Pediatric Elimination Disorders

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Pediatric Elimination Disorders

• NPN 200
• Medical Surgical I

2
External Defects

• Serious conditions because psychological effects
• Surgical correction is usually successful and is
  carried out as early as possible
• Major anomalies
• Inguinal hernia
• Hydrocele
• Phimosis
• Hypospadias
• Epispadias

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Defects

• Inguinal hernia
• Protrusion of abdominal contents through the
  inguinal canal into the scrotum
• Usually painless and repaired by surgery
• Hydrocele
• Fluid in the scrotum
• May resolve spontaneous, but if not in 1 year
  will repair
• Phimosis
• Narrowing ot stenosis or the opening in the
  foreskin
• May need circumcision if severe

4
Defects, cont.

• Hypospadias
• Urethral opening located behind the glans penis
  or anywhere along the ventral surface of the
  penis
• Repair allows child to void in the standing
  position and direct stream in usual manner
• Improves physical appearance and produce a
  sexually adequate organ

5
Defects, cont.

• Epispadias
• Meatal opening located on the dorsal surface of
  the penis
• Correction involves penile and urethral
  lengthening and bladder neck reconstruction

6
Defects, cont.

• Cryptorchidism
• Undescended testicles
• Detected by inability to palpate testes
• If older child may give human chorionic
  gonadotropin
• Orchiopexy
• Must prevent damage to testicles
• Avoid trauma

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Defects, cont.

• Nursing considerations
• Child may develop a distorted body image
• Usually , if accomplished between 6-15 months,
  may avoid problems
• After surgery, the usual post-op care for
  pediatric client is performed

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Megacolon (Hirschsprung Disease)

• Congential
• Mechanical obstruction caused by inadequate
  motility of part of the intestines
• Lack of nerve innervation to segments of colon
• Accounts for ¼ of all neonatal obstructions
• Can be acute, life threatening and fatal
• Almost always includes the anus and rectum
• Bowel becomes distended and ischemia can occur
• Death may occur from enterocolitis (inflammation
  of the small bowel and colon)
• Diagnosed by age and symptoms

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Megacolon (Hirschsprung Disease)

• Management
• Removal of diseased portion
• Usually done in 2 stages colostomy and then
  wait until child weighs 20 lbs and anastomose the
  colon together
• May have anal stricture and incontinence post
  procedure
• Nursing care
• Assist parents
• Diet management low fiber, high calorie, high
  protein

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Anorectal Malformations

• Imperforate anus
• Encompasses many forms of malformation
• No obvious anal opening
• May have fistula from distal rectum to the
  perineum or GU system
• Diagnosed at birth
• Abdominal ultrasound further determines extent of
  problem
• Treated with reconstruction if possible
• Post-op care is challenging
• Challenge for family to care for

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Pilonidal Sinus

• Pilonidal sinus is a small tract under the skin
  between the buttocks and the sacrococcygeal area
• Can communicate with the spinal tract
• In an infant, may indicate spina bifida
• May be covered by a tuft of hair
• The area is moist and warm and the wiry hair can
  penetrate the skin and cause an infection, which
  is called a pilonidal cyst or abscess
• Treatment of cyst
• Incision and drainage
• Warm moist compresses
• Sitz baths
• Antibiotics