Hypospadias and Epispadias; Nursing Assessment, Diagnosis, and Interventions for Hypospadias and Epispadias; and 4 Nursing Care Plan Examples for Hypospadias and Epispadias.

Hypospadias and Epispadias; Nursing Assessment, Diagnosis, and Interventions for Hypospadias and Epispadias; and 4 Nursing Care Plan Examples for Hypospadias and Epispadias.

This study guide is about hypospadias and epispadias; nursing assessment, diagnosis, and interventions for hypospadias and epispadias; and 4 nursing care plan examples for hypospadias and epispadias. It can be used to create educational nursing care plans.

Hypospadias and Epispadias

What is hypospadias and epispadias? 

Hypospadias and Epispadias; Nursing Assessment, Diagnosis, and Interventions for Hypospadias and Epispadias; and 4 Nursing Care Plan Examples for Hypospadias and Epispadias.
Hypospadias and Epispadias in Females

The earliest medical text describing hypospadias dates back to the second century CE and was the work of Galen, the first to use the term.

  • Hypospadias is an abnormality of anterior urethral and penile development in which the urethral opening is ectopically located on the ventral aspect of the penis proximal to the tip of the glans penis, which, in this condition, is splayed open.
  • Epispadias is a rare congenital malformation of the male or female urogenital apparatus that consists of a defect of the dorsal wall of the urethra.

What is the pathophysiology of hypospadias and epispadias?

The pathophysiology of hypospadias and epispadias occur as follows:

https://www.youtube.com/watch?v=g0pqwWzZ6gM

  1. Hypospadias is a congenital defect that is thought to occur embryologically during urethral development, between 8 and 20 weeks’ gestation.
  2. The external genital structures are identical in males and females until 8 weeks’ gestation; the genitals develop a masculine phenotype in males primarily under the influence of testosterone.
  3. The classic theory is that the urethral folds coalesce in the midline from base to tip, forming a tubularized penile urethra and median scrotal raphe.
  4. The anterior or glanular urethra is thought to develop in a proximal direction, with an ectodermal core forming at the tip of the glans penis, which canalizes to join with the more proximal urethra at the level of the corona.
  5. The prepuce normally forms as a ridge of skin from the corona that grows circumferentially, fusing with the glans.
  6. Failure of fusion of the urethral folds in hypospadias impedes this process, and a dorsal hooded prepuce results.
  7. In males, epispadias causes impotentia coeundi, which results from the dorsal curvature of the penile shaft, and impotentia generandi, which results from the incomplete urethra.
  8. Also reported are frequent ascending infections to the prostate or bladder and kidneys and psychological problems related to the deformity.
  9. If epispadias is distal to the bladder neck, urinary continence may not be present.

What is the incidence of hypospadias and epispadias?

Hypospadias and epispadias occur across the world and may go untreated and neglected.

  • Hypospadias occurs in approximately 1 in every 250 male births in the United States.
  • In general, the frequency seems rather constant, at 0.26 per 1000 live births in Mexico and Scandinavia and 2.11 per 1000 live births in Hungary.
  • The incidence of hypospadias is higher in whites than in blacks, and the condition is more common in those of Jewish and Italian descent.
  • Epispadias occurs more commonly in males than in females, with a prevalence of 1 case in 10,000-50,000 persons; the male-to-female ratio is 2.3:1.

What are the causes hypospadias and epispadias?

Several etiologies for hypospadias have been suggested, including genetic, endocrine, and environmental factors.

  • Genetic. A genetic predisposition has been suggested by the eightfold increase in incidence of hypospadias among monozygotic twins as compared with singletons.
  • Endocrine. A decrease in available androgen or an inability to use available androgen appropriately may result in hypospadias.
  • Environmental. Endocrine disruption by environmental agents is gaining popularity as a possible etiology for hypospadias and as an explanation for its increasing incidence.

Unlike hypospadias, epispadias can be explained by:

  • Defective migration. There is a defective migration of the paired primordia of the genital tubercle that fuse on the midline to form the genital tubercle at the fifth week of embryologic development.
  • Abnormal development. Another hypothesis relates the defect to the abnormal development of the cloacal membrane.

What are the clinical manifestations of hypospadias and epispadias?

Physical examination of the child with hypospadias reveal the following:

  • Dorsal hood. A dorsal hood of foreskin and glanular groove are evident, but upon closer inspection, the prepuce is incomplete ventrally and the urethral meatus is noted in a proximally ectopic position.
  • Chordee. Chordee may be readily apparent or may be discernible only during erection.

Physical examination of the child with epispadias reveal the following:

  • Mucosal strip. The normal urethra is replaced by a broad mucosal strip lying on the dorsum of the corpora cavernosa; the meatus is divided dorsally between the tip of the glans and the pubis, the penile shaft is curved dorsally with the absence of the preputial apron, and a cleft is present on the upper surface of the penis
Hypospadias and Epispadias; Nursing Assessment, Diagnosis, and Interventions for Hypospadias and Epispadias; and 4 Nursing Care Plan Examples for Hypospadias and Epispadias.
Hypospadias and Epispadias in Males

Nursing Assessment, Diagnosis, and Interventions for Hypospadias and Epispadias

How do you assess for hypospadias and epispadias?

