Foundation University Mission, Vision & Life Purpose: Penile Degloving: A Case Presentation

PENILE DEGLOVING: A CASE PRESENTATION
FOUNDATION UNIVERSITY MISSION, VISION & LIFE PURPOSE
Mission
To enhance and promote a climate of excellence relevant to the challenges of the times, where individuals are committed to the pursuit of new knowledge
and life-long learning in service of society.
Vision
To be a dynamic, progressive school that cultivates effective learning, generates creative ideas, responds to societal needs and offers equal opportunity for
all.
Life Purpose
To educate and develop individuals to become productive, creative, useful and responsible citizens of society.
Core Values
• Excellence
• Commitment
• Integrity
• Service
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AKNOWLEDGEMENT
The researchers, as the student nurse responsible for this case presentation, wish to convey an overwhelming gratitude to several kind-hearted people for
their support in the completion of this piece. They are indebted to the following:
GOD almighty for giving them the strength to make this behavioral analysis possible. Thank you for the blessing and guidance that You have given
throughout the rotation.
The researcher’s family, benefactors, and others who in one way or another shared their support either morally, physically and financially thank you so
much.
The researcher’s patient, Mr. H.S for sharing his thoughts and feelings as well as entrusting the group, and establishing a therapeutic relationship with them.
They really appreciated your full cooperation and support as they rendered their care. Thank you for the trust and for being an instrument in the conduct of this
study
The researcher’s Clinical Instructor Ms. Drema Ruth Buling who gave opportunity to cultivate their knowledge regarding exposure in the Psychiatric
rotation. Thank you very much for all the guidance, patience, and understanding.
.
And to everyone else who had helped the researcher in their own unique ways, you know who you are. Thank you very much.
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STATEMENT OF OBJECTIVES
This behavioral analysis aims to identify and determine the general health problems and needs of the patient with mental illness/disorder. It helps patient
promote health and medical understanding of such condition through the application of nursing skills. This paper is also intended to provide a better understanding
of the disorder process based on the patient’s health history and as a reference for future nursing students.
Specific Objectives
At the end of the discussion, the learners will be able to:
• obtain the needed information of the client base on its demographic data completely but not surpassing the patient’s privacy;
• identify the physical assessment accurately;
• identify both medical and nursing intervention, satisfactorily;
• identify the different medical interventions and their rationale;
• comprehend the nursing theory applicable to care of the patient;
• determine the three priority nursing diagnoses comprehensively;
• formulate nursing care plans towards the care of the client critically; and
• evaluate the case presentation by asking relevant questions.
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INTRODUCTION
“Notice any new, concerning symptoms involving penis? They could be a sign of many things, from harmless skin condition to a sexually transmitted infection that
needs treatment”
Male genital degloving injuries are unusual and rarely caused by animal bite. Usually patients attend health care immediately if bitten in the genital area.
Prophylactic antibiotics is routinely used (Gomes et al., 2000).
A penile degloving usually begins just proximal of the coronal line and progress down to the base of the shaft. Deep erectile tissue and the spermatic cord are
seldom damaged and the endogenous skin of glans usually survives (Brown and Fryer, 1957; Morey et al., 2004; Finical and Arnold, 1999). When searching the
scientific literature for references on male genital degloving injuries there are only few articles to be found. PTO describes an injury caused by power being
transmitted from one place to another. Among those that are described, utterly few are degloving injuries. However, searching the literature, one article concerning
penile degloving injuries by Finical et al. notably, it is described that degloving injuries of the penile skin is not a painful condition.
Importantly regarding PTO injuries, is that the skin tears loose at the corona, so that the glans is usually left intact. The cutaneous blood supply of the penile shaft is
derived from a pair of axial arteries in the superficial fascia whereas the glans has additional supply from the deep dorsal artery and corporal vessels. This
anatomical situation explains why different types of local flaps or split-thickness skin grafts have become the most popular ways to reconstruct the penile skin after
a degloving injury if re-implantation of the endogenous skin is not possible. In the summary report by Finical et al., a one stage procedure to treat these injuries is
presented.
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According to Center for Disease Control (CDC) (2018), in the United States of America (USA) (2018), with more than one-third of the world’s population
living in areas at risk Penile fracture is an uncommon urological trauma; there were 1331 cases reported between 1935 and 2001.1 It is defined as a rupture of the
tunica albuginea due to trauma or abrupt lateral bending of the penis in an erect state. Lesions on a flaccid penis or lesions in suspensor ligament of the penis are not
included in this definition. Forceful sexual intercourse is the most common cause of penile fractures; masturbation is also a reported cause. Other rare lesions could
occur during a nocturnal erection and due to a partial rollover. The United States of America (USA) and Europe have considerably low incidence rates of penile
cancer compared to other geographic regions. The incidence rate of penile cancer in the USA is 0.58 per 100 000. In Europe, the incidence rate of the disease is 1.33
per 100 000. Even with the USA reporting low incidence rates, ethnic and geographic differences occur nationally. Hispanics in the USA are disproportionately
affected with penile cancer, with rates 72% higher than in other ethnic groups. Penile cancer incidence rates are 43% higher in low socio-economic counties in
southern USA. The incidence of the disease increases with age, but Hispanics have the lowest age at diagnosis and a lower mortality rate than other groups. (Mayo
Clinic 2018)
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DEMOGRAPHIC DATA
Name: B.T.M Gender: Male Age: 32y/o
Address: Maria, Siquijor Birth-date: 08/28/198 Civil Status: Single
Religion: Roman Catholic
Date of Admission: Dec 15, 2018 (1:44PM)
Past Health History:
4 days PTA, the patient was noted swelling and enlargement of skin in the area. Discoloration of urine noted during urinated.
General Impression: Received patient lying on bed awake and responsive, hair is messy and pale looking. Able to communicate well, and has a loud and clear
voice, coherent and responds well to questions.
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GROWTH AND DEVELOPMENTAL TASK
SIGMUND FREUD’S PSYCHOSEXUAL THEORY
Psychosexual Stages
Freud (1905) proposed that psychological development in childhood takes place in a series of fixed psychosexual stages: oral, anal, phallic, latency, and
genital.
These are called psychosexual stages because each stage represents the fixation of libido (roughly translated as sexual drives or instincts) on a different area
of the body. As a person grows physically certain areas of their body become important as sources of potential frustration (erogenous zones), pleasure or both.
Freud believed that life was built round tension and pleasure. Freud also believed that all tension was due to the build-up of libido (sexual energy) and that
all pleasure came from its discharge.
In describing human personality development as psychosexual Freud meant to convey that what develops is the way in which sexual energy accumulates and
is discharged as we mature biologically. (NB Freud used the term 'sexual' in a very general way to mean all pleasurable actions and thoughts).
Freud stressed that the first five years of life are crucial to the formation of adult personality. The id must be controlled in order to satisfy social demands;
this sets up a conflict between frustrated wishes and social norms.
The ego and superego develop in order to exercise this control and direct the need for gratification into socially acceptable channels. Gratification centers in
different areas of the body at different stages of growth, making the conflict at each stage psychosexual.
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The Role of Conflict
Each of the psychosexual stages is associated with a particular conflict that must be resolved before the individual can successfully advance to the next stage.
The resolution of each of these conflicts requires the expenditure of sexual energy and the more energy that is expended at a particular stage, the more the important
characteristics of that stage remain with the individual as he/she matures psychologically.
Implication:
Some people do not seem to be able to leave one stage and proceed on to the next. One reason for this may be that the needs of the developing individual at
any particular stage may not have been adequately met in which case there is frustration. Or possibly the person's needs may have been so well satisfied that he/she
is reluctant to leave the psychological benefits of a particular stage in which there is overindulgence.
Both frustration and overindulgence (or any combination of the two) may lead to what psychoanalysts call fixation at a particular psychosexual stage.
JEAN PIAGET COGNITIVE DEVELOPMENT
Piaget's (1936) theory of cognitive development explains how a child constructs a mental model of the world. He disagreed with the idea that intelligence
was a fixed trait, and regarded cognitive development as a process which occurs due to biological maturation and interaction with the environment.
Piaget was employed at the Binet Institute in the 1920s, where his job was to develop French versions of questions on English intelligence tests. He became
intrigued with the reasons children gave for their wrong answers to the questions that required logical thinking. He believed that these incorrect answers revealed
important differences between the thinking of adults and children.
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Piaget (1936) was the first psychologist to make a systematic study of cognitive development. His contributions include a stage theory of child cognitive
development, detailed observational studies of cognition in children, and a series of simple but ingenious tests to reveal different cognitive abilities.
What Piaget wanted to do was not to measure how well children could count, spell or solve problems as a way of grading their I.Q. What he was more interested in
was the way in which fundamental concepts like the very idea of number, time, quantity, causality, justice and so on emerged.
Before Piaget’s work, the common assumption in psychology was that children are merely less competent thinkers than adults. Piaget showed that young
children think in strikingly different ways compared to adults.
According to Piaget, children are born with a very basic mental structure (genetically inherited and evolved) on which all subsequent learning and
knowledge are based.
Implication
In man’s human development, they are capable to think and determine for themselves whatever lead them rightly. Determining diseases and being
responsible through it would be their utmost priority.
KOHLBERG MORAL DEVELOPMENT
Lawrence Kohlberg (1958) agreed with Piaget's (1932) theory of moral development in principle but wanted to develop his ideas further.
He used Piaget’s storytelling technique to tell people stories involving moral dilemmas. In each case, he presented a choice to be considered, for example,
between the rights of some authority and the needs of some deserving individual who is being unfairly treated.
One of the best known of Kohlberg’s (1958) stories concerns a man called Heinz who lived somewhere in Europe.
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ANATOMY AND PHYSIOLOGY

