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Children & Orthopedic Nursing Basic Nursing Interventions, Related To Children & Orthopedic Nursing The 5 Ps (Pain, Pallor, Paralysis, Paresthesia , Pulse ) Pain LocationNature stabin, throbingFrequency, how often, with , use , at rest, constantlyRemember Child May Deny Pain, if they think their gona get introuble Pallor – Really Skin Color Warm Skin With Blue TingePossible Venous StatusCool Pale SkinPossible Arterial InsufficiencyCast may be to tight Paralysis – Really Movement Compare BilaterallyWiggling Fingers Or Toes Does Not Always adequate to Assess Motor DamageParesthesia – Really Sensation, wht des that limb feel like..Hard For A Young Child To DescribeNumb, Tingling.. children may not understand these use the list below“Bugs Crawling”“Pins And Needles”“Burning”“Asleep”Loss Of SensationPulse Assess Uninjured Limb First To Establish BaselineAssess pulse distal to the injuryDon’t Forget To Assess Capillary RefillOrthopedic Appliance (brace)Clothing Between Appliance And Skin to protectNo Lotion Under Appliance, can lead t yeast build upNo Powder Under Appliance, can be abrasiveToughen Skin In Contact With MetalCan do this by using Alcohol Or Tannic AcidWhat About Balance? Legg-Calve-Perthes Disease Avascular Necrosis ( blood flow just stops) Of The Femoral Head Which Occurs In Four Stages LCP: PathoBlood Flow To Femoral Head Is Interrupted Resulting In Bone NecrosisBlood Supply Returns To Femoral HeadNew BoneRemodeling Of New Bone ( bone taking proper shape) very important.. needs to fit up into acetabulumProcess Takes 18 Months to Several YearsLCP: Assessment Usually A Boy 2- To 12-Years-OldSlow OnsetLimpPain In Thigh, Hip, And/Or KneeWorse With Activity, Relieved By RestLimited MotionEventually Muscle Atrophy, cause of lack of useDefinitive Test Is MRILCP: Treatment Keep Head Of Femur high In The Acetabulum to assume proper shapeTreatment Plan Is Influenced ByChild’s AgeCondition Of The Femoral HeadPosition Within the AcetabulumLCP: Overview Treatment Initial Therapy IsInitaially RestNon-Weight Bearing for short period. While delicate bone is being laid at risk for Activity Can Cause MicrofracturesConservative Versus Surgical ContainmentLater, Active Motion Is Encouraged Nonsurgical Containment Non-Weight Bearing DevicesAbduction Brace.. (take away) to keep femoral head high in the acetabulumLeg CastsLeather Harness SlingWeight Bearing DevicesAbduction-Ambulation BracesCasts After A Period Of Bed Rest And TractionCan Take 2 – 4 Years Surgical Intervention OsteotomyScrews And PlatesSpica CastFrequently From Chest To Toes6 – 8 WeeksPhysical TherapyPartial-Weight BearingEncloses A Portion Of The Trunk And 1 Or 2 LimbsLCP: Prognosis Excellent In Most CasesOutcome Is Influenced ByChild’s AgeEarly Treatment, better for the bne to remodel before it hardensPossibilitiesOsteoarthritisLeg Length Discrepancy Osteomyelitis Infection Of A Bone. Primarily A Long Bone In ChildrenThe Infection (in Pd generally talking about long bones)In Children: Most Common Between 1 – 12 YearsBoys Affected More Often Than GirlsHematogenous SpreadAnother infection somewhere in the body and the Organism Reaches The Bone Through The BloodOpen Fracture Or WoundStaphylococcus aureus Patho Bacteria Adheres To Bone ▼ Purulent (puss) Exudate In Bone Tissue ▼ Exudate (puss) Moves Beneath The Periosteum. Abscess Formation ▼ Necrosis Of The Bone AssessmentFeverIrritabilityPain with MovementSwelling And WarmthLab LeukocytosisElevated Erythrocyte Sedimentation Rate (ESR)This is a