Assessment of a child with hypospadias or epispadias include the following:

  • History. Obtain a thorough history and physical examination, including any history of a familial pattern of hypospadias, any past medical history or comorbidity, and a physical assessment focusing on the meatal location, glans configuration, skin coverage, and chordee.
  • Physical examination. Although the diagnosis of hypospadias has been made with both antenatal fetal ultrasonography and magnetic resonance imaging (MRI), the diagnosis is generally made upon examination of the newborn infant.

How is hypospadias and epispadias diagnosed?

Hypospadias and epispadias are diagnosed mainly through physical examination. Upper urinary tract anomalies are rarely associated with hypospadias and do not justify routine imaging in these patients unless other organ system anomalies are present.

What are the Nursing Interventions for hypospadias and epispadias?

Nursing interventions for the child are:

  • Relief from pain. Encourage use of relaxation techniques; apply ice compress as indicated; and educate parents that medications will prevent pain and restlessness and allow for healing.
  • Improve urinary elimination. Encourage high fluid intake after catheter removed, offer favored choice of liquids hourly; and instruct parents to notify the physician of changes in the urinary pattern or inability to void.
  • Lessen anxiety. Encourage verbalization of concerns and allow time for parents and child to ask questions about condition, procedures, recovery; Answer questions calmly and honestly; use pictures, drawings, and models for information; and reassure parents and child that defect or surgery will not compromise sexual the activity and will not affect reproductive ability.
  • Prevent infection. Obtain urine specimen for culture and sensitivities as indicated; inform parents to avoid allowing the child to straddle toys, play in a sandbox, swim, or engage in rough activities until advised by the physician; and apply sterile technique during dressing changes, catheter care or draining urine bag.

Evaluation

Goals are met as evidenced by:

  • Child will experience decreased pain as evidenced by infrequent crying episodes and exhibit normal sleeping pattern.
  • Child will experience improved urinary elimination.
  • Parent will experience less anxiety.
  • Child will remain free from infection as evidenced by clean and intact wound without redness, edema, odor or drainage and negative urine culture.

Documentation Guidelines

Documentation in a patient with hypospadias and epispadias include:

  • Client’s description of response to pain.
  • Acceptable level of pain.
  • Current antibiotic therapy.
  • Plan of care.
  • Teaching plan.
  • Response to interventions, teaching, and actions performed.
  • Attainment or progress towards desired outcomes.
  • Modifications to plan of care.

4 Nursing Care Plan Examples for Hypospadias and Epispadias

What are some of the available nursing care plans for hypospadias and epispadias?

Hypospadias and Epispadias; Nursing Assessment, Diagnosis, and Interventions for Hypospadias and Epispadias; and 4 Nursing Care Plan Examples for Hypospadias and Epispadias.
4 Nursing Care Plan Examples for Hypospadias and Epispadias

Major nursing care plan objectives for the child with hypospadias or epispadias include improving the child’s physical appearance, ensuring a positive body image, providing relief of pain and discomfort, decreasing parental anxiety, and absence of complications (bleeding, infection, catheter obstruction and sexual dysfunction).

  1. Acute Pain
  2. Impaired Urinary Elimination
  3. Anxiety
  4. Risk for Infection

Nursing Diagnosis

  • Acute Pain

May be related to

  • Surgery

Possibly evidenced by

  • Verbalization of pain
  • Crying
  • Irritability, restlessness
  • Distractive behavior
  • Changes in vital signs

Desired Outcomes

  • Child will experience decreased pain as evidenced by infrequent crying episodes and exhibit normal sleeping pattern.
Nursing Interventions Rationale
Assess location, characteristics, onset, duration, frequency, location, and severity of pain; Observe for verbal and nonverbal cues. Provides data about the description of pain which can be used as a guideline for analgesic therapy.
Maintain a position of comfort; Properly set the catheter to avoid tension and kinking. Promotes comfort and avoids pain due to pulling on or manipulating catheter.
Encourage use of relaxation techniques. Promotes rest and refocus attention thus decreases discomfort.
Apply ice compress as indicated. Relieves pain and decreases edema.
Administer analgesic (e.g., Tylenol) as ordered. Lessens pain and promotes rest which reduces stimuli and pain.
Educate parents that medications will prevent pain and restlessness and allow for healing. Provides information about the need for pain medications for child’s comfort.

Nursing Diagnosis

  • Impaired Urinary Elimination

May be related to

  • Mechanical trauma from surgery (urethroplasty)

Possibly evidenced by

  • Bladder spasms
  • Dysuria
  • Urinary frequency, urgency, retention
  • Decreased urine output
  • Urethral edema

Desired Outcomes

  • Child will experience improved urinary elimination.
Nursing Interventions Rationale
Record input and output; Assess voiding stream, color and amount of urine on first flow of urine and each succeeding void. Provides data on voiding pattern after clamping or removal of the catheter.
Assess for pain, abdominal distention, inability to void for 8 hours after catheter. Indicates urinary dysfunction and possible obstruction or continuing edema of the meatus.
Encourage high fluid intake after catheter removed, offer favored choice of liquids hourly. Maintain hydration and free flowing of urine.
Support child after the catheter is removed and provide privacy for voiding. Avoids embarrassment on the part of an older child.
Instruct parents to notify the physician of changes in the urinary pattern or inability to void. Allows for early intervention to avoid further complications.

