4 Hypospadias and Epispadias Nursing Care Plans

February 5, 2018

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

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

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.