blood test, that test for inflimation, not specific to where its located, just saids there is inflimationCulturesBlood And Nearest Joint, to see if there is bacteria in the bld stream. Ex; If in femor, then would culter the kneeX-Ray, MRI, CT Scan, Bone Scan MedicationAntibiotics 4 – 6 Weeks and inhigh dosesImportant To Monitor Hematological, Renal, Hepatic, Ototoxic And Other Potential Side EffectsCommon MedicationsNafcillinClindamycinVancomycinInterventions (Osteomyelitis)Assess And Document 5 P’s (Pain, Pallor, Paralysis, Paresthesia , PulsePainHandle With Extreme Care, very tender and painfull to moveOn Bed Rest Or Wheelchair (Maybe) even if they don’t feel badImmobilization (Probably)High Protein Diet, to help heal the boneSurgical Intervention Surgical Drain (Maybe)Two Tubes Are Placed In WoundOne Tube Instills An Antibiotic Solution Directly Into Infected AreaOne Tube Provides DrainageAnd if reallt really bad ,Surgical Removal Of Dead Bone (Sequestrectomy) (Maybe)ScoliosisCurvature Of The Spine Associated With Vertebral RotationCausing Rib Asymmetry Potentially Effecting Heart/Lung Function ScoliosisStructural ( has to do with spinal cord it self)Most common is called idiopathic scolAdolescent Growth Spurt is whn is is seen most>10°FunctionalFactors Outside Spinal Column,,EX; leg length discrepancy. Or a result of a disease process. Muscles can be to weak to support the spineScoliosis: AssessmentForward Bending Test ( test for symmetry)Assess Standing And Bending.. !!Need to see the back!!You could look at the their waste band of pants . see if there straightAssess Symmetry ( text book pg 1781 pictures)ShouldersScapulasWaistHipsScoliometerProtractor Used To Measure CurvatureAssess For Leg Length DiscrepancySo in this case looking for functional scoliosisScoliosis: TreatmentSerial Observation (10° to 20°)Bracing (20° to 40°)Purpose Is To Prevent Further CurvatureUsually Worn 16 – 23 Hours A Day. Menas they pretty much sleep with itGradually Weaned Off Brace After Spinal Growth Has StoppedBecause there may have been some bone dematerializing.. gives it time to solidifyMay Wear At Night For 1 – 2 YearsBrace (Scoliosis: Treatment) doses not reverse cuverture, just prevents it from getting worseBoston BraceStandard TLSO Brace (Thoracolumbosacral Orthotic)Custom FitMilwaukee BraceKyphosis Surgical Intervention > 40? CurveRealignment And StraighteningInstrumentation Developmental Dysplasia Of The Hip Separation Of The Femoral Head From Acetabulum DDH: TypesDysplasiaMildest FormUp and back (shortens leg)Femoral Head Remains In AcetabulumSubluxationGreatest Percentage Of CasesStill in contact (shortens leg)Incomplete DislocationDislocationFemoral Head Not In Contact With AcetabulumDDH:Infant Assessment Shortened Limb On Affected SideAsymmetry Of Gluteal FoldsOrtolani ClickInto Place ( when you move the leg and you hear a cllickPositive Barlow SignPassive Dislocation.. NURSING ALERT!! Ortolani & Barlow tests must be performed by an experienced clinician to prevent damage to the hip. If these tests are performed too vigorously in the first 2 days of life, persistent dislocation may occur. DDH: Child Assessment Level Of Knees( lay on back , feet flat and bend at knee. See level of knee. Are they evenLimpLeg Length DiscrepancyPositive Trendelenburg SignStand On One Foot (Affected Side). Pelvis Tilts Downward On Normal SideDDH: TreatmentNewborn to 6 Months (extremely important that we pick this up at birthPavlik HarnessLegs Abducted, Knees And Hips Are Flexed. Hold femoral head high in the acetabulumWorn