RUA: Discharge Teaching Guidelines

Everything you are going to need is in the attachment with all the instructions and don’t forget to do as it asks. Topic “Breastfeeding.”

I need five slides of PowerPoint on numbers 4 and 5. Introduction to Topic and Reference One Statistic. Identification of Risk Factors and/or Benefits. I need a side note on each slide, also don’t forget to put images to support the slides. RUA: Discharge Teaching Guidelines

Supports ideas with scholarly literature.

NR327_RUA_Discharge_Teaching_Guidelines_May20_v2.pdf
RUA-CircumcisionDosDont1.pptx

Presented by:

Discharge Teaching: The Do’s & Don’t of Circumcision

Introduction and Purpose

To provide instructions of care

Purpose 3

To provide information of risk & benefits

Purpose 2

To Define Circumcision

Purpose 1

To provide resource information

Purpose 4

In this presentations we will define circumcision and give a statistical information on the importance of it.

We will provide information on the risk and benefits of circumcision

There will be information of the different techniques used to perform the circumcision procedure and who does them

We will give information on what to expect after the procedure, care instructions, and when to seek medical attention

We will provide resource information

And discuss the recommended health promotion of circumcision

Statistical Information

RUA: Discharge Teaching Guidelines

Circumcision reduces the risk of contracting HIV

Increase risk of UTI for uncircumcised infants

Circumcision is on the decline

Across the 32-year period from 1979 through 2010, the national rate of newborns circumcision declined 10% overall from 64.5% to 58.3% with and overall percentage of hospitalized infants there were 64.9% of males being circumcised in 1981 which again a decline to 55.4% by 2007

According to the World Health Organization (WHO), there is compelling evidence to suggest that circumcision reduces the risk of contracting HIV during vaginal sex by 60%. (Newman, 2020)

It is estimated that 10 of 1000 (1%) uncircumcised male infants will develop a UTI during the first year of life compared with 1 of 1000 (0.1%) circumcised male infants who do.

Reference:

Newman, T. (2020, April 24). Benefits and Risks of Circumcision:MedicalNewsToday.com. Retrieved (09/13/2021) from Circumcision: Possible benefits, recovery, and risks (medicalnewstoday.com)

Owings, M., Uddin, S., and Williams, S. (2015).Trends in Circumcision for Male Newborns in U.S. Hospitals: 1979-2020: Centers for Disease Control and Prevention. Retrieved (09/06/2021) from Products – Health E Stats – Trends in Circumcision Among Male Newborns Born in U.S. Hospitals: 1979–2010 (cdc.gov)

Shapiro E. (1999). American academy of pediatrics policy statements on circumcision and urinary tract infection. Reviews in urology, 1(3), 154–156. Retrieved (09/06/2021) from American Academy of Pediatrics Policy Statements on Circumcision and Urinary Tract Infection (nih.gov)

What is Circumcision?

Circumcision is an elective surgical procedure to remove the foreskin, also called the prepuce, from the head of the penis.

As I mentioned this procedure is elective and requires parental consent to be performed by the pediatrician or the obstetrician.

The foreskin is a double-layered fold of skin that protects the head (glans) of the penis from dryness and irritation that may be caused by contact with urine, feces, and clothing.

And according to Chamberlain University, (2021) “ it is noted that the benefits are not so great that procedure should be routinely recommended for all infants.”

Reference:

Chamberlain University. (2021). Module, Week 5: Diagnostic and Laboratory Tests for Newborn, NR327 – Maternal Child Nursing: Chamberlain University College of Nursing. Retrieved (09/27/2021) from https://chamberlain.instructure.com/courses/89158/pages/week-5-diagnostic-and-laboratory-tests-for-newborns?module_item_id=12699014

Miles, K. (2021, Feb. 5). Circumcision in newborn boys: babycenter.com. Retrieved (09/02/2021) from https://www.babycenter.com/baby/newborn-baby/circumcision-in-newborn-boys_10419911

Image Address: https://www.babycenter.com/ims/2020/01/bc-circumcision-logo-updated-2020_wide.jpg.pagespeed.ce.Ggz4Bq6Ubl.jpg

The Risk of Circumcision

Blood loss and Hemorrhage can occur

cut too short or left too long

Amputation of the head of the penis

wound doesn’t heal properly, septicemia develops

ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS

Foreskin

Blood Loss

Poor Healing

Amputation

RUA: Discharge Teaching Guidelines

Circumcision is normally a safe procedure and severe complications are rare, but there is still some risk to consider with circumcision.

