Discuss edematous and erythematous penis in infants
Diagnosis and Management of Genitourinary Disorders, NURS6541 Case Study: Infant with edematous and erythematous penis
Diagnosis and Management of Genitourinary Disorders, NURS6541 Case Study: Infant with edematous and erythematous penis
Evaluation and Management of Renal and Genitourinary Disorders, NURS 6541 Week 9
NURS 6541: Primary Care of Adolescents and Children | Week 9
The care of genitourinary (GU) disorders can range from primary care diagnosis and treatment to referral for specialized care, making it essential for you to identify when a patient’s needs fall within your scope of practice. Consider Hannah, who received specialized treatment for a GU disorder. When Hannah was born, her bladder was misshapen and located outside of her body, requiring immediate surgery. Although the surgery was a success, she began to present with complications at age 2. As is common among children with her condition, bladder exstrophy, she suffered from frequent urinary tract infections (Miami Children’s Hospital, 2012). Although you might not treat bladder exstrophy as an advanced practice nurse, you must be able to treat resulting complications that present later in the patient’s life. In your role, you will care for pediatric patients with GU disorders, and like Hannah, some of these patients will have unique needs, requiring long-term treatment and management.
This week you explore genitourinary disorders in pediatric patients. You also examine differential diagnoses for these disorders, as well as the impact of patient culture on treatment, management, and education.
Learning Objectives – Evaluation and Management of Renal and Genitourinary Disorders, NURS 6541 Week 9 Case Study: Infant with edematous and erythematous penis
By the end of this week, students will:
- Analyze treatment and management plans for pediatric patients with genitourinary disorders
- Analyze strategies for educating patients and families on the treatment and management of genitourinary disorders
- Evaluate the impact of culture on the treatment and management of genitourinary disorders
- Understand and apply key terms, principles, and concepts related to genitourinary disorders in pediatric patients
- Evaluate diagnoses for pediatric patients
- Evaluate treatment and management plans
- Assess pediatric patients with signs of hematologic and metabolic disorders*
- Assess pediatric patients with signs of gastrointestinal disorders*
*These Learning Objectives support assignments that are due this week but were assigned in Weeks 8 and 9.
Discussion: Diagnosis and Management of Genitourinary Disorders, NURS6541
Many genitourinary (GU) disorders such as kidney disease begin developing during childhood and adolescence (Johns Hopkins Children’s Center, 2010). This early onset of disease makes it essential for you, as the advanced practice nurse caring for pediatric patients, to identify potential signs and symptoms. Although some pediatric GU disorders require long-term treatment and management, other disorders such as bedwetting or urinary tract infections are more common and frequently require only minor interventions. In your role with pediatric patients, you must evaluate symptoms and determine whether to treat patients or refer them for specialized care. For this Discussion, consider potential diagnoses, treatment, and/or referral options for the patients in the following three case studies.
Discussion board posting assignments are assigned alphabetically by FIRST NAME to ensure all cases are covered and discussed.
- Case Study 1: A-F
- Case Study 2: G-M
- Case Study 3: N-T
- Case Study 4: U-Z
Case Study 1
HPI: This is a 3 year old girl with a 2-day history of complaints of dysuria with frequent episodes of enuresis despite potty training about 7 months ago. She is afebrile and denies vomiting.
PMH: Last UTI, 6 months ago.
PE: Dipstick voided urine analysis reveals: specific gravity 1.015, Protein 1+ non-hemolyzed blood, 1+ nitrites, 1+ leukocytes, and glucose-negative.
Case Study 2
Jacob is a 1.5 week old brought in by his distressed mother. While changing his diaper last night, she noted that his penis was edematous and erythematous. He has been crying and fussy. Per mom, no other complaints. He’s been breastfeeding every 1-2 hours without any issues.
PE: Stable VS and growth patterns. Essentially a normal examination with the exception of a slightly erythematous and edematous glans penis with retracted prepuce.