Continually 3 – 6 Months, babies sleep in itStraps only adjusted by practitioner Pavlik Harness Position Chest Halter At Nipple LineFasten With VelcroPosition Legs And Feet In The StirrupsHips Are Flexed And AbductedConnect The Chest Halter And Leg StrapsIn FrontThen In BackSkin Is Marked With Indelible Ink At Strap Lines DDH: Treatment 6 to 8 Months OldTractionClosed Reduction Under AnesthesiaSpica Cast For ~ 2 – 4 MonthsBraceOlder Child… the hip is up and back, so the muscles grow that way ,and tighten. Have to be releasedTenotomy Of Contracted MusclesReconstruction Of Acetabulum, because nolonger smooth. Over growth of tissue. Head doesn’t fitCastRehab Never fully heals ,, Fractures A Review BendBent But Not BrokenMay Bend 45° Or More Before Breaking, not completely ossifiedMost Common In Ulna And FibulaOften Associated With Fractures Of Radius And TibiaGreenstickBent Beyond EnduranceBuckleCompression Of Porous Bone (skatingIOccurs Near Growth Plate..Tends To Be Seen In Young ChildrenSpiral FractureTwisting MotionPlanted Foot, Twist To Throw FootballSkiingMaltreat In Nonambulating ChildEpiphyseal Growth Plate Injury. Damage to this can result in permanent damage and can stop growth.. biggest concernWeakest Point Of BonesCan Result In Growth DisturbanceFracture: AssessmentHistoryChild’s Story May Not Be ReliableChild May Be Afraid Of Getting In TroubleMuscle ContractionMuscles Contract To Splint Fracture.. muscles pull bones further apartSwelling Peaks In 1 – 2 DaysCasts A Review Swelling & Cast PlacementSwelling Peaks In 1 – 2 DaysCurrent Trend Is To Cast 1 – 2 Days After FractureElevate.. after, fracture, casted, and above level of heart. Reduce swellingIf you think its reducing circulation then Bivalve Cast, If NeededTop And Bottom Of Cast Held Together With Elastic BandageDon’t move child by the bar on the spica castSynthetic CastsDry Quickly (10 – 30 Minutes)LightweightCan Be Durable In WaterCast ApplicationAssess Limb For Alteration In Skin And JewelryTube Of Cloth Stockinet Over AreaBony Prominences Covered With Cotton SheetingWet Casting Material Molded To LimbStockinet May Be Pulled Over Rough Edges Of Cast And Secured With Casting MaterialCasts: Nursing Cast To Dry Inside Out.. don’t use anything to dry it, needs to happen naturallyReposition Wet Cast With Palms To Avoid Pressure Points (Hot Spots).. After The Cast Has Dried Petal The Cast, If Needed.. if there is rough edges, tape over the edges..Arm Sling Distributes Weight Evenly Over Large Area Of The Shoulders And Trunk, Not Just NeckDiscouraged After First Few Days, Especially With Short Arm CastEncourage Normal Movement A Few Other Items WindowsAllows Abdominal Expansion.. to they wont throw upOdorCan Indicate Infection.. especiall spica castNeed to differentiate btwn regular odor and infectionObjects in CastMoisture in Cast5 P’s of CirculationCast Removal Cast CutterCuts By VibrationGenerates HeatNoisyFlakey SkinLotion, and takes days to get normalTraction A Review Purpose Of TractionIs to Fatigue Muscle To Reduce Muscle Spasms.. traction or anesthesia is the ony thing that reduces the spasmRealign BoneImmobilize During HealingCheck ThesePosition Of Frames, Splints, Etc.Ropes & PulleysAlignmentGood Working OrderWeightsCorrect AmountHanging Freely, not on floorBed PositionManual Traction Limb Is Held In Position By Person Skin Traction Primary Purpose Is To Decrease Painful Muscles SpasmsLimited Weight To Prevent Skin InjuryIf “Oked” By Physician Remove Bandage Every 8 Hours to Assess SkinManual Traction Buck TractionShort Term