A SURGICAL REVIEW ON

RELEASE OF CHORDEE; REPAIR OF HYPOSPADIAS

By: April Dianne N. Castillo, RN, ORNT Batch 5 - Year 2009

Patients Data
Name: Name: Baby Zeke Age/Gender: Age/Gender: 2-year old/Male Birth Date/Place: October 15, 2007 @ Kidapawan Date/Place: City Birth Weight: 3.6 kilograms Address: Address: Country Homes Subdivision, Cabantian, Cabantian, Davao City Religion: Religion: Roman Catholic Mothers Age: 26 yrs. old Age: Occupation: Housewife Occupation: Fathers Age: 26 yrs. old Age: Occupation: Cadet/3D Operator SocioSocio-economic Status: Average

Patients Clinical History

Complaint: Abnormal urethral opening Since birth patient has abnormal urethral opening; opening; sought consultation at Kidapawan Doctors Hospital; referred to DMC; advised to Hospital; undergo an elective surgery thus admitted. GUT Assessment: (+) urethral opening at distal shaft, shaft, ventral aspect of chordee Admission Date: January 15, 2010 @ 10:15 am Admitting Diagnosis: Hypospadias with Chordee

Laboratory Findings
Hematology Lymphocytes Leukocytes 0.44 (0.25-0.35) (0.2515.1 (5-10) (5-10)

Blood Chemistry Creatinine 30 umol/L (53-115) umol/L (53-115) Urinalysis Microscopic: WBC/hpf Microscopic: WBC/hpf is 0-1 (LSA) Mucous Threads (+)

Anatomy and Physiology

The Male Reproductive System

The Penis

The normal male urethral opening is at the tip or end of the penis. penis.

Pathophysiology
Etiology: Etiology: Unknown Possible: low birth weight, twin or triplet pregnancies, maternal use of iron supplements, maternal smoking, paternal exposure to pesticides (Genetic Predisposition, Placental Insufficiency, Substances that interfere with natural hormones) 5th Fetal Week Penis begins to form (Testosterone) fusion of urethral folds stops (interrupted) proximal to the tip of glans penis

shortening of urethral groove/ventral skin ventral tethering of the penis Chordee Chordee alters the position of the meatus (urethral opening) Classifications: Glanular Coronal Midpenile/ Midpenile/Midshaft Penoscrotal/Scrotal Penoscrotal/Scrotal Perineal

Signs & Symptoms

- Opening of the urethra below or at the bottom side of the penis - Abnormal appearance of the glans penis (the tip) - Incomplete foreskin in which the foreskin extends only around the top of the penis - Curvature of the penis during an erection - Buried penis or Hidden Penis - Abnormal position of scrotum with respect to penis Prognosis: Good

Definition of Terms
Chordee ventral curvature of the penis, most apparent on erection d/t congenital shortness of the ventral skin and can occur with or without a hypospadias

Hypospadias a birth defect found in boys in which the urethral opening is not at the tip of the penis; occurs in about 1 in 100 to 1 in 200 boys; a boy with hypospadias has a 20% chance of finding this in another family member such as father or a brother; with different degrees, some minor and others more severe.

Nursing Interventions
PrePre-operative  Pre-operative visit/checklist Pre Case Classification: Clean  Patient Identification  Chart Reviewed/Pre-operative Orders checked Reviewed/PreNPO Strategy: 8 hours PTOR solid food (12 midnight) 6 hours PTOR formula milk (2am) 4 hours PTOR human milk (4am) 2 hours PTOR clear fluid (6am) IVF of D5IMB 500cc to run @ 50cc/hour

 Medications: Paracetamol/Ranitidine/Cefuroxime Paracetamol/Ranitidine/Cefuroxime  Vital signs: PR 145 bpm SPO2 98% RR 18 cpm

 Position prior to induction: Supine  Anesthesiologists: Dr. Mastura & Dr. Julices F. Anesthesiologists: Laforteza Type of Anesthesia: General Endotracheal Tube Anesthesia: Anesthesia (GETA) (GETA) Anesthetic: Anesthetic: Sevoflurane (O2) or fluoromethyl hexafluoroisopropyl ether

Time of Induction: 9:07am Time of Intubation: 9:12am

Skin Preparation

IntraIntra-operative  Time Started: 9:35am  Operative Technique: Induction by GA Asepsis/Antisepsis/Draping done Coronal penile incision proximal to glans penis Penile skin degloved Chordee excised Erection test done Using penile skin, ventral and proximal were tubularized (Fr. 8 Feeding tube) and laid over distal penile shaft passing through glans; tube glans; was attached to sterile urobag Repair of skin by chromic 4-0 4-

Vuala!!! Vuala!!!

 Other Medications given: Atropine Sulfate anticholinergic Succinylcholine muscle relaxant  Sponges & Instruments

 Needles/Sutures used Mersilk 3-0 (W570) atraumatic Vicryl 6-0 (W9552) Catgut/Chromic 4-0 (HR22) (HR22)  Time Ended: 11:00am PostPost-operative  Cleaning and dressing done  Kept warm and thermoregulated  Time Extubated: 11:07am Extubated:  VS prior to transport to PACU: RR: RR: 23 cpm PR: 139 bpm PR: SPO2: 99%  Out of room: 11:25am

Discharge Planning
Medications Advise mother to follow all the prescribed medications Exercise Once at home, he does not have to stay in bed, but he needs to be watched closely; may walk and play quietly; may not use straddle toys, walkers, or bicycles until permitted by his doctor Treatment Apply bacitracin ointment gently on the tip of the penis 4 to 6 times a day to soothe the area and help prevent infection and crusting. Health Teaching Always do proper hand washing/proper hygiene; Avoid strenuous activities that would lead to bleeding; Have adequate rest & sleep

Out-Patient Always have a regular check up at least utonce a week to monitor the progress of the treatment; Report immediately to the physician if theres unusual ties occur. Follow up appointment in clinic. Diet Advice mother to give her son fruit juice, soups and crackers to help prevent stomach upset; important, drinking plenty of fluids; foods high in fiber, such as cereal or fruits to prevent constipation. Spiritual Pray for the guidance of the Lord. Spiritual health affects the wellness of an individual greatly. Strengthen relationship with Lord by showing love and respect to the people around you.

Common Suffixes in Surgery

Ectomy removal of an organ or a gland Rrhaphy repair Ostomy providing an opening (stoma) Otomy cutting into Plasty formation or plastic repair Scopy looking into

Constant attention by a good

nurse may be just as important as a major operation by a surgeon

Thank you!!!