPOSPADIAS
Repair of Hypospadias
Generic name: 156mg/5ml 5ml Co-amoxiclav BID Brand name: Per Natravox
Antibiotic
Hand washing before & Superficial after the procedure tooth discolorati Observe 10 Rights when on giving medication Nausea Watch out for any untoward reaction of the drug, if its occur intervene and refer it immediately Teaching points: Informed the parent or the significant other that tooth discoloration is expected but can be removed by brushing teeth.
Dosage/ Frequency
Classificatio n
Mechanism of Action
Indication
Contraindication
Side Effect
Nursing Responsibility
Antibacterial It blocks the activity of an Agent enzyme called isoleucyl-tRNA synthetase within the bacteria. This enzyme is necessary in order for the bacteria to make proteins. Without the ability to make proteins, the bacteria die.
Treatment for impetigo due to Staphylococ cus aureus and Streptococc us pyogenes.
o
Hand washing before & after the procedure Observe 10 Rights when giving medication Watch out for any untoward reaction of the drug, if its occur intervene it immediately Teaching points: Apply small/thin amount to affected area, may be covered with a gauze dressing Daily wound care
Dosage/ Frequency
Classification
Mechanism of Action
Indication
Contraindication
Side Effect
Nursing Responsibility
Generic 250 mg/5ml Acetaminoph name: 5ml every 6 en Paracetamol hours for Brand name: fever and Biogesic pain
Antipyretic: Reduces fever by acting directly on hypothalamic heat-regualating center to cause vasodilation and sweating which helps dissipate heat Analgesic
Hypersensitivity to Acetaminophen
Skin Rashes
Hand washing before & after the procedure Observe 10 Rights when giving medication Refer to physician for any untoward reaction of the drug.
X.
Assessment A risk diagnosis is not evidenced by signs and symptom, as the problem has not occurred and nursing interventions are directed at prevention. Objectives: Surgical Incision Site (suprapubic catheter & stent)
X.
Intervention y Stressed proper hand hygiene by all care givers between therapies and the client. y Changed surgical/ other wound dressing, as indicated, using proper technique for changing/ disposing of contaminated materials. y Monitored client s visitors/caregivers for respiratory illnesses. Offered masks and tissues to visitors who are coughing/sneezing. y Encouraged early ambulation and deep breathing exercises. y Emphasized necessities of taking antibiotics as ordered.
y y
For early mobilization Premature discontinuation of treatment when client begins to feel well may result in return of infection and potentiate drug resistant strains.
X.
ASSESSMENT Subjective: y Reported irritability at the surgical site Objectives: y Disruption of skin surface (suture)
X.
INTERVENTION y Observed for complications. y Kept the area clean and dry, carefully dressed wounds. y Used appropriate wound dressing. y Applied Mupirocin Ointment on the affected site as ordered.
EVALUATION After 5-7 days of nursing intervention, the patient s wound displayed timely healing without complication.
Exercise
Out-Patient Diet
Spiritual
THANK YOU!!!