Immobilization.. once traction is released the spams cme back.. used to by time until surgeryPt slips in bed. Draw a line to knw where hes is supposed to be or if movementPreoperative Management OfMuscle Spasm Associated With FracturesDislocated HipBryant's Traction Hip Dislocation Or Fractured FemurWeigh Less Than 40 PoundsButtocks Off The BedThis Is The Countertraction7 – 10 DaysSpica Cast, Maybe Feed on back, and increased risk for aspirationSkeletal Traction Primary Purpose Is Bone RealignmentPins, Wire, Tongs, Screws Are Implanted In BoneLonger Traction Time And Heavier Weights Than Skin Traction NURSING ALERT “Skeletal traction is never released by the nurse (unless under direct supervision of practitioner).” If foot is lookin g pale . don’t do anything, call the doctor or prac… could pull bone out of alignment and cause more damage90° - 90° TractionTwo 90° AnglesSteinmann Pin Or Kirschner Wire In The Distal Fragment Of FemurLower Portion Of Leg Is Supported In Cast Boot Or SlingTraction: AssessmentInspect Skin At Least Every 8 HoursExternal HardwareInspect Insertion Sites For InflammationDrainageColorOdorPin Care ControversyPin Care Prevents InfectionPin Care Disrupts Skin’s Natural Barrier To InfectionTriad Of InjuriesWhen A Child Is Hit By A Car Assess ForBroken FemurChest InjuryHead InjuryChildren & Genitourinary Nursing Urinary Tract InfectionBroad Term for Infection Anywhere In The Urinary TractIncidencePediatrics2 to 6 Years-OldSexually Active GirlsFemales More Often Than MalesExcept in Neonate PeriodFemalesShorter Urethra Than MalesUrethra Is In Close Proximity To AnusSingle Most Important FactorUrine Stasis. Urine stays in bladderExcellent Culture MediumVoiding Removes Bacteria From The Bladder And Allows More Efficient Destruction Of Bacteria Remaining On The Bladder WallExamplesVesicoureteral RefluxNeurogenic BladderBladder CompressionUA with Culture & Sensitivity Cotton Ball In Diaper is ok for a UA, but NOT for a culture and sensitivityBagged SpecimensMidstream Clean CatchOlder ChildSterile Catheter Specimen..(BEST SPECIMIN for culture and sensitivity)The Very Young & OthersUA With Culture & Sensitivity 100,000 Organisms/mlBEST in first culture in the first n=void morning, cause they haven’t been drinking during the nightGram Negative BacteriaFalse-PositiveContaminated With Organisms From Perineal/Perianal AreasFalse-NegativeChildren Given Large Volume Of FluidFirst Morning Void Is Most Accurate Other Tests To Detect Anomalies Or Renal ScarringRenal And Bladder UltrasoundVoiding Cystoureteral Gram (VCUG) Signs & Symptoms Age Of ChildLocation Of The InfectionCystitisUrethra Or BladderPyelonephritisUreters Or Kidney Neonate And Infant (Urinary Tract Infection)FeverPoor FeedingVomiting And/Or DiarrheaFailure To ThriveStrong Smelling Urine..BEST indication of a UTIPersistent Diaper RashCystitis After InfancyFrequency & UrgencyEnuresis.. bed wetting or inc0ntinence in a toilet trained child Strong Smelling UrineDysuria (uncomfortable feeling when voidingInfants And Very Young Children Cannot Verbalize Discomfort Of VoidingThey don’t want to void, they hold it until they cantPyelonephritis After InfancyHigh Fever & ChillsCostovertebral Angle TendernessPersistent VomitingModerate To Severe DiarrheaDysuriaFrequency & UrgencyDesired OutcomesEliminate Current InfectionIdentify Contributing FactorsCertain can lead to a UTI.. Preserve Renal FunctionA UTI under 2 yrs, can lead to kidney disfunctionEliminate Current Infection…(give the med until the symptoms stop.. have to take even if asymptoAntibioticsEventually