Such as the foreskin being cut too short or left too long by the surgeon and the foreskin left behind might reattach to the penis and require further minor surgery

Damage can be done to the urethra which can make urination difficult.

The wound does not properly heal and Septicemia, which is a Blood infection or poisoning can develop

There may be excessive blood loss or hemorrhage

And in rare cases, there may be accidental amputation of the head of the penis

Reference:

Newman, T. (2020, April 24). Benefits and Risks of Circumcision:MedicalNewsToday.com. Retrieved (09/13/2021) from Circumcision: Possible benefits, recovery, and risks (medicalnewstoday.com)

Why Choose Newborn Circumcision

Muslims and Jews

Religion

Reduces the bacteria that can live under the foreskin

Hygiene

Decreased risk of STIs later in life

Health

Less risk of urinary tract infections

Lower Risk

Foreskin can be used to repair defects

Repair

RUA: Discharge Teaching Guidelines

Why some parents may choose to have their newborn circumcised?

Well for one, it may be for religious purposes. It is part of the Muslims and Jews cultural or religious practice to have their newborn males circumcised.

Another reason is for hygiene purposes, it will help to reduce the bacteria that can grow and live under the foreskin

Then to promote future sexual health, being circumcised will decrease the risk of sexually transmitted infections later in life

And lower the risk for urinary tract infections

Citation for above information (The American College of Obstetricians and Gynecologist (ACOG), 2019)

And lastly the foreskin can be used for defect repair such as the repair of hypospadias.

Hypospadias is when the urethra (the tube that carries urine from the bladder to outside the body) does not end at the tip of the penis but instead, it ends on the underside of the penis.

It is recommended that the baby is not circumcised right away after birth, but wait until he is about 6 months to 2 years of age and perform the procedure and uses the foreskin to repair the defect. (MedlinePlus Medical Encyclopedia, 2019). RUA: Discharge Teaching Guidelines

Reference:

The American College of Obstetricians and Gynecologist. (2019). Newborn Male Circumcision: American College of Obstetricians and Gynecologist (ACOG). Retrieved (10/5/2021) from https://www.acog.org/womens-health/faqs/newborn-male-circumcision#:~:text=Circumcision%20reduces%20the%20bacteria%20that,the%20first%20year%20of%20life.

MedlinePlus. (2019). Hypospadias Repair: U.S. National Library of Medicine: MedlinePlus. Retrieved (10/05/2021) from https://medlineplus.gov/ency/article/003000.htm

There are three common circumcision methods, namely, Mogen clamp, Plastibell device and Gomco clamp (Razzaq et al., 2018).

Surgical procedure in babies circumcision

Parents must be very keen about where they take their newborns for circumcision. The operation is crucial just like any other surgical procedure. Therefore, it must be done by an expert to ensure it is done in the right way and avoid complications in future.

ØThe choice of technique used depends on the physicians’ experience and preference.

ØThe primary purpose of the operation regardless of the technique is to cut and remove the foreskin.

ØDuring the procedure, the child lays on the back, with legs and arms secured.

ØAn anesthetic is administered to the baby through cream or injection to numb the penis.

Gomco Clamp Circumcision Procedure

The Gomco clamp is a metal device with a bell-shaped end. During circumcision using a Gomco clamp, the baby’s foreskin is stretched over the bell, and the clamp is tightened over his foreskin. If the foreskin can’t be pulled back (is not retractable), it usually needs to be cut before the clamp is put in place. The foreskin is cut away and the clamp removed. According to Bawazir (2020), Gomco circumcision is the safer method and is accompanied with lowest rate of complication compared to the plastibell procedure

For video to view of procedure:

https://med.stanford.edu/newborns/professional-education/circumcision/gomco-clamp-technique.html

Mogen Clamp Circumcision Procedure

The Mogen clamp does not require a cut in the foreskin before its placement.During a circumcision using a Mogen clamp, the baby’s foreskin is pulled forward through the hinge of the clamp. The clamp is closed and locked in place for about 90 seconds, crushing the foreskin to decrease bleeding. The foreskin is removed surgically and the clamp taken off.