Case Study 3
HPI: Mark is a 15-year-old with complaint of acute left scrotal pain with nausea. The pain began approximately 6 hours ago after a wrestling match. He describes the pain as a dull ache and has gradually worsened to where he can no longer stand without doubling over. He is afebrile and in marked pain.
PE: Physical exam is negative except for elevation of the left testicle, diffuse scrotal edema, and the presence of a blue dot sign.
Case Study 4
HPI: Maya is a 5-year-old who presents for a well-child visit. She is a healthy child with no complaints.
PE: VS stable; Height and weight within the 60th percentile. Head to toe examination is normal.
Diagnostics: Routine urinalysis indicates 2+ proteinuria; specific gravity 1.020; negative for glucose, blood, leukocytes, and nitrites. 60th percentile for height and weight.
To prepare:
- Review “Genitourinary Disorders” in the Burns et al. text.
- Review and select one of the three provided case studies. Analyze the patient information.
- Consider a differential diagnosis for the patient in the case study you selected. Think about the most likely diagnosis for the patient.
- Think about a treatment and management plan for the patient. Be sure to consider appropriate dosages for any recommended pharmacologic and/or non-pharmacologic treatments.
- Consider strategies for educating patients and families on the treatment and management of the genitourinary disorder.
ORDER INSTRUCTION-COMPLIANT PAPERSBy Day 3
Post an analysis of your assigned case by responding to the following:
- What additional questions will you ask?
- Has the case addressed the LOCATES mnemonic? If not, what else do you need to ask? What additional history will you need? (Think FMH, allergies, meds and so forth, that might be pertinent in arriving to your differential diagnoses).
- What additional examinations or diagnostic tests, if any will you conduct?
- What are your differential diagnoses? What historical and physical exam features support your rationales? Provide at least 3 differentials.
- What is your most likely diagnosis and why?
- How will you treat this child?
- Provide medication treatment and symptomatic care.
- Provide correct medication dosage. Use the knowledge you learned from this week’s and previous weeks’ readings as well as what you have learned from pharmacology to help you with this area.
- Patient Education, Health Promotion & Anticipatory guidance:
- Explain strategies for educating parents on their child’s disorder and reducing any concerns/fears presented in the case study.
- Include any socio-cultural barriers that might impact the treatment and management plans.
- Health Promotion:
- What immunizations should this child have had?
- Based on the child’s age, when is the next well visit?
- At the next well visit, what are the next set of immunizations?
- What additional anticipatory guidance should be provided today?
Read a selection of your colleagues’ responses.
By Day 6
Respond to at least two of your colleagues on two different days in both of the ways listed below. Respond to colleagues who selected different case studies than you did.
- Describe how culture might impact the diagnosis, management, and follow-up care of patients with the genitourinary disorders your colleagues discussed.
- Based on your personal and/or professional experiences, expand on your colleagues’ postings by providing additional insights or different perspectives. Diagnosis and Management of Genitourinary Disorders, NURS6541 Case Study: Infant with edematous and erythematous penis
Discuss edematous and erythematous penis in infants
Introduction
Acute penile problems in infants include phimosis and paraphimosis of the penis, balanitis and balanoposthitis, urinary tract infections (UTIs), meatal stenosis, and contact dermatitis.
Introduction
Erythema, erythematous, and edematous are all terms that are used to describe an area of skin that appears red or pink in color. However, each has its own meaning and usage.
Erythema means “redness” while erysipelas refers to a more severe form of inflammation caused by bacteria (not viruses). Erysipelas is often associated with bacterial infections on the skin such as impetigo or acne rosacea. When this condition occurs on the genitals it might cause swelling due to fluid buildup under pressure from pus formation within infected tissue which then breaks open when pressure increases during sexual activity causing pain and discomfort for both partners involved in sexual intercourse at least once per week throughout their entire lives together until death occurs sometime between 40-50 years old depending on how well they take care of themselves physically because it’s important too keep yourself healthy if possible so long as possible without feeling bad about yourself too much even though sometimes we forget how important these things really are!