Based On Sensitivity CulturesTeach The Importance Of Taking All The AntibioticEncourage FluidsFlush Out PathogensCarbonated Or Caffeinated Liquids May Irritate BladderVoid FrequentlyIdentify Contributing FactorsIs There An Anatomical Anomalie Resulting In Urine Stasis? Something causing them not to drain rtGood Perineal HygieneWiping Front To BackAvoid IrritantsBubble Baths/ShampoosCotton UnderwearAllows Air Through FabricIncreased Fluid IntakePromotes Flushing Of The Normal BladderLowers Concentration Of OrganismsVoid RegularlyEveryoneSexually Active Females Identify Contributing Factors (Urinary Tract Infection)Acidify UrineMost Pathogens Favor An Alkaline MediumVegetarian Diet Increases Urine AlkalinityTo Acidify UrineApple JuiceVitamin CIncreased ProteinCranberry Juice Helps Prevent Bacteria Adhering To Bladder Wall Preserve Renal FunctionRenal Scarring Can Occur From First InfectionProgressive Renal Injury Is Greatest In Children Under 2 Year-Of-AgeVesicoureteral RefluxReflux Of Urine Up The UretersTypes Of RefluxPrimary Reflux (something wrong with anatomYAbnormal Insertion Of Ureters Into BladderSecondary Reflux (AcquiredEdema Caused By InfectionNeurogenic BladderThese Children Have Frequent Kidney Infections (Pyelonephritis)Voiding Cystoureterogram (VCUG) Contrast Medium Is Injected Into The Bladder Through A CatheterPictures Are Taken Before, During, And After VoidingShows Urine Reflex diagram on pg somethingGrading System 1 to 5Interventions 9 DON’T Daily Low-Dose Antibiotic TherapyNot Associated With Candida Infections Or OvergrowthExamplesNitrofurantoinBactrimLiberal FluidsRegular Voiding & Double Voiding BEFORE BEDUreteral ReimplantationHigh Grade Reflux With fams who are Noncompliance With Antibiotic Therapy..Infrequent Access To Health Care SystemGlomerular Filtration Membrane A Patho ReviewGlomerular Filtration MembraneWalls Of Glomerulus Composed Of 3 LayersMiddle Layer Is Glomerular Filtration MembraneFilters Blood Resulting In Formation Of UrineLarge Molecules Such As Blood and Plasma Proteins Do Not Pass Through The MembraneNephrotic SyndromeIncreased Permeability Of Glomerular Filtration MembraneNS: TypesPrimary DiseaseUnknown EtiologyMost common type Minimal Change Nephrotic SyndromeSecondary DiseaseA Result Of Damage To The Glomerulus; from lupus, cancerOnset Of Nephrotic Syndrome (minimal change nephroticOften Preceded By A Viral IllnessRelapsing Course Throughout Childhood the child will get better , then it will come back until 20 or 30Clinical State Characterized ByMassive ProteinuriaHypoalbuminemiaEdemaHyperlidpidemiaWhat Happens In The BodyIncreased Permeability Of The Glomerular Filtration Membrane To Plasma Protein, Especially Albumin.. albumin crosses the basement membrane into the urine Which leads toMassive ProteinuriaHypoalbuminemiaTwo Reasons For EdemaDecrease In Plasma Osmotic Pressure.. the albumin missing ; doesn’t bring fluid bback into vesslesFluid Moves From Intravascular Space Into Interstitial SpaceHypovolemiaRenin-Angiotensogen Mechanism, NEED to knw that this is activated and increased edemaWhat Else Happens In The BodyAs The Liver Rapidly Manufacturers Replacement Proteins, Large Amounts Of Lipids Are Created As WellHyperlipidemiaAt Risk For InfectionImmunoglobulins Are Lost. Especially IgG Resulting In Altered ImmunityAt Risk For Venous ThrombosisHypovolemiaLoss Of Antithrombin III (anticlotting factor) do need to knw your loosing clotting factorNS: EdemaGeneralized EdemaMay Develop Gradually Or RapidlyEventually Brings Child Into Health Care