Reference:

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.semanticscholar.org%2Fpaper%2FFeasibility-and-acceptability-of-early-infant-male-Mavhu%2F3e760180ad9354635c5105b77c841d47f21223b5%2Ffigure%2F19&psig=AOvVaw0H1PkXHxfVs6tb0FMA8pLN&ust=1632191825890000&source=images&cd=vfe&ved=0CAwQjhxqFwoTCNjxws_CjPMCFQAAAAAdAAAAABAQ

Plastibell Technique Circumcision

Above picture shows the step by step procedure for plastibell technique. The good thing about this technique is parent just have to keep the penis area clean, there is no need for vaseline or gaze because there is nothing exposing it as a raw wound, the wound is in between the string and the ring of the plastibell. The Plastibell has the advantage of continuing hemostasis after the procedure is over, as the suture remains in place for a few days. The disadvantage is that there is a foreign body at the site, which could become dislodged or infected.

Reference:

https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.obstetricexcellence.com.au%2Fbaby%2Fcircumcision%2F&psig=AOvVaw1sUZEs8NDGk2jSzc4r4ZaC&ust=1632192686219000&source=images&cd=vfe&ved=0CAwQjhxqFwoTCOiVlq3GjPMCFQAAAAAdAAAAABAE

Who Performs the Procedure

Obstetrician-gynecologist

Pediatrician

Urologist

Religious leader

Traditional practitioners

The procedure may be done by your obstetrician–gynecologist (ob-gyn) or by a pediatrician, a physician who takes care of the health of children. In some cases, a circumcision may be done in a non medical setting for religious or cultural reasons. If this is the case, the person doing the circumcision should be well trained in how to do the procedure, how to relieve pain, and how to prevent infection.

Reference:

Lawal, T. A., & Olapade-Olaopa, E. O. (2017). Circumcision and its effects in Africa. Translational andrology and urology, 6(2), 149–157.

https://doi.org/10.21037/tau.2016.12.02

What to expect after the circumcision procedure

After circumcision, the infant might be irritable and fussy.

The parent or caregiver must take caution in holding the infant.

The tip of the penis might be sore, with the entire penis looking swollen.

There might be a yellow crust at the tip of the penis.

After circumcision, the infant might be irritable and fussy (Lemyre et al., 2019).

The parent or caregiver must take caution to hold the infant carefully and not to press the penis, unless in the case of bleeding as explained earlier.

The tip of the penis might be sore, with the entire penis looking swollen.

Besides, there might be a yellow crust at the tip of the penis.

The parent or caregiver should keep washing the penis regularly and apply a petroleum jelly as directed. Keeping the penis clean helps to prevent infections.

All these signs are normal and should not make the parent or caregiver worried. Such symptoms are expected to go away after a few days on their own. However, the parent should seek medical attention of the symptoms become severe, or if they fail to go away after ten days.

Who should not be circumcised?

Preterm or sick infants should not be circumcised until they are healthy to tolerate the procedure.

Infants with clothing disorder.

Infants who has hypospadias or epispadias.

Things to avoid in infants circumcision

Infants should be circumcised within the first ten days after birth to avoid complications, such as excessive bleeding and pain.

Infants should not be circumcised at home. It is recommended to take the child to a hospital or any approved healthcare facility that offers circumcision services.

Remove the bandage after 48 hours and do not put it back.

Ensure that you do not pull on the plastibell because it can cause bleeding and soreness.

Avoid using diaper wipes because they may sting.

Putting the bandage back after 48 hours can lower the healing rate and cause complications. Instead of using diaper wipes when washing the healing penies, only use water and do it gently to avoid bleeding and other complications.

According to Morris et al. (2017), infants should be circumcised within the first ten days after birth to avoid complications, such as excessive bleeding and pain.