Anatomy of the Skin
Structurally, the skin consists of two principal parts. The outer, thinner portion, which is composed of epithelium, is called the epidermis. The epidermis is
attached to the inner, thicker, connective tissue part called the dermis.
Beneath the dermis is a subcutaneous layer called the superficial fascia or hypodermis, which consists of areolar and adipose tissues. Fibers from it extend
down into the subcutaneous layer and anchor the skin to it. The subcutaneous layer, in turn, attaches to underlying tissues and organs. Epidermis is composed of
stratified squamous epithelium and contains four principal types of cells.
Four types of cells found in the epidermis: Keratinocytes consist 90% of the epidermal cells. These produce the protein keratin that helps waterproof and
protect the skin and underlying tissues. Melanocyte comprise about 8% of the epidermal cells and produce the pigment melanin. Their long, slender projections
extend between and transfer granules of melanin to keratinocytes contain melanin (melan = black), which is a brown-black pigment that contributes to skin colour
and absorbs ultraviolet (UV) light. Once inside keratinocytes, the melanin granules cluster to form a protective veil over the nucleus, on the side toward the skin
surface thus shields the genetic material from damaging UV light Langerhans cell arise from bone marrow and migrate to the epidermis interact with white blood
cells called helper T cells in immune responses and are easily damaged by UV radiation. Merkel cell are located in the deepest layer (stratum basale) of the
epidermis of hairless skin, where they are attached to keratinocytes by desmosomes make contact with the flattened portion of the ending of a sensory neuron (nerve
cell), called a tactile (Merkel) disc, and are thought to function in the sensation of touch. Four or five distinct layers of cells form the epidermis since: In most
regions of the body the epidermis is about 0.1 mm thick and has four layers. Parts such as such as the palms and soles, where exposure to friction is greatest, the
epidermis is thicker (l to 2 mm) and has five layers. Constant exposure of thin or thick skin to friction or pressure stimulates formation of a callus, an abnormal
thickening of the epidermis. The names of the five layers (strata), from the deepest to the most superficial, are: Stratum basale- A single layer of cuboidal to
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columnar cells contains: stem cells- are capable of continued cell division. They multiply and produce keratinocytes, which push up toward the surface and become
part of the more superficial layers. Others migrate into the dermis and give rise to sweat and oil glands and hair follicles. Melanocytes sometimes referred to as the
stratum germinativum to indicate its role in germinating new cells and also contains tactile (Merkel) discs that are sensitive to touch. Stratum spin sum contains 8 to
10 rows (sheets) of polyhedral (many sided) cells that fit closely together appear to be covered with prickly spines (spinosum prickly) because the cells shrink apart
when the tissue is prepared for microscopic examination. Stratum granulosum consists of three to five rows of flattened cells that develop darkly staining granules
of a substance called keratohyalin, which is the precursor of keratin that forms a barrier that protects deeper layers from injury and microbial invasion and makes the
skin waterproof. The nuclei of the cells in the stratum granulosum are in various stages of degeneration. As their nuclei break down, the cells can no longer carry on
vital metabolic reactions, and they die. Stratum lucidum. Normally, only the thick skin of the palms and soles has this layer. Consists of three to five rows of clear,
flat, dead cells that contain droplets of an intermediate substance that is formed from keratohyalin and is eventually transformed to keratin. Stratum corneum
consists of 25 to 30 rows of flat, dead cells completely filled with keratin. These cells are continuously shed and replaced by cells from deeper serves as an effective
barrier against light and heat waves, bacteria, and many chemical.
B. Dermis
The dermis is the layer of skin that lies beneath the epidermis and above the subcutaneous layer. It is the thickest layer of the skin, and is made up of fibrous
and elastic tissue. Thus it provides strength and flexibility to the skin.
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It is composed of connective tissue containing collagen and elastic fibers few cells in the dermis include fibroblasts, macrophages, and adipocytes
is very thick in the palms and soles and very thin in the eyelids, penis, and scrotum tends to be thicker on the dorsal than the ventral aspects of the body and
thicker on the lateral than the medial aspects of the extremities. Blood vessels, nerves, glands, and hair follicles are embedded in the dermis.
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Portions of the dermis:
Papillary region (layer)
The outer portion of the dermis, about one-fifth of the thickness of the total layer, consists of areolar connective tissue containing fine elastic fibers its
surface area is greatly increased by small, finger like projections called dermal papillae, which are nipple-shaped structures that indent the epidermis and many
contain loops of capillaries some dermal papillae also contain tactile receptors called corpuscles of touch (Meissner's corpuscles), nerve endings that are sensitive to
touch dermal papillae cause ridges in the overlying epidermis that leave fingerprints on objects that are handled
Reticular region (layer)
This is the deeper portion of the dermis consists of dense, irregular connective tissue containing interlacing bundles of collagen and coarse elastic fibers its
combination of collagen and elastic fibers in the reticular region provides the skin with strength, extensibility, and elasticity which is readily seen in pregnancy,
obesity, and edema and manifests as silvery white streaks called striate or stretch marks. It is attached to underlying organs, such as bone and muscle, by the
subcutaneous layer, also called the hypodermis or superficial fascia. It is the subcutaneous layer also contains nerve endings called lamellated or Pacinian
corpuscles that are sensitive to pressure nerve endings sensitive to cold are found in and just below the dermis, while those sensitive to heat are located in the middle
and outer dermis.
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Physiology of the Skin
Skin serves several functions, which are: Regulation of body temperature. In response to high environmental temperature or strenuous exercise, the
evaporation of sweat from the skin surface helps lower an elevated body temperature to normal. In response to low environmental temperature, production of sweat
is decreased, which helps conserve heat. Changes in the flow of blood to the skin also help regulate body temperature.
Protection. The skin covers the body and provides a physical barrier that protects underlying tissues from physical abrasion, bacterial invasion, dehydration,
and ultraviolet (UV) radiation. Hair and nails also have protective functions.
Sensation. The skin contains abundant nerve endings and receptors that detect stimuli related to temperature, touch, pressure, and pain.
Excretion. Besides removing heat and some water from the body, sweat also is the vehicle for excretion of a small amount of salts and several organic
compounds.
Immunity. Certain cells of the epidermis are important components of the immune system, which fends off foreign invaders.
Blood reservoir. The dermis of the skin houses extensive networks of blood vessels that carry 8 to 10% of the total blood flow in a resting adult. In moderate
exercise, skin blood flow may increase, which helps dissipate heat from the body. During hard exercise, however, skin blood vessels constrict (narrow) somewhat,
and more blood is able to circulate to contracting muscles.
Synthesis of Vitamin D.
Vitamin D is a group of closely related compounds. Synthesis of vitamin D begins with activation of a precursor molecule in the skin by ultraviolet (UV)
rays in sunlight. Enzymes in the liver and kidneys then modify the molecule, finally producing calcitriol, the most active form of vitamin D. Calcitriol contributes to
the homeostasis of body fluids by aiding absorption of calcium in foods. According to the synthesis sequence just described, vitamin D is a hormone, since it is
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produced in one location in the body, transported by the blood, and then exerts its effect in another location. In this respect, the skin may be considered an endocrine
organ.
The penis is the male sex organ, reaching its full size during puberty. In addition to its sexual function, the penis acts as a conduit for urine to leave the body.
The penis is made of several parts: Glans (head) of the penis: In uncircumcised men, the glans is covered with pink, moist tissue called mucosa. Covering the glans is the
foreskin (prepuce). In circumcised men, the foreskin is surgically removed and the mucosa on the glans transforms into dry skin. Corpus cavern sum: Two columns of
tissue running along the sides of the penis. Blood fills this tissue to cause an erection. Corpus spongiosum: A column of sponge-like tissue running along the front of the
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penis and ending at the glans penis; it fills with blood during an erection, keeping the urethra -- which runs through it -- open. The urethra runs through the corpus
spongiosum, conducting urine out of the body.
An erection results from changes in blood flow in the penis. When a man becomes sexually aroused, nerves cause penis blood vessels to expand. More blood flows
in and less flows out of the penis, hardening the tissue in the corpus cavern sum.
Penis Conditions
Erectile dysfunction: A man's penis does not achieve sufficient hardness for satisfying intercourse. Atherosclerosis (damage to the arteries) is the most common cause
of erectile dysfunction. Priapism: An abnormal erection that does not go away after several hours even though stimulation has stopped. Serious problems can result from
this painful condition. Hypospadias: A birth defect in which the opening for urine is on the front (or underside), rather than the tip of the penis. Surgery can correct this
condition. Phimosis (paraphimosis): The foreskin cannot be retracted or if retracted cannot be returned to its normal position over the penis head. In adult men, this can
occur after penis infections. Balanitis: Inflammation of the glans penis, usually due to infection. Pain, tenderness, and redness of the penis head are symptoms.
Balanoposthitis: Balanitis that also involves the foreskin (in an uncircumcised man). Chordee: An abnormal curvature of the end of the penis, present from birth. Severe
cases may require surgical correction. Peyronie’s Disease: An abnormal curvature of the shaft of the penis may be caused by injury of the adult penis or other medical
conditions. Urethritis: Inflammation or infection of the urethra, often causing pain with urination and penis discharge. Gonorrhea and chlamydia are common causes.
Gonorrhea: The bacteria N. gonorrhea infects the penis during sex, causing urethritis. Most cases of gonorrhea in men cause symptoms of painful urination or discharge.
Chlamydia: A bacteria that can infect the penis through sex, causing urethritis. Up to 40% of chlamydia cases in men cause no symptoms. Syphilis: A bacteria transmitted
during sex. The initial symptom of syphilis is usually a painless ulcer (chancre) on the penis. Herpes: The viruses HSV-1 and HSV-2 can cause small blisters and ulcers on
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the penis that reoccur over time. Micropenis: An abnormally small penis, present from birth. A hormone imbalance is involved in many cases of micropenis. Penis warts:
The human papillomavirus (HPV) can cause warts on the penis. HPV warts are highly contagious and spread during sexual contact. Cancer of the penis: Penis cancer is
very rare in the U.S. Circumcision decreases the risk of penis cancer.
Penis Tests
Urethral swab: A swab of the inside of the penis is sent for culture. A urethral swab may diagnose urethritis or other infections. Urinalysis: A test of various
chemicals present in urine. A urinalysis may detect infection, bleeding, or kidney problems. Nocturnal penis tumescence testing (erection testing): An elastic device worn
on the penis at night can detect erections during sleep. This test can help identify the cause of erectile dysfunction. Urine culture: Culturing the urine in the lab can help
diagnose a urinary tract infection that might affect the penis. Polymerase chain reaction (PCR): A urine test that can detect gonorrhea, chlamydia, or other organisms that
affect the penis.
Penis Treatments
Phosphodiesterase inhibitors: These medicines (such as sildenafil or Viagra) enhance the flow of blood to the penis, making erections harder. Antibiotics:
Gonorrhea, chlamydia, syphilis, and other bacterial infections of the penis can be cured with antibiotics. Antiviral medicines: Taken daily, medicines to suppress HSV can
prevent herpes outbreaks on the penis. Penis surgery: Surgery can correct hypospadias, and may be necessary for penis cancer. Testosterone: Low testosterone by itself
rarely causes erectile dysfunction. Testosterone supplements may improve erectile dysfunction in some men.
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NURSING THEORIES APPLICABLE TO CARE OF CLIENT
CARE, CORE, CURE THEORY: LYDIA E. HALL
Nursing is participation in care, core and cure aspects of patient care, where care is the sole function of nurses, whereas the core and cure are shared with
other members of the heath team. The major purpose of care is to achieve an interpersonal relationship with the individual that will facilitate the development of the
core.
Care is based in the natural an biological science, includes the intimate aspect of bodily care, and is exclusive to nursing like the nursing given to him,
explanation about his condition, emotional attachment, application of the nursing care plan.
Core is based on the social sciences, involves the therapeutic use of self, and is shared with other members of the health care team. This is manifested by the
therapeutic communication skills used during assessment of the patient as well as his significant others. This also deals on the innermost feelings of the client.
Cure is based on the pathological and therapeutic sciences, involves working with the patient and family in relation to medical care, and is shared with other
members of the health care team. This includes the following of the doctor’s order, continuity of nursing and medical care, adherence to medication and hospital
regimen, proper diet and carrying out health care providers role in the care of this patient.
Her the1ory is applicable in the nursing process. The core and cure aspects are applicable to each phase of the nursing process.
Implication:
This theory provides a vivid description of the role of the client, nurses, significant others and the rest of the members of the team in meeting the goals and
objective of care towards the recovery. As a nurse provider, we are considering the best interventions that we can render to our client so that he can be able to
achieve optimum health. The support system also willingly participates in the care of the client by providing the medicines and following other doctor’s order of
their ill family member.
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NURSING HISTORY
Chief Complaints
“Ng hupong akong kinatawo” as verbalized by the patient
Diagnosis
Penile degloving & exclusions of granulomas removal of beads foreign body
History of Present Illness
On October 15, 2018 Mr. BM sees his penile shafts were swollen and disfigured, with irregular semi-mobile masses extending into the scrotum and he
decided to go to the hospital to seek help about his condition that he experiencing. At the hospital, Mr. BM was being assessed and being advised that Mr. BM is
better to be admitted in order for the Doctor to know what is the complication is about.
General Impression
It can be seen in the physical view of the patient that he felt nervous. Even though he felt anxious about his situation, he was still able to manage to answer
some of the questions and communicate well with us. He felt better upon receiving D5LR IL @ 20 gtts/min infusing well on his left metacarpal vein. He was able to
answer relevant questions properly.
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GENOGRAM
FM, 67
PM, 55
Highblood
Heart
Fishermen
Problem
Housewife
FM, 24 AM, 18
BM, 35 BM , 34
JM, 33
Heart Problem HS Student
Fishermen Housewife
Housewife
Penile degloving No known illness Heart Problem No known illness