Acute Penile Problems in Infants
Acute penile problems in infants include phimosis, paraphimosis, balanitis, balanoposthitis and urinary tract infections.
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Phimosis: This is a condition where the foreskin cannot be retracted over the glans penis. It is usually caused by improper hygiene or scarring from circumcision as an infant. If left untreated it can lead to painful erections as well as troubles during intercourse because of pain caused in the shaft of your penis when attempting penetration with another person (or yourself). Treatment involves stretching out your foreskin manually until it has grown back over your glans (head) so that it covers both sides completely when standing upright.* Paraphimosis: This occurs when one part of their body gets stuck outside another part; for example if they’re trying to urinate but their sphincter muscle contracts too much and squeezes tightly around them preventing them from going inside themselves anymore than necessary! Treatment includes allowing some time for this muscle relaxation process before trying again later on down road once things have calmed down again…
Phimosis and Paraphimosis of the Penis
Phimosis is the inability to retract the foreskin. Paraphimosis can occur in infants and adults, causing pain, swelling and bleeding. If a baby’s penis gets stuck behind his foreskin (phimotic), he may cry out as if in pain.
If you see an infant with this condition, first use gentle pressure on his penis until it returns to its normal position by itself. This will usually happen within 15 minutes without any intervention from you at all! If your child continues to cry after trying this method, then go ahead and seek medical advice immediately!
Balanitis and Balanoposthitis
Balanitis is an inflammation of the glans of the penis, which can be caused by a variety of factors. The most common cause of balanitis is poor hygiene, including dirty hands and smelly genitals. Other causes include diabetes and sexually transmitted diseases (STDs).
Balanoposthitis is an inflammation of both foreskin and glans that can also occur from STDs or improper hygiene. It’s important to note that these two conditions are not the same thing; balanoposthitis affects only one side (the side with less skin coverage), whereas balanitis affects both sides equally
Urinary Tract Infections in Children
Urinary tract infections (UTIs) are common in children, with symptoms including fever, pain and frequent urination. They can also be caused by a bacterial infection of the bladder or kidneys. UTIs may lead to kidney damage if left untreated.
Treatment depends on how severe your child’s UTI is. Antibiotics will help kill off any bacteria that are present in your child’s urine; this will prevent him from passing these germs on to other people who may then get an infection themselves. You should always see a doctor if you think one of your children has an infection because they may need treatment even though they don’t have any visible signs yet!
Meatal Stenosis
Meatal stenosis, also known as meatal occlusion, is a common congenital defect in infants. It occurs when the opening from the urethra to the urinary bladder is narrowed or partially blocked by an abnormally large or poorly formed ureter and/or bladder outlet. Because of this narrowed opening, urine cannot drain properly from the kidneys into this tube (which drains excreted waste). This condition can cause serious complications if not treated early on; it may lead to dehydration and even death if left untreated for long periods of time.
Symptoms include:
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A whistling sound when urinating (this may be loud enough for you)
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Blood in your urine during urination
Conclusion
The first step in the management of edematous and erythematous penile lesions is to determine whether they are caused by a true infection or a benign noninfectious process. If it is determined that these lesions are benign, then treatment will focus on managing any associated pain and discomfort. In addition to treatment, follow-up visits with your child’s primary care physician are important so that he or she can monitor any changes in their condition over time.
Some acute penile problems in infants include phimosis, paraphimosis, balanitis, balanoposthitis, and urinary tract infections.
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Phimosis is a condition where the foreskin cannot be retracted.
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Paraphimosis is when the glans becomes stuck behind the foreskin.
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Balanitis is an inflammation of the glans penis that may cause pain and swelling in infants under 6 months old (also known as balanoposthitis).
Conclusion
In conclusion, the penis should be inspected for infection and inflammation. If any of these problems are found, then a circumcision may be recommended to prevent further complications.
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