Hemodialysis and Blood Access Methods

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Questions and Answers

What is the purpose of applying antibacterial ointment daily in pediatric urology?

To increase fluid intake

To prevent infection (correct)

To reduce pain

To promote healing of the surgical site

What is the recommended age for performing orchiopexy in cryptorchidism treatment?

Between 2 to 5 years of age

Before the child's 2nd birthday (correct)

After the child's 5th birthday

Only if the testes do not descend spontaneously

What is the primary concern in caring for a child with bladder exstrophy?

Preventing infection (correct)

Pain management

Increasing fluid intake

Promoting healing of the surgical site

What is the term for the narrowing or stenosis of the preputial opening of the foreskin?

Phimosis Signup and view all the answers

What is the treatment for severe phimosis?

Circumcision Signup and view all the answers

What is the term for the presence of fluid in processus vaginalis?

Hydrocele Signup and view all the answers

What is the recommended advice to parents regarding hydrocele?

The condition is temporary and will resolve on its own Signup and view all the answers

Why is laparoscopic surgery recommended for cryptorchidism?

It improves outcomes in males with cryptorchid testes Signup and view all the answers

During embryologic development, what is the normal outcome of the urachus?

It closes, forming a normal bladder Signup and view all the answers

What is the characteristic appearance of the penis in males with bladder exstrophy?

Short and wide Signup and view all the answers

What is the hallmark of bladder exstrophy?

Wide pubic diastasis Signup and view all the answers

How is the diagnosis of patent urachus confirmed?

Nitrazine paper test Signup and view all the answers

What is the typical gait of children with bladder exstrophy?

Waddling gait Signup and view all the answers

What is the characteristic of the vagina in females with bladder exstrophy?

50% shorter and 30% wider Signup and view all the answers

What is the management of patent urachus?

Surgical correction Signup and view all the answers

What is the urethral defect in males with bladder exstrophy?

Epispadias Signup and view all the answers

What is the ideal time for surgical closure of the bladder and anterior abdominal wall in bladder exstrophy?

Within the first 24-72 hours of life Signup and view all the answers

Why is it important to keep the bladder mucosa moist and covered with a protective topical ointment in bladder exstrophy?

To prevent drying Signup and view all the answers

What is the purpose of continent urinary diversion in bladder exstrophy?

To allow for the passage of urine without affecting the GI tract Signup and view all the answers

What is the characteristic of a severe case of hypospadias?

The meatus is located on the perineum between the halves of the scrotum Signup and view all the answers

Why should an infant with hypospadias not be circumcised?

Because the foreskin is used for repair Signup and view all the answers

What is the purpose of applying testosterone cream or injection in hypospadias management?

To encourage penis growth Signup and view all the answers

What is the purpose of inserting a urinary catheter after hypospadias surgery?

To allow urine output without putting tension against the urethral sutures Signup and view all the answers

What is the typical duration of time the urinary catheter is left in place after hypospadias surgery?

3-7 days Signup and view all the answers

Study Notes

Therapeutic Management of Bladder Exstrophy

Surgical closure of the bladder and anterior abdominal wall
Construction of the urethra
Ideal time for closure is within 24-72 hours of life if the bladder is of suitable size and quality
Protective topical ointment, such as A&D ointment, karaya gum, or maalox, must be applied to prevent drying of the bladder mucosa

Postoperative Care

Positioning on the back with legs raised in traction for 4-6 weeks after surgery
Continent urinary diversion involves separating a small segment of intestine from the intestinal tract and reanastomosing it to ensure the GI tract is unaffected

Hypospadias

Urethral opening is not at the end of the penis, but rather on the ventral (lower) aspect of the penis
Tends to be familial/multifactorial genetic focus
Mild cases: meatus is below the tip of the penis
Severe cases: meatus is located on the perineum between the halves of the scrotum (bifid scrotum)
Assessment: short chordee (fibrous band that causes the penis to curve downward)
Therapeutic management: surgery, testosterone cream or injection to encourage penis growth, and correction before school age

Cryptorchidism (Cryptorchism)

Failure of one or both testes to descend
Assessment: nonpalpable testes
Diagnosis: ultrasonography, CT scan, MRI, and laparoscopy (most accurate for locating nonpalpable testes)
Therapeutic management: luteinizing hormone-release hormone (nasal spray) and human chorionic gonodotropin (injection) may be attempted; orchiopexy (surgery) performed before the child's 2nd birthday

Phimosis

Narrowing or stenosis of the preputial opening of the foreskin that prevents retraction
Causes dribbling or ballooning of the foreskin due to obstructed urine flow
Severe phimosis is treated with circumcision
Nursing management: proper hygiene of phimotic foreskin, avoiding forced retraction to prevent scarring

Hydrocele

Presence of fluid in the processus vaginalis
Asymptomatic except for a palpable bulge in the inguinal or scrotal area
Nursing management: advice parents about temporary swelling and discoloration of the scrotum

Patent Urachus

Bladder and umbilicus are connected by a narrow tube (urachus) that fails to close during embryologic development
Assessment: clear fluid draining at the base of the umbilical cord
Diagnosis: nitrazine paper for pH testing acid content
Therapeutic management: surgical correction, sub-umbilical incision

Exstrophy of the Bladder

Midline closure defect during the 10th week of pregnancy
Detected by fetal ultrasound, which reveals a lack of anterior wall of the bladder and skin covering the lower anterior abdomen
Assessment: bladder appears bright red, pelvic bone defects, particularly wide pubic diastasis (hallmark of exstrophy)
Males: anterior corporal length is 50% shorter, and posterior corporal segment is 40% larger, leading to a short, wide penis
Females: urethra is abnormally formed, vagina is 50% shorter and 30% wider

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Description

This quiz covers the different methods of blood access for hemodialysis, including grafts, fistula, and external access devices. It also explains the differences between short-term and long-term external access.