&exclusions of No known illness
present present
granulomas removal of present
beads foreign body
Legend
Patient
Girl
Boy
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UPDATED APPROACHES FOR MANAGEMENT OF UTERINE FIBROIDS
A penile injury is a medical emergency that afflicts the penis. Common injuries include fracture, avulsion, strangulation, entrapment, and amputation.[1]
What are the types of penile injury?
Fracture
Penile fractures are the result of rupture of the tunica albuginea. They are fairly rare and can co-occur with partial or complete urethral rupture, though this is
rare. Urethral damage occurs in 10–38% of cases.[1] Fractures are treated with emergency surgery, and can be diagnosed with ultrasound, especially in pediatric
cases. Penile fractures are caused by trauma to the erect penis, typically by suddenly bending it laterally during penetrative intercourse with the receptive partner on
top of the penetrating partner, or during masturbation. They can be diagnosed by the "eggplant sign" and are characterized by a loud popping sound at the time of
the injury, the result of the tunica albuginea rupturing. Other symptoms include severe pain, loss of erection, and swelling. Symptoms of urethral injury include
hematuria, blood at the meatus, and dysuria. If left untreated, complications result in 28–53% of cases; these include permanent curvature of the
penis, fistula, urethral diverticulum, priapism, and erectile dysfunction.
Degloving and avulsion
Degloving and avulsion injuries involve the removal of the penis skin, which is a serious medical emergency. Treatment of these injuries involves either
closure of the torn skin, or a skin graft to replace the skin lost in the injury. Skin grafts are constructed to attempt to preserve erectile function and sensation.
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Soft-tissue injuries
Strangulation
Strangulation injuries to the penis, also called incarceration injuries, caused by hair, rubber bands, or other objects are the second most common soft tissue
injury in children. Hair strangulation may be hard to diagnose due to the anatomy of the penis; the hair causing the strangulation may be hidden under the coronal
sulcus if it is swollen. In adults, strangulation injuries that require medical treatment can be caused by a variety of objects typically used for the purpose of sexual
gratification, extending the time of an erection, or enuresis, including metal rings, which must be removed by specialized cutting instruments. The object can also be
removed by decompressing the penis. Because the vasculature of the penis is compressed, a variety of complications can result from strangulation injuries,
depending on whether the veins, arteries, or both are compressed, including mild, reversible vascular obstruction; ischemic necrosis; gangrene and kidney
damage; lymphedema; ulceration; urethrocutaneous fistula, loss of sensation; urethral injury; sepsis; and auto amputation.
Penile strangulation injuries that require medical attention are rare: since their first description in 1755, there have been approximately 60–120 reported cases.
Though usually acute, cases of chronic strangulation and acute cases lasting up to one month have been reported.
Various objects have been involved in cases of strangulation:
 Wedding ring
 Steel ring
 Bottle
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 Chastity belt
Entrapment
The most common soft-tissue injury is an entrapment injury involving the penis caught in a zipper; these injuries are particularly common in young children
who are uncircumcised and are always superficial. They are treated by removing the zipper with local anesthesia using a bone cutter, lubrication, or hacksaw,
dismantling the zipper, or removing the affected tissue, and can be prevented in most situations by circumcision. If not treated promptly, the affected tissue
can swell and become infected. In some cases, emergency circumcision is necessary.
Other
Other soft-tissue injuries to the penis can be caused by burns, animal bites, and human bites. Animal bites are common in children, and dogs are the most
common animals involved. Though typically not severe, animal bites can cause amputation or infection. Treatment for animal bites and human bites involves
antibiotic treatment and closure of the wounds by secondary intention because they are contaminated.
Penis burns can be very severe and often require specialized care in a burn unit to prevent contractures, severe scarring, or other complications including
lymphedema, hypospadias, or necrosis. This treatment can involve debridement, skin grafts, antibiotics, and the use of a suprapubic catheter. Because of its thin
skin, the penis is susceptible to full-thickness, third-degree burns. Burns to the penis typically co-occur with other severe burns. Most thermal penis burns are first or
second degree burns caused by flame; some are caused by grease or boiling water. Electrical burns are typically deeper than thermal burns and require more
extensive tissue removal.
Amputation
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Amputation of the penis can be either partial or complete. Often self-inflicted by people with psychiatric disorders, it may be occur with other trauma, such
as in an assault or a mechanical accident. These injuries are treated by re-implantation if possible, with or without anastomosis of the vasculature to restore erectile
function; skin necrosis and loss of sensation are common complications after treatment. Microsurgery on the vasculature decreases the risk of necrosis significantly.
Klingsor syndrome is a psychiatric disorder that causes self-harm, which can involve the penis. Paranoid schizophrenia, eating disorders, and psychotic breaks can
also be associated with penile injury. In some cases, transgender people who are not able to access genital surgery may self-amputate their penis. Favorable
prognostic factors for replantation of amputated penises include short ischemic time and a clean incision (as opposed to a crush injury or ragged incision).
Replantation of an amputated penis can be done up to 24 hours after the injury, though fewer than 16 hours of cold ischemia or 6 hours of warm ischemia leads to
the best outcomes. If replantation is not possible or desired, a penile stump can be closed and phalloplasty could be performed later.
Penetration
Penetrating injuries can be caused by accidents during sexual activities (typically, by foreign objects inserted into the urethra) by weapons (i.e. bullets)
during wartime, or by stabbing. These injuries can have varying severity and be superficial, affect the corpora cavernosa, other soft tissue, and/or urethra. In 50% of
cases, the urethra is injured. Some foreign objects may be removed like any other penetrating object in soft tissue; using forceps and gentle traction. However, if the
foreign object was inserted into the urethra or has damaged the urethra transversely, urethography is used to avoid further injury to the urinary tract while removing
the object. Penetrating injuries make up approximately 45% of civilian penile injuries.
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Classification
Organ Injury Scale

