Penile necrosis Outcome??

[mlauren]

Tomorrow is my last clinical day and my patient this week has Down Syndrome and was admitted with penile necrosis. I thought this wasn't going to be a hard one, but since I've never dealt with a patient with either of these it's been a little challenging. I'm stuck trying to find an outcome for impaired tissue integrity. I don't know what the goal should be. And I have no idea what the prognosis for this kind of injury is. I can't find anything on the internet or in my book. This patient actually left a rubber band on too long and ended up with I assume some pretty severe injuries. The chart said that irrigation/debridement/with circumcision. So I'm wondering if my outcome should be for him to not get an infection there, but that just sounds too much like a risk for infection outcome. I don't know if it would be ok to use that. Do you guys have any advice?? So far I have spent 3 hours researching that and DS and I still have hardly anything other than a patho for necrosis.

[Esme12, ASN, BSN, RN]

Since this involves that placement of a rubber band around the member and cutting off circulation. The pathophysiology of necrosis is correct. The removal of the rubber band restores circulation and IF surgery removed all necrotic tissue the expectation of healing/infection is as any other wound in that area.

However, there is a condition known as Fournier's Gangrene, Medscape: Medscape Access, (medscape requires registration but it is free and an excellent source/resource of information) which is essentially necrotizing fascitis of the member, is a critical infection....but again dependent on the cause and how much necrosis was involved and as long as circulation is re-established the prognosis should be good.

(http://en.wikipedia.org/wiki/Fournier_gangrene....this is actually pretty good explanation)

This is extremely painful for for the patient.....for a little critical thinking......I would also look up circumcision of the adult male for post op information......I hope this helps

Fournier's gangrene. Fournier's gangrene is an uncommon type of gangrene that involves the genital organs. Men are more often affected, but women can develop this type of gangrene as well. Fournier's gangrene usually arises due to an infection in the genital area or urinary tract and causes genital pain, tenderness, redness and swelling.

Gangrene: Causes - MayoClinic.com

[nurseprnRN, BSN, RN]

Try not to think of nursing diagnosis as a consequence of the medical diagnosis, but as a result of your nursing assessment of this patient. Remember also that he is not your only patient-- does he live with family or other caregivers? What do they need to know, what are their concerns? You aren't going to find nursing diagnoses in the pathophysiology texts; you need to know the pathophysiology and understand any surgical and medical plans of care for his medical diagnosis, sure, but your nursing diagnosis will derive from what YOU SEE/ASSESS with this individual person.

Do your studying on patho and medical plan of care, then put it aside and look at your patient with informed eyes. Does he have pain? Is he scared? Does he understand what happened to him? What self-care (or caregiver care) will he need later, after discharge? Does he/they understand how to do it? All of these are HUGE hints to help you find some applicable nursing diagnoses so you can make your nursing plan of care, separate and distinct from his medical plan of care.

[mlauren]

thank you so much for the excellent resources and advice!

[Esme12, ASN, BSN, RN]

You're welcome sometime you just need to know where to look.