Infants should not be circumcised at home. It is recommended to take the child to a hospital or any approved healthcare facility that offers circumcision services.

Remove the bandage after 48 hours and do not put it back.

Ensure that you do not pull on the plastibell because it can cause bleeding and soreness (Razzaq et al., 2018).

Avoid using diaper wipes because they may sting.

When to consider re-circumcision

Sometimes the skin from the penis attaches at the edge of the penis and forms adhesions after circumcision.

The condition occurs usually if too much skin was left during the initial circumcision.

The extra skin covers the penis head causing mild adhesions or completely covering the head making the penis look uncircumcised.

In such a scenario, the parent should take the child back to the hospital so that the physician can determine whether re-doing the procedure is necessary.

The parent should not decide whether or not the child requires re-circumcision without consulting an expert. A revision is usually done if the redundant skin is uneven, or if it leads to infection or irritation.

When to see a doctor or seek medical attention

Always be keen to observe the healing process of the infant to detect when something goes wrong.

Go to the nearest hospital or emergency department if you notice that your child has excessive bleeding.

Slow down the bleeding before you get to the emergency department by using your index finger and thumb to create a ring around the edge of the penis and squeeze it for about five minutes (Malm-Buatsi et al., 2020).

Excessive bleeding can be indicated by the presence of blood spots on the diaper that are larger than a two-dollar coin or small blood pools. The parent should also seek medical attention if they observe any of the following signs in the infant.

•Vomiting or poor feeding

•Yellow fluid draining from the incision

•Fever

•Redness of skin extending to legs and abdomen

•Difficulties with urinating (diapers less wet than normal).

National Organization of Circumcision Information Resource Centers (NOCIRC)

Autonomy

NOCIRC believes that circumcision denies a male’s right/choice for his own body

Protection

NOCIRC points out that the foreskin is a normal and protective organ

Unnecessary

NOCIRC argues that circumcision has unnecessary risks and harms

National Organization of Circumcision Information Resource Centers Intactivists (nocirc.org)

Professional organization

The National organization of circumcision information resource centers (NOCIRC), is an organization by healthcare professionals to provide information to expectant parents, healthcare professionals, educators, lawyers, ethicists, and concerned individuals about circumcision and genital cutting of male, female, and intersex infants and children, genital integrity, and human rights.()

The NOCIRC believes that circumcision goes against the autonomy of the patient. They also believe that the foreskin is a vital protective organ for the penis and circumcision isn’t necessary because of the risk and harms and not benefits.

NOCIRC Main Resources

Young Man’s Circumcised Penis

Young Man’s Intact Penis

Infant circumcision

Retraction of foreskin

Circumcision & MRSA

Care Of the Circumcised

penis in Geriatric/Disabled population

ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS

Professional organization

The NOCIRC published pamphlets with the answers and information on the above topics.

Community Based Resource

Primary Care Physician/

Pediatrician

Community Health Clinics

Circumcision Clinics

Community Resource

Community based resources to help with circumcision is primary care physician, community health clinics, and circumcision clinics. All these resources is readily available to the patient for any discharge questions/help or if complications occur.

Community Resources

Above is a picture of the type of procedure that a circumcision clinic in the community does which is called the ring method. Houston Circumcision – Procedure

Resource Information

National Organization of Circumcision Information Resource Centers (NOCIRC)

National Organization of Circumcision Information Resource Centers Intactivists (nocirc.org)

Address: NOCIRC

PO Box 2512

San Anselmo, CA 94979-2512

Email: info@nocirc.org

Phone: 415-488-9883

Fax: 415-488-9660

Houston Circumcision Clinic

www.houstoncircumcisionclinic.com

Address: 7707 Fannin St Ste 107, Houston, TX 77054 ·

Phone: (713) 825-4009

-Obstetrician/ Pediatrician

-Community Health Clinics

These are contact information for the National Organization of Circumcision Information Resource center and houston Circumcision clinic. You can also contact you OB or pediatrician doctor for help along with your primary care provider if needed. The community health clinics are also readily available to assist if needed.