Grad Description of injury
e
I Superficial injury to the skin (laceration or contusion)
II Injury to the cavernosa/Buck's fascia, no tissue loss
III Avulsion or laceration through the urethral meatus, glans, or cavernosa, or urethral damage less than 2 cm in size
IV Partial penectomy (amputation) or a cavernosal/urethral injury more than 2 cm in size
V Complete penectomy (amputation)
Causes
The causes of penile injury are mostly the same as other causes of trauma; however, penile injury is more likely to occur during sexual intercourse and
masturbation than other traumas. Nocturnal erections and sleeping positions can be another cause of penile injury. Industrial and automobile accidents can also
cause penile injury. Self-injury may also affect the penis.
Diagnosis
Most penile trauma can be diagnosed by visual and physical examination, but in some cases, ultrasonography can indicate the extent of the injury and help a
clinician decide if the injured person needs surgical treatment.
Treatment
25
The type of injury dictates the treatment; however, surgery is a common treatment. Catheterization is usually a part of treatment for penis injuries; when the
urethra is intact, urethral catheterization may be used, but if it has been injured, suprapubic catheterization is used. Some injuries, including animal bites, are also
treated with antibiotics, irrigation, and rabies prophylaxis.
TREATMENT MODALITIES
TREATMENT RATIONALE
December 15, 2018
 Secure consent of admission  This help secure permission for patient treatment
 Vital signs  For baseline data and maintain normal vital signs and detect any changes
26
 Nurse admit under OB By  For patient to be admitted

 DAT, CBC, URINALYSIS  To know the result of each test for further diagnosis
 Monitor BP every shift  For baseline data and maintain normal vital signs and detect any changes
 Pls. inform OR of their patient for penile degloving to proceed on Monday  Enhance patient preparation by reinforcing instructions on preoperative
12-17-18 under spinal anesthesia fasting, medications, anesthesia, and postoperative care.
 Secure consent slip and prepare field of surgery  This helps secure permission for patient treatment.
December 15, 2018
 NPO post-midnight  This could help prevent for getting food or liquid in their lungs during
anesthesia or sedation, which could cause pneumonia or other serious health
problems.
 For penile degloving and incision of fibro-granulomas & foreign body in  Enhance patient preparation by reinforcing instructions on preoperative
A.M. under spinal anesthesia fasting, medications, anesthesia, and postoperative care.
 Prepare field of surgery  Preparation for upcoming surgery