Nursing Diagnosis

  • Anxiety

May be related to

  • Threat to self-concept
  • Change in health status
  • Change in environment

Possibly evidenced by

  • Expressed apprehension and concern about correction of defect by surgery and the imperfect appearance of the penis following surgery
  • Preoperative and postoperative care

Desired Outcomes

  • Parent will experience less anxiety.
Nursing Interventions Rationale
Assess source and level of anxiety and
need for information that will relieve anxiety.
Provides information about anxiety level and need to relieve it; concerns include the type of procedure and appearance of penis after surgery; whether the penis will be sexually adequate; possibility that
correction may need to be done in stages if the child is old enough; fear of castration and change in body image.
Encourage verbalization of concerns and allow time for parents and child to ask
questions about condition, procedures, recovery.
Provides an opportunity to vent feelings and fears and secure environment.
Encourage parents to stay with the child
during hospitalizations and to assist in care.
Allows parents to participate in the care of the child and continue the parental role.
Provide parents an opportunity to make decisions on care and common routines. Allows for control over situations and maintains familiar routines for care.
Answer questions calmly and honestly;
use pictures, drawings, and models for information.
Promotes better understanding, trust and a calm, supportive environment.
Inform parents regarding the type, and purpose of surgery, the appearance of the penis post op and cosmetic results to expect; inform older child that penis will not be cut off and that procedure is not a form of punishment. Provides rationale for surgery which includes voiding in a standing position with the ability to direct stream, improve the appearance of the penis and preserve self-image, and to develop a sexually adequate penis.
Inform parents of cause of defect, and
extent of defect to be corrected,
whether a mild defect or severe defect, that correction is best done between 3 to 9 months, placement of meatus on the penis, and the possible number of procedures necessary to correct defect.
Provides information that will enhance understanding of the defect to relieve anxiety.
Teach parents about postoperative care
(indwelling meatal or suprapubic
catheter or stents will be in place;
restraints maybe in place; medications will be administered to control pain and promote sedation.
Provides information about postoperative care and what to expect following surgery.
Teach parents relaxation techniques. Decreases anxiety and promotes ability to provide calm and parental care.
Reassure parents and child that defect or surgery will not compromise sexual the activity and will not affect reproductive ability. Relieves anxiety produced by fear caused by misinformation.

Risk for Infection

Nursing Diagnosis

  • Risk for Infection

May be related to

  • Inadequate primary defenses (surgical incision)
  • Invasive procedure (catheter)

Possibly evidenced by

  • [not applicable]

Desired Outcomes

  • Child will remain free from infection as evidenced by clean and intact wound without redness, edema, odor or drainage and negative urine culture.
Nursing Interventions Rationale
Assess wound for redness, swelling,
drainage on dressing.
Provides information on the presence of infection or impaired healing.
Observe catheter insertion site for
redness, irritation, swelling; Monitor urine in the catheter bag for cloudiness, foul odor, sediment.
Indicates infectious process at catheter site or in the urinary bladder.
Obtain urine specimen for culture
and sensitivities as indicated.
Determines the specific organism and sensitivity to the antibiotic.
Note urinary output of at least 1 ml/
kg/hr and report if less.
Indicates that catheter obstruction may be present with urinary retention which results in infection.
Encourage to increase fluid intake
according to age needs.
Promotes dilution of urine to prevent urinary infection and after catheter removed will encourage voiding.
Apply sterile technique during dressing changes, catheter care or draining urine bag. Prevents contamination by introducing organisms into sterile wound or cavity.
Maintain catheter and collection bag
below level of the bladder and a closed
drainage system free of kinks in the tubing then maintain catheter and collection bag—marked in red.
Provides information that will enhance understanding of the defect to relieve anxiety.
Reinforce dressing as needed, and secure catheter to penis with dressing and tape, and to leg or abdomen with tape. Promotes comfort and prevents infection and catheter displacement.
Immobilize arms and legs with restraints, remove periodically; use a bed cradle following surgery. Prevents accidental removal of catheter or contamination of wound if surgical correction is done for a more severe defect.
Inform parents to avoid allowing the child
to straddle toys, play in a sandbox, swim, or engage in rough activities until advised by the physician.
Prevents trauma to or dislodging of catheter or infection.
Teach parents to sponge bathe the child and use loose-fitting clothing, disallowing the contact of feces with the wound, and instruct in cleansing after each bowel elimination. Promotes cleanliness and comfort without constriction.
Educate parents in signs and symptoms of infection. Provides information about the need to report immediately for early management.
Teach parents on catheter care,
irrigation, emptying of urine bag or using a diaper for urine drainage, securing the catheter with a tape; provide a time for return demonstration.
Provides knowledge and skill in caring and maintaining patency for catheter as child may go home with a catheter or stent in place.

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