System\Scale may say their ganing, but loosing body weight not eating wellPatternFacial Edema Especially Around The Eyes In The MorningPeripheralLabial Or Scrotal SwellingNS: Edema May Be Gaining Weight But Losing True Body WeightIntestinal SwellingAbdominal PainDiarrheaAscitesPleural EffusionRespiratory DifficultyNS: UrineDecreased VolumeDark And FrothyProteinuriaGreater Than 3+.. albumin going into urineMay Have A Few RBCsNS: Corticosteroids Initial TreatmentPrednisone 4 – 6 WeeksPositive Response In 7 To 21 DaysZero To Trace Urine Protein For A WeekTapered off until relapseRelapseIncrease Urine ProteinRepeat Course Of Steroid TherapyChildren Who Do Not Respond To Steroids Other Immunosuppressants (Cyclosporine)NS: NursingIntake And Output Plus Daily Weight (important. The best way to moniter is weightAssessment Of Edema“Hide The Salt Shaker” During Acute Edematous PhaseNo Foods With High Salt Content May Be Fluid Restriction During This PhaseNS: Home CareTesting Urine For AlbuminMedication Administration, not to stop abruptlyRisk For Infection, beacasue their on prenison ,a dnt the decreased prenisonPrognosisRenal Function Can Be Normal Or Near Normal As Adult With Early Detection And Prompt Treatment In ChildhoodHemolytic – Uremic SyndromeClassic Triad Hemolytic Anemia Thrombocytopenia Acute Renal FailureHUS Generally Seen In Children Less Than 4 Years-Of-AgeOften Linked To A Strain Of E. coliRaw Hamburger MeatUnpasteurized Milk HUS: AssessmentPreceded By IllnessDiarrhea & VomitingRespiratory InfectionAnorexia, Irritability, LethargyPallorBruisingPurpuraRectal BleedingHUS: Assessment Oliguria To AnuriaHematuriaProteinuriaPossibly Central Nervous System Involvement, toxins candamage any arterialSeizure , coma, acute hrt failurePossibly Signs Of Acute Heart FailureHUS: NursingHemodialysisFluid Replacement If Needed, But Managed With Great Care, cause they could be put in fluid over loadBlood Transfusion If Needed, But Done With Great CautionPlasma Infusion May Be NeededHUS: TeachingCook All Meat ThoroughlyScrub Fruits & VegetablesConsume Only Pasteurized Milk & Dairy ProductsDrink Only Water That Has Been Properly TreatedDon’t Swim In Sewage Contaminated WaterGood HandwashingAcute Poststreptococcal Glomerulonephritis (caomparison chart ( nepr syndromeIncreased Permeability Of The Glomerular Filtration Membrane Caused By Damage From Immune Complexes As A Result Of Group A β-Hemolytic StreptococcusAGN: Assessment Primarily School-Age ChildrenPeak 6 – 7 Years-Of-AgeMore Often In BoysHistory Of Infection – Usually StrepAGN: Edema Periorbital And DependentMild To ModerateMay Progress In Sever edema, in nepho sydrom.. is more severAcute Edematous Phase Lasts 4 – 10 Days (a week)AGN: Urinalysis Red Blood Cells, “Tea Or Cola” compare urin in the two diseases ( nephro is dark and frothyLeukocytesCasts, hardened material that consumes the shape of the vessel its in.. RBC or WBC cast3+ To 4+ Proteinuria..( nephro is at least 3+. Also losing albumin so higherElevated Specific Gravity, Oliguria May Or May Not Be PresentAGN: Other Signs Sudden Elevation Of Blood PressureElevated Antistreptolysin O Titer (ASO Titer) A bld test tht check for past strep infectionMeasures Antibodies From A Recent Strep InfectionElevation In 1 Week To 1 MonthAnorexia, Fatigue, IrritabilityAGN: Complications If pt report a HA , check BP, could be spiking a BPHypertensive EncephalopathyHyperfusion Of The Brain With EdemaCardiac DecompositionDuring Acute Edematous PhasePulmonary EdemaRenal FailureAGN: NursingSupportive Measures & Early