 Cefuroxime 750 mg IVTT on call to OR  This medication is known as a cephalosporin antibiotic. It works by
stopping the growth of bacteria.
11-7
 Received patient on bed, asleep
 BP- 110/70 mmhg  For baseline data and maintain normal vital signs and detect any changes
December 16, 2018
 For penile degloving (+) proceed on Monday (12-17-18)  Enhance patient preparation by reinforcing instructions on preoperative
fasting, medications, anesthesia, and postoperative care.
 On informed consent signed  This helps secure permission for patient treatment.
-no complaints made
7-3
 On bed, awake
 VS monitoring  For baseline data and maintain normal vital signs and detect any changes
 Needs attended, made comfortable  For proper staff/doctor communication or for proper patient care
3.11NPO Post until midnight  Preparing for surgery; patients who have full stomachs are at risk for getting
 Received patient on bed, awake food or liquid in their lungs during anesthesia or sedation.
27
 Care needs attended  for proper patient care
 Forward penile degloving in anesthesiologist  For proper patient care and for further instructions prior to surgery.
December 17, 2018
NPO
7-3
 Received patient on wheelchair with IVF level refusing well
 O2 inhalation administered via nasal cannula @ every 3L  It delivers oxygen gas for the patient to breathe
 Final skin prep done  It is a protective film to help reduce friction during removal of tapes and
films.
 Final counting of instruments, packs, needles count & complete  Help promote optimal perioperative patient outcomes and demonstrate the
perioperative practitioner’s commitment to patient safety.
 Operation ended  For documenting purposes
 To PACU  Vital signs are closely observed, pain management begins, and fluids are
given and recognizing and managing problems in patients after receiving
anesthesia.
 Endorsed to NOP  For patients recovery and further patient care.
28
MEDICAL MANAGEMENT
LABORATORY EXAMS RESULT NORMAL CORRELATION/IMPLICATIONS

VALUES
CBC
WBC 7.9 4.5-10 mm3 Helps fight against infection. For my patient its normal and within normal range. The
total number of white blood cells is often used as indicator of bacterial and viral
infections. For my patients it’s normal.
The red blood cells’ primary function is to carry oxygen in the bloodstream. If the total
RBC 4.42 3.8-5,2 mm3
RBC count is below normal levels, anemia may be present. This may lead to insufficient
supply of oxygen to the body. On the other hand, if the total RBC count is above normal,
polycythemia vera may be present. For my patients it’s Normal.
HGB 14.3 13.0-18.8g/dl High hemoglobin levels are usually present among people living in high altitude levels
and among smokers. It’s the body’s compensatory mechanism in response to low supply
of oxygen. On the other hand, low hemoglobin levels may be present in a variety of blood
diseases like sickle cell disease and thalassemia.For my patient its normal
HCT 49.9 40-52% Hematocrit is also known as packed cell volume or PCV. It reflects the volume
29
percentage of red blood cells in the whole blood. The result is dependent on the size,
structure and total number of red blood cells. Determining hematocrit is helpful in
diagnosing and assessing blood diseases, nutritional deficiencies and hydration status. For
my patient its normal
Macrocytic Anemia: When the number is BIGGER than it should be, this means that the
MCV 97 80-96 FL
cell is LARGER than normal.
Microcytic Anemia: When the number is SMALLER than normal, the cell is too
SMALL. For my patient it’s above normal
MCH 32.2 33-36 g/dL MCH can be used to determine if an anemia is hypo-, normo-, or hyperchromic. For my
patient it’s normal.
MCHC 33.2 33-36 g/dL MCHC, when increased, can be useful clinically as an indicator of increased spherocytes
(spherocytosis), as in hereditary spherocytosis or autoimmune hemolytic anemia. It is also
increased in homozygous sickle cell or hemoglobin C disease. For my patients it’s
normal.
RDW 14.3 11.5-14.5% One reason for a low RDW level is macrocytic anemia. A high RDW (over 14.5%) means
that the red blood cells vary a lot in size. To my patient it’s High.
Determining platelet count is vital in assessing patients for tendencies of bleeding and
PLT 260 150-400
thrombosis.
High Level: Cancer, allergic reactions, polycythemia vera,1 recent spleen removal,
chronic myelogenous leukemia, inflammation, secondary thombocytosis.
30
Low Level: Viral infection, aplastic anemia, leukemia, alcoholism, vitamin B12 and
folic acid deficiency, systemic lupus erythematosus, hemolytic uremic condition. For my
patients its low.
MPV 7.8 7.5-11.5 fL A low MPV count does increase the risk for serious blood loss if you are injured. MPV is
higher when there is destruction of platelets.
If a person is sick, and sepsis is suspected, the procalcitonin lab would then be drawn to
PCT 0.203 0.05- mg/mL
help determine if an infection is present.
PDW 12.3 8.3-25.0 fL Normal PDW indicates platelets that are mostly the same size, while a high PDW means
that platelet size varies greatly, a clue that there may be a disorder affecting platelets.
URINALYSIS
Urine color Yellow Yellow to dark In visual examination, the urine sample is inspected for color, cloudiness and odor.
yellow Clear to dark yellow – normal.
Amber to honey yellow – dehydration.
Orange – dehydration, intake of rifampicin, consumption of orange food dye.
Urine is usually clear but its color may be affected by certain medications and foods. If
Transparency Hazy Clear or cloudy
cloudiness and unpleasant odor are present, there might be infection in the urinary tract
system.For my patient it’s normal.
Specific gravity reflects how concentrated the urine is. It can measure the proportion of
Specific Gravity 1.010 1.005-1.030
solutes present in the urine when compared to pure water. Determining specific gravity is
useful when you want to detect a particular substance in the urine sample. For example, if
you suspect that a patient secretes small amounts of protein in the urine, the first
morning-void urine is the best sample because it has high specific gravity and appears
31
concentrated.
Glucose should not be present in the urine. However, in some circumstances the renal
Glucose Negative (-) Negative
threshold allows the excretion of glucose in the urine when the blood glucose levels are
too high. The conditions that can cause glucosuria are pregnancy, diabetes mellitus, liver
diseases and hormonal disorders. For my patient its normal.
Other types of protein compounds are not detectable in dip stick test and can be measured
Protein Negative (-) Negative or traces
through a different urine protein test. Conditions that usually produce high amounts of
protein in the urine include preeclampsia, multiple myeloma, inflammation, urinary tract
injuries, malignancies and other disorders that destroy red blood cells. For my patients it’s
normal.
The pH level of the urine is related to the acid-base balance maintained by the body.
pH 7.0 7.35-7.45
Therefore, consumption of acidic or basic foods as well as the occurrence of any
condition in the body that produces acids or bases will directly affect the pH of the urine.
In some circumstances, too acidic or basic urine produces crystals. When this
phenomenon happens inside the kidney, kidney stones can develop. For my patient its
normal.
MICROSCOPIC
EXAMINATION
0-1 0.4 p.v.f Presence of pus cells in urine is a definite indication of some type of infection. Pus is a
Pus Cells whitish or yellowish or slightly green substance which is thick like glue. Pus in urine
signifies that the body is fighting an infection in the lower or upper urinary tract. For my
patient it’s normal.
RBCs are present in the urine sample of a person with severe urinary tract infection, renal
Red Cells 5.10 0.4 p.v.f
disorders, urinary tract injuries and inflammation. It can also reflect improper collection
32
of urine specimen (e.g. Urine contaminated by blood from menstruation or hemorrhoids).