Health Promotion Recommendations

Health Promotion Defined:

– the process of enabling people to increase control over, and to improve, their health (WHO, n.d.).

– a behavioral social science that draws from the biological, environmental, psychological, physical and medical sciences to promote health and prevent disease, disability, and premature death through education-driven voluntary behavior change activities.

WHY IS HEALTH PROMOTION IMPORTANT?

Health promotion improves the health status of individuals, families, communities, states, and the nation.

Health promotion enhances the quality of life for all people.

Health promotion reduces premature deaths.

By focusing on prevention, health promotion reduces the costs (both financial and human) that individuals, employers, families, insurance companies, medical facilities, communities, the state and the nation would spend on medical treatment.

Reference:

World Health Organization. (n.d.). Health promotion. World Health Organization. Retrieved October 4, 2021, from https://www.who.int/health-topics/health-promotion#tab=tab_1.

Health Promotion Benefits – Male

32% – 35%

HRHPV

Reduces the risk of developing genital ulceration by 47%

Reduces the risk of acquiring genital herpes by 28% – 34%

Reduces the risk of oncogenic high-risk human papillomavirus by 32% – 35%

Decreases human immunodeficiency virus acquisition in men by 51% – 60%

28% – 34%

100%

47%

51% – 60%

HIV

HSV

Reference:

Tobian, A. A. R., & Gray, R. H. (2011, October 5). The medical benefits of male circumcision. JAMA. Retrieved October 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684945/.

Health Promotion Benefits – Female

28%

HRHPV

Reduces the risk of trichomoniasis vaginosis by 48%

Reduces the risk of bacterial vaginosis by 40%

Reduced the risk of oncogenic high-risk human papillomavirus in women by 28%

No data available on reduction of male to female transmission of HIV-1

40%

100%

48%

trich

HIV

Reference:

Tobian, A. A. R., & Gray, R. H. (2011, October 5). The medical benefits of male circumcision. JAMA. Retrieved October 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684945/.

Health Promotion Concerns

– pain due to the operation (this can be extreme where the right type of pain medication is not used)

– bleeding

-infection

-loss of some function of the penis due to complications

-in some cases psychological harm for the child

-the ‘violation’ of individual rights – as the child is unable to decide for themselves in regards to their body

Reference:

Tobian, A. A. R., & Gray, R. H. (2011, October 5). The medical benefits of male circumcision. JAMA. Retrieved October 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684945/.

Tobian, A. A. R., Gray, R. H., & Quinn, T. C. (2010, January). Male circumcision for the prevention of acquisition and transmission of sexually transmitted infections: The case for neonatal circumcision. Archives of pediatrics & adolescent medicine. Retrieved October 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907642/.

Health Promotion Conclusion

– In conclusion, benefits and risks have been identified concerning male circumcision. Circumcision is usually elected for the three broad reasons of; health, hygiene and appearance, and religion or culture.

– The choice of circumcision remains with the parents of the male child in present society. As opposed to being mandated like the Hib vaccine and/or Hep B vaccines.

– The American Academy of Pediatrics (AAP) acknowledges the potential medical benefits of newborn male circumcision, but caveats that “data are insufficient to recommend ‘mandate universal’ routine neonatal circumcision ((Tobian et al., 2010))”.

Pros

Choice

Cons

Reference:

References

Malm-Buatsi, E., Anderson, A. G., Gubbins, E., Page Phillips, E., Maizels, M., & Washington, K. T. (2020). A qualitative study of parental preferences for post circumcision care education. Journal of pediatric urology, 16(1), 46-e1.

Many, B. T., Rizeq, Y. K., Vacek, J., Cheon, E. C., Johnson, E., Hu, Y. Y., … & Goldstein, S. D. (2020). A contemporary snapshot of circumcision in US children’s hospitals. Journal of pediatric surgery, 55(6), 1134-1138.

MedlinePlus. (2019). Hypospadias Repair: U.S. National Library of Medicine: MedlinePlus. Retrieved (10/05/2021) from https://medlineplus.gov/ency/article/003000.htm

Miles, K. (2021, Feb. 5). Circumcision in