Identification Of ComplicationsChildren With Normal Blood Pressure And Adequate Urine Output Can Generally Be Treated At HomeIntake And Output, so if thy start developing oliguriaAcute Edematous PhaseUsually 4 – 10 DaysChild Will Generally Put Themselves On BedrestAGN: Nursing Elevated Blood PressurePRN Antihypertensive MedicationMaybe prn DiureticNutritionMost Children Regular Diet With No Added SaltDiet Restriction Depends Upon Severity Of Edema And HypertensionRestrict Foods With High Potassium For Child With Oliguria AGN: Signs Of ImprovementSmall Increase In Urine Output With Corresponding Decrease In Body WeightFollowed In 1 – 2 Days By Copious DiuresisReduction In Blood Pressure With Reduction In EdemaWeight goes down and BP stops spikingAGN: Discharge TeachingTeach ParentsMedicationsDietary RestrictionsSigns & Symptoms Of Complications, not really how to chk BPHow ToCheck Blood PressureCheck UrineFollow For At Least One YearAnomalies Of The Genitourinary TractCryptorchidismInguinal HerniaHydroceleHypospadiasGeneral Interventions Related To Surgical RepairBefore Child Has Developed Body Image And Castration AnxietyBefore Preschool PeriodKeep Dressing Clean And DryChange Diapers When Damp, especially if surg is in diaper areaSponge BathCatheter Or Stent Care, (tube in body to keep “tube”open) teach how to care Limit Activity To Promote HealingStraddle toysSandboxesSwimmingLiftingPushingWrestlingFightingBicycle RidingAthleteticsUndescended Testes (Cryptorchidism)Review: Normally Testes DescendThey distend 7 to 9 Months Intrauterine LifeUp to 6 Weeks After BirthCryptorchidism May Be Bilateral Or UnilateralScrotum Will Appear Small And MisshapenRetractile Testes Is Not CryptorchidismTestes That Move Out Of The Scrotum Into Inguinal CanalTreatmentIn Majority Of Infants With Cryptorchidism (~75%) Testes Will Descend By 1 Year-Of-Age1)Chorionic Gonadotropin Hormone (bad side effects)GynecomastiaPrecocious Puberty2)OrchiopexyPreferred Treatment6 – 24 Months-Of-AgeMaintain Future Fertility. Sperm does not produce in the abdomenDecreases Incidence Of Tumor FormationInguinal Hernia Protrusion Of Abominal Contents Through Inguinal Canal Into ScrotumPainless Inguinal Swelling Of Variable SizeInfantAppears During Crying Or StrainingChildAppears During Crying, Straining, Or Standing For A Long PeriodIncarcerated Inguinal Hernia Loop Of Bowel Becomes TrappedIntestinal ObstructionGangrene Hydrocele Fluid In The ScrotumCommon In NewbornsOften Resolves Spontaneously As Fluid Is Gradually AbsorbedSurgical Repair Required If Hydrocele Is Not Absorbed By 1-Year-Of-Age HypospadiasUrinary Opening on Underside of PenisEpispadiasUrinary Opening On Dorsal Surface Of PenisFamilial10% - 15% Have A First-Degree Relative With Same ConditionFrequently Associated With ChordeeVentral Curvature Of The PenisReplacement Of Normal Skin With Fibrous Band Of TissueCryptorchidism (Undescended Testes)Hypospadias Repair Staged Surgical RepairVariety Of Possible Procedures Based On Severity Of ConditionNo Circumcision At Birth – Skin Needed For RepairPreferred Age Is 6 – 18 MonthsDesired OutcomesChild Is Able To Void In Standing Position And Direct Stream Voluntarily In Usual MannerImprove Appearance Of GenitaliaProduce Sexually Active OrganPrepare ParentsMay Expect A Perfect Penis After SurgeryTemporary Urinary Diversion While Reconstructed Urethra Is HealingStent Or CatheterExcessively Restless Child May Need SedationPostoperative Epidural Pain Management May Be Needed ................
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