In a normal urine specimen, there are few epithelial cells that can be seen under
Epithelial Cells Moderate 0.4 p.v.f
microscopic examination. However, in cases of severe urinary tract infection,
inflammation and malignancies, there will be increased number of epithelial cells in the
urine. Elevated number of epithelial cells can also signify improper collection of urine
specimen, especially if it is not collected using the midstream-catch technique.
Crystals can be formed from the solutes of the urine especially if the urine is concentrated
Crystals Negative No crystal present
or when the pH is too high or too low. Examples of casts that are not typically present in
the urine include leucine, cystine and tyrosine. These casts may signify malignancies and
abnormal metabolic processes. For my patient it’s normal.
Threads appear as fibers bundled together to form a pale, irregular, longitudinal fragment
Mucous Threads Few No, some
that is narrow on one end. For my patients its normal.
When the urine is refrigerated, amorphous urates might develop in the sample. This is
Amorp. Urates Few A few
detected when the urine is put through a centrifuge, which is part of the analysis process.
Tiny pink pellets will appear during this process. When the urine is examined under a
microscope, these amorphous urates might appear as particles that are yellow or yellow-
brown in color. For my patients its normal.
If microbes are seen, they are usually reported as "few," "moderate," or "many" present
Bacteria Moderate No
per high power field (HPF). Bacteria from the surrounding skin can enter the urinary tract
at the urethra and move up to the bladder, causing a urinary tract infection (UTI).
33
Drug study
Doctor’s Order: CEFUROXIME 750 mg IVTT q hrs
Generic Name: CEFUROXIME
Brand Name: Zoltax
Classification: Antibiotic
Mechanism of Action: Second-generation cephalosporin that inhibits cell-wall synthesis, promoting osmotic instability; usually bactericidal.
Side Effects: Thrombophlebitis (IV site); pain, burning, cellulitis ( IM site);superinfections, positive Coombs' test.
Adverse Effects: Large doses can cause cerebral irritation and convulsions; nausea, vomiting, diarrhea, GI disturbances; erythema multiform, Stevens-Johnson
syndrome, epidermal necrolysis. Potentially Fatal: Anaphylaxis, nephrotoxicity, pseudomembranous colitis.
Drug to drug interaction: Probenecid increases the concentration of cefuroxime in the blood. Drugs that reduce acidity in the stomach (for example, antacids,
H2-blockers, proton pump inhibitors) may reduce absorption of cefuroxime
Contraindications: Contraindicated in patients hypersensitive to drug. Use cautiously in patients hypersensitive to penicillin because of possibility of cross-
sensitivity with other beta-lactam antibiotics.
34
Nursing Responsibilities: Determine history of hypersensitivity reactions to cephalosporin, penicillin and history of allergies particularly to drugs before
therapy is initiated.
Report onset of loose stools
Absorption of cefuroxime is enhanced by food.
Notify prescriber about rashes or super infections.
Instruct patient to use with caution in breast-feeding women and inpatients with history of colitis or renal sufficiency.
35
Physical Assessment
HEALTH HISTORY NORMAL FINDINGS PHYSICAL FINDINGS
A. Integumentary System Skin Skin

As claimed by the client, he has no history of •Evenly colored skin tone without usual or •Skin is brownish in color and is consistent with the
alopecia and other skin problems. He has not prominent discoloration. client’s race. Brown complexion is noted at the exposed
experienced any skin condition that causes •Client has slight or no odor of perspiration, areas of the client while the unexposed areas are lighter in
lesions to the integumentary system. No depending on activity. color. Skin is smooth with equal distribution of hair
previous hospitalization due to skin disease. •Skin is brown, intact and no lesion. No bilaterally. Oiliness noted in all areas of the body. No
No history of surgery due skin disorder. presence of nodules. papule, macule or vesicle noted to the client. Skin
•Skin is intact and there are no reddened areas. bilaterally warm to touch. No unusual odor noted. Calluses
•Skin is smooth and even. noted on hands and sole of the feet. Upon palpation, skin is
•Normally thin but presence of calluses (rough, non tender. Skin is easily lifted and returns to non-
thick section of epidermis) are common on areas stretched phase more than 3 seconds.
of the body that are exposed to constant  Skin is swelling in the penis area
pressure.  Skin is having discoloration in the penis area due to
•Moist to dry. beads inside
•Older client’s skin may feel dyer that a younger  Skin is red in color
36
skin because sebum production decreases with

age. Nail
•Skin is warm in temperature. Noted some dirt within the nails. Nails is translucent and is
•Skin pinches easily and immediately returns to smooth. Absence of clubbing to all nails (foot and hand).
original position. Nail has no sharp edges. Nail bed is pinkish in color.
Nail Lunular is present. Capillary refill noted less than 3
• Nails are clean seconds.
As Verbalized by the client, he has no history • Pink tone should be seen
of in-grown and has no fungal infection. • 160 angle between the nail base and the
skin Head- The head of the client is rounded; norm cephalic and
• Nails are hard and immobile. symmetrical.
Head: absence of nits and scaliness, lesions,
deformities and lumps
• Quantity: Hair is thick, long and wavy
According to the client, he has no any • Distribution: hair is equally distributed
infections on his head and no deformities • Texture: coarse Face- The face of the client appeared smooth and has
noted. There are no nodules or masses and uniform consistency and with no presence of nodules or
depressions when palpated. Face: masses.
• Contour: Oval Shape, brown in color
• Symmetry: Symmetrical Eyes and Vision- The eyes and the vision of the patient are
As claimed by the client, he has no pimples or • Involuntary movements: There is no normally within the limit because she don’t have any
discharge on his face. And he has no history involuntary movements such as ticks in the eye discharges on her eyes.
37
of any involuntary movements on her face. • Edema: absence of edema The Eyebrows also of the patient are equally distributed:
And there is no achene noted. • Absence of masses and pustules Quantity: Equally distributed
Absence of masses nodules, lumps and scaliness
Eyes and Vision Eyes:
Conjunctiva and sclera: Conjunctiva is moist, glossy and
 Eyebrows: Hair is evenly distributed.
pinkish while Sclera is china white in color
The client’s eyebrows are symmetrically
Noted Eye bags due to lack of sleep in the hospital and also
aligned and showed equal movement when
the environmental manipulation also in the hospital.
asked to raise and lower eyebrows.
Cornea and Lens: No opacities or cloudiness, it is clear,
 Eyelashes: Eyelashes appeared to be
As verbalized by the client, he don’t have any shiny and smooth
equally distributed and curled slightly
problem on his eyes, there is no history of Eyelids: position is symmetrical, absence of edema, and is
outward.
astigmatism and also any operation on his same color of the skin
 Eyelids: There were no presence of
eyes. And there is no discharges on his eyes When patient opens or closes her eyes, there is adequacy of
discharges, no discoloration and lids close
also. he don’t have any cataract on his eyes he closure and it is also symmetrical
symmetrically with involuntary blinks
is very caring in terms on her health There are Absence of masses also on her eyes.
approximately 15-20 times per minute.
especially on his eyes.
 Eyes
 The Bulbar conjunctiva appeared transparent

with few capillaries evident.
o The sclera appeared white.
o The palpebral conjunctiva
38
appeared shiny, smooth and pink.

o There is no edema or tearing of
the lacrimal gland.
o Cornea is transparent, smooth
and shiny and the details of the iris are
visible. The client blinks when the cornea
was touched.
o The pupils of the eyes are black
and equal in size. The iris is flat and round.
PERRLA (pupils equally round respond to
light accommodation), illuminated and non-
illuminated pupils constricts. Pupils constrict
when looking at near object and dilate at far
object. Pupils converge when object is
moved towards the nose.
o When assessing the peripheral Ears and Hearing-
visual field, the client can see objects in the Upon palpation, client doesn’t feel any tender, absence of
periphery when looking straight ahead. nodules and the texture of the skin was smooth.
o When testing for the Extra Upon inspection, the size is not too small and not too large,
ocular Muscle, both eyes of the client the shape was oblong and symmetrical with each other and
coordinately moved in unison with parallel the auricles are level with each other whose upright point
alignment. of attachment is in straight line with the lateral canthus of
39
o The client was able to read the the eye the position was vertical and the color of the skin
newsprint held at a distance of 14 inches. was the same with the color of his skin. There were no
discharges or impacted serumen and its color way
Ears and Hearing uniformly pink with tiny hair in the outer part.
 Ears: The Auricles are symmetrical and

