Hypospadias and epispadias are congenital anomalies of the penis that result in the incomplete development of the anterior urethra. In hypospadias, the urethral opening is located along the underside of the penis, near the tip. In epispadias, the urethral opening is on the upper surface (dorsum) of the penis.
The incidence of this defect in the United States is approximately 3.2 in 1,000 live male births or about 1 in every 300 male children. The cause of this defect is unknown but is associated with genetics, low birth weights, and by race/ethnic background (more common in whites, Italians, and Jews). Chordee, an abnormal curvature of the penis, is usually linked with hypospadias. Other associated anomalies include undescended testes, an inguinal hernia, and Wilms tumor.
The goal of treatment of this anomaly is to reconstruct a straight penis with a meatus close to the normal anatomic location. Usually, the surgical repair is recommended to be done in the early year of life to prevent psychological trauma. Currently, the recommended age for urethroplasty (hypospadias/epispadias repair) is between 3 to 12 months of age and for orthoplasty (chordee repair) is during the first year of the child.
Nursing Care Plans
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).
Here are four (4) nursing care plans (NCP) and nursing diagnosis (NDx) for hypospadias and epispadias:
Acute Pain
Nursing Diagnosis
May be related to
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. |
See Also
You may also like the following posts and care plans:
- Nursing Care Plan: The Ultimate Guide and Database – the ultimate database of nursing care plans for different diseases and conditions! Get the complete list!
- Nursing Diagnosis: The Complete Guide and List – archive of different nursing diagnoses with their definition, related factors, goals and nursing interventions with rationale.
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