Page 1092 - Saunders Comprehensive Review For NCLEX-RN

Circumcision may not be performed on a newborn with epispadias or

hypospadias. Although there are other surgical techniques used to repair these defects,
the pediatric surgeon may prefer using the foreskin for surgical reconstruction.
D. Postoperative interventions

1. The child has a pressure dressing and may

have some type of urinary diversion or a urinary stent
(used to maintain patency of the urethral opening)
while the meatus is healing.
2. Monitor vital signs.
3. Encourage fluid intake to maintain adequate urine
output and maintain patency of the stent if a stent
was placed.
4. Monitor intake and output and the urine for
cloudiness or a foul odor.
5. Notify the pediatric surgeon if there is no urinary
output for 1 hour, because this may indicate kinks in
the urinary diversion or stent or obstruction by
sediment.
6. Provide pain medication or medication to relieve
bladder spasms (anticholinergic) as prescribed.
7. Administer antibiotics as prescribed.
8. Instruct parents in the care of the child who has a
urinary diversion or stent.
9. Instruct parents to avoid giving the child a tub bath
until the stent, if present, is removed.
10. Instruct parents about fluid intake, medication
administration, signs and symptoms of infection, and
need for follow-up for dressing removal after surgery
as prescribed.
VIII. Bladder Exstrophy
A. Description
1. Bladder exstrophy is a congenital anomaly
characterized by extrusion of the urinary bladder to
the outside of the body through a defect in the lower
abdominal wall.
2. The cause is unknown; it is possibly a combination of
genetic and environmental risk factors during
pregnancy.
3. The condition can include specific defects of the
abdominal wall, bladder, genitals, pelvic bones,
rectum, and anus.
4. Children with bladder exstrophy will also experience
vesicoureteral reflux, in which urine flows back up
into the ureters to the kidneys; epispadias is also
noted.
5. These defects are treated through surgical procedures

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