As verbalized by the client, he don’t have any Nose:
has the same color with his facial skin. The
history about on his ears, neck and nose, he Upon inspection, the external structure of the nose is
auricles are aligned with the outer canthus
don’t even went to hospital for medical symmetrical, smooth, same color of the face and has no
of eye. When palpating for the texture, the
checkup. There is no masses and discharges deformity.
auricles are mobile, firm and not tender. The
of the areas. Upon inspection of the nasal mucosa, the color was pink,
pinna recoils when folded. During the
and moist without lesions, there were no swelling, exudates
assessment of Watch tick test, the client was
and bleeding occurred.
able to hear ticking in both ears.
Upon inspection of nasal septum, it is close to the midline,
and thicker in the anterior portion than in the posterior.
Upon inspection of the inferior and middle turbinates, the
Nose and Sinus color was pinkish and there were no swelling, exudates and
polyps.
 Nose: The nose appeared symmetric, Upon palpation of the frontal and maxillary sinuses, there
straight and uniform in color. There was no were no signs of tenderness.
presence of discharge or flaring. When Upon palpation, there were no signs of tenderness and there
lightly palpated, there were no tenderness and were no nodules and masses presence.
lesions Mouth:
40
 Mouth: Lips: the color of client’s lips is somewhat pallor, there

o The lips of the client are were no lumps, it is symmetrical and there were no ulcers
uniformly pink; moist, symmetric and have a but her lips have little cracks.
smooth texture. The client was able to purse Gums/Buccal Mucosa: Upon inspection, the color was
his lips when asked to whistle. pink, it was moist, smooth, with tight margin at each tooth.
o Teeth and Gums: There are no There were no edema, retraction, bleeding and lesions.
discoloration of the enamels, no retraction of Teeth: There were no missing tooth, loose tooth
gums, pinkish in color of gums Tongue: The dorsum of the tongue was dull red, moist and
o The buccal mucosa of the client its texture was slightly rough on the top surface, and
appeared as uniformly pink; moist, soft, smooth along the lateral margins. As the client sticks out
glistening and with elastic texture. her tongue and move it side to side, there were no
o The tongue of the client is deviation, and limitation in movement. The tongue was
centrally positioned. It is pink in color, moist symmetrical with each inspection, floor of the mouth, the
and slightly rough. There is a presence of thin ventral surface, was pink and smooth with large veins
whitish coating. between the frenulum folds.
o The smooth palates are light pink Neck:

The neck muscles were symmetrical, without scars, growth
and smooth while the hard palate has a more
and enlargement of parotid glands. Patient’s head moves
irregular texture.
freely without discomfort or dizziness, lymph nodes are not
o The uvula of the client is
palpable. The patient’s trachea was located in the midline
positioned in the midline of the soft palate.
of the neck just above the suprasternal notch. Thyroid
gland cannot be visualized.
41
As verbalized by the client, he don’t have Any

History of neck fracture and also he don’t
have any masses on her neck.  Neck: Upon doing assessment patient has no presence of any
o The neck muscles are equal in problem of his heart.
size. The client showed coordinated, smooth
head movement with no discomfort. Abdomen:
o The lymph nodes of the client are Upon palpation of the client abdomen, the abdomen is not
not palpable. tender... Liver and spleen are not palpable.
o The trachea is placed in the Upon auscultation, bowel sounds were 19 bowel sound/min
midline of the neck. (RLQ) absence of bruit sounds.

As claimed by the client, she don’t have any o The thyroid gland is not visible Upon percussion, the spleen and the liver were dull.
history of operation on her heart and also on Unblemished skin, uniform in color, symmetric contour,
on inspection and the glands ascend during
her abdomen, there is no masses or any not distended.
swallowing but are not visible.
tenderness noted.
 Heart: There were no visible pulsations
on the aortic and pulmonic areas. There is -Upon Inspection, when the client breathes, there is no
no presence of heaves or lifts. evidence of accessory muscle use. As the client inhales,
 Abdomen: The abdomen of the client there is obvious lung expansion. Skin is consistent to the
has an unblemished skin and is uniform in client’s race and similar to the surrounding skin.
colour. The abdomen has a symmetric Upon palpation, no tenderness noted to both anterior and
42
contour. There were symmetric movements posterior chest. No palpable lymph nodes noted.
caused associated with client’s respiration. Tactile Fremitus diminishes as the hand lowers down from
o The jugular veins are not visible. upper part of the anterior and posterior chest down to the
Respiratory System o When nails pressed between the lower area of the anterior and posterior chest. When two
According to the client he has no problem of fingers (Blanch Test), the nails return to thumb is placed on the T10 area of the client, the lung
difficulty in breathing and a problem of usual colour in less than 4 seconds. expands symmetrically.
speaking. Upon Percussion, Both anterior and posterior is resonant.
•Palpation No wheezing sounds noted. Upon Auscultation of the anterior chest, 3 types of
Increased tactile fremitus normal oxygen saturation respiration is noted. No abnormal breath sounds noted.
•Percussion position of Upon auscultation of the posterior chest, no abnormal
Dullness on percussion sternum is breath sounds noted.
level with ribs
Auscultation -no masses Noted sound wheezing in her posterior chest area, and
•clear breath sounds -lungs clear upon inspection the client is using accessory muscle
•Bronchial breath sounds upon Equal in size both sides of the body, smooth coordinated
auscultation
•Percussion movements, 100% of normal full movement against gravity
Dullness on percussion and full resistance
Auscultation Without scars and lesions on both extremities.

As claimed by the client she don’t have any •normal breath sounds
history of past operations like fracture etc., •Bronchial breath sounds
she can moves freely. •Increased vocal fremitus
Extremities
43
 The extremities are symmetrical in size

and length.
 Muscles: The muscles are not palpable
with the absence of tremors. They are
normally firm and showed smooth,
coordinated movements.
 Bones: There were no presence of bone
deformities, tenderness and swelling.
 Joints: There were no swelling,
tenderness and joints move smoothly.
GORDON’S FUNCTIONAL HEALTH PATTERN
USUAL FUNCTIONAL PATTERNS INITIAL APPRAISAL ONGOING APPRAISAL
I. Health perception – Health management

pattern  Describes health as poor.  Describes health as poor.
 General health is good.  Admission due to swelling of penis skin area.  Rates pain as 5 on a scale of 0-10
 No known illness  Rates pain as 7 on a scale of 0-10 “gahupong ako kinatawo” as verbalized by
 No bad habits “sakit jud kayo ako kinatawo” as verbalized the patient.
 Complete immunization by the patient.  Diet: NPO For penile degloving and
 Vitamins: Vitamin C  The doctor doesn’t allow letting the patient incision of fobro granuloma and foreign
44
 Do walking as an exercise and take any food or liquid due to the procedure body under spinal anesthesia
fishing every time he goes home  NPO  Medication:
from school  Weight estimated is 55 kg  Cefuroxime 750mg IVTT onroute to OR
 Good appetite  Medication:  “sakit kayo akong kinatawo mangehi ko”
 Eats green leafy vegetables and  Cefuroxime 750mg on call to OR as verbalized by the patient
fruits.  Vital signs:  “wala may lami i’lihok kay mo sakit man
 No known allergies  BP: 134/74 mmhg siya pag mangusog ko” as verbalized by
 T: 35oC the patient
 RR: 18 cpm  Vital signs:
 P: 58 bpm  BP: 110/80
 T: 36.3’C
 Complained of being very hungry.  RR: 21 cpm
 NPO  P: 78bpm
 IVF refusing well
 O2 inhalation administered via nasal canula
 No known allergies
UTZ result: enlargement of penis and swelling of
penis for penile degloving +
II. Nutrition – Metabolic pattern
 Breakfast: Rice 1 cup, fish, milk 1  NPO
glass,  Diet is NPO
 Lunch: Rice 1-2 cups, fish or meat,  “Paminaw nako mura man ko og naniwang
water ma ayo” as verbalized by the patient
 Dinner: Rice 1-2, fish/ meat, water.
 No dental problem
 Appetite: Good
 Food Restrictions: None
 No skin lesions, no allergies
III. Elimination Pattern

 Bowel movements depend on the  Urine is yellow in color.
food intake.
 Urine Dark yellow in colour with clear blood.
45
 Urinary elimination is normal, no  Pre op urine: 100cc

substance or problems in control.  Post op urine: 100cc
 No problem in urinary tract
IV. Activity Exercise Pattern  Claims to be bored, anxious about his health.  “Gi kapoy nko dris hospital” as verbalized
 Walking going home from school  Always complaining about the pain he felt in by the patient
describe as an exercise for him. his ‘’kinatawo’’  “Sakit ra japon akong tahi” as verbalized
 Usual daily routine by the patient.
 6:30 prepare for school
 7:00 – 12nn working as
fisherman
 12nn-1pm Eating lunch
 1pm-4:30pm going home
 6pm – 8pm preparing for
dinner
 9-10 preparing to sleep
 Leisure activities: watching TV and
playing with son  Usual sleep pattern:
 Usual sleep pattern: Onset: 9:30pm
V. Sleep-Rest Pattern Onset: 8pm Awakening: 230:00 am
 Usual sleep pattern Awakening: 4am-5am ‘’wala kayo ko katulog ky gutom nya sakit
Onset: 9 or 10 pm “depend ras unsa “wala ko kayo tulog kay sige ra sakit ako ako pamate sa ako kinatawo’’ as verbalized
oras kung katulogon nako’’as paminaw og pamukaw na sakit kayo’’ as by the patient.
verbalized by the patient. verbalized by the patient.  Sleep problem: occasional awakening due
Awakening: 4am or 5am Sleep problem: occasional awakening due to to pain felt in the penis area.
 # of hurs of sleep: 8 to 9 hours pain felt in the penis area.
 Sleep aids: none
 Sleep problems: none
 Complains on and off pain.
 Rates pain as 7 on a scale of 0-10
VI. Cognitive-Perceptual Pattern  Complains on and off pain  When it pains he always call his wife
46
 No sensory-perception deficits  Rates pain as 7 on a scale of 0-10  Facial grimacing is present when pain felt.
 She’s a Public School Teacher  When in pain, facial grimacing.  “luya ako lawas” as verbalized by the
 Finds easy to learn in life.  Restlessness patient.
VII. Self Perception Pattern  Always bothering his wife to let them
 Describes self as a good father  Doesn’t want to be hospitalized because he discharge from hospital.
 Easily cope problems in life. doesn’t want to feel any pain.  Doesn’t want to be hospitalized that’s why
 Doesn’t want to talk more due to the pain he he wants to go home.
felt.  Always worrying about his son and wife
 Her parents especially his wife are very
alert when he wants someone to help him.
VIII. Role – Relationship pattern  Wife is always at the bed side.
 Language spoken at home: Dialect  His family is very attentive to his needs
 Lives with his own house  He always call his wife when he was in pain.  Eager to go back to school and at home
 Turns to his wife every time he has
a problem.
 Dependent on his own life
 Cannot decide alone he always
asking plan to hi live in partner
 No difficulties in relating with his
family.
 Have many friends at home
 No problem
IX. Sexuality-Reproductive Pattern  Aware of gender equality.  Sexually active
 Active sexuality  Sexually active
 Playing always with his son as his stress
X. Coping – Stress Management Pattern  Always sharing his problem to his wife reliever
47
 Always make decisions with his

family.
 When stress he want to sleep and
watch television and always
working and finding food as a  Feels sad and anxious about his
fisherman complications / situation.
XI. Value-Belief pattern  he feels bad about is hospitalization.  he wants to go home and sleep at home.
 Finds God as a source of strength. “dli man ko ganahan ma hospital unya kapoy  “maayo na unta og ma discharge name kay
 Goes to church every Sunday pod og gasto kayo pud” as verbalized by the makakapoy ra sige higda dri hospital nya
together with his family. patient. gahunahuna ko gasto” as verbalized by the
 he wants to go home as soon as possible patient
 he misses his son and wife everyday  Always pray for fast recovery
 His faith is greater than his fear.
 Always pray at night.
 he prays that he will be discharged and no
pain felt at all.
Foundation University
COLLEGE OF NURSING
Dumaguete City
Bibliography
Books
Bunner & Suddarth (2006) Medical-Surgical of Nursing 12th Edition.
48

Foundation University Mission, Vision & Life Purpose: Penile Degloving: A Case Presentation

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PENILE DEGLOVING: A CASE PRESENTATION

FOUNDATION UNIVERSITY MISSION, VISION & LIFE PURPOSE

Name: B.T.M Gender: Male Age: 32y/o

Address: Maria, Siquijor Birth-date: 08/28/198 Civil Status: Single

Religion: Roman Catholic

Date of Admission: Dec 15, 2018 (1:44PM)

Past Health History:

GROWTH AND DEVELOPMENTAL TASK

SIGMUND FREUD’S PSYCHOSEXUAL THEORY

all pleasure came from its discharge.

this sets up a conflict between frustrated wishes and social norms.

The Role of Conflict

JEAN PIAGET COGNITIVE DEVELOPMENT

important differences between the thinking of adults and children.

children think in strikingly different ways compared to adults.

knowledge are based.

responsible through it would be their utmost priority.

KOHLBERG MORAL DEVELOPMENT

ANATOMY AND PHYSIOLOGY

Portions of the dermis:

Papillary region (layer)

Reticular region (layer)

and outer dermis.

Physiology of the Skin

spongiosum, conducting urine out of the body.

affect the penis.

NURSING THEORIES APPLICABLE TO CARE OF CLIENT

CARE, CORE, CURE THEORY: LYDIA E. HALL

“Ng hupong akong kinatawo” as verbalized by the patient

Penile degloving & exclusions of granulomas removal of beads foreign body

History of Present Illness

Penile degloving No known illness Heart Problem No known illness

UPDATED APPROACHES FOR MANAGEMENT OF UTERINE FIBROIDS

What are the types of penile injury?

penis, fistula, urethral diverticulum, priapism, and erectile dysfunction.

Degloving and avulsion

damage; lymphedema; ulceration; urethrocutaneous fistula, loss of sensation; urethral injury; sepsis; and auto amputation.

Various objects have been involved in cases of strangulation:

can swell and become infected. In some cases, emergency circumcision is necessary.

extensive tissue removal.

Organ Injury Scale

 Nurse admit under OB By  For patient to be admitted

 Prepare field of surgery  Preparation for upcoming surgery

LABORATORY EXAMS RESULT NORMAL CORRELATION/IMPLICATIONS

of urine specimen (e.g. Urine contaminated by blood from menstruation or hemorrhoids).

Doctor’s Order: CEFUROXIME 750 mg IVTT q hrs

Generic Name: CEFUROXIME

Brand Name: Zoltax

Report onset of loose stools

Absorption of cefuroxime is enhanced by food.

Notify prescriber about rashes or super infections.

HEALTH HISTORY NORMAL FINDINGS PHYSICAL FINDINGS

A. Integumentary System Skin Skin

skin because sebum production decreases with

 The Bulbar conjunctiva appeared transparent

appeared shiny, smooth and pink.

alignment. of attachment is in straight line with the lateral canthus of

 Ears: The Auricles are symmetrical and

 Mouth: Lips: the color of client’s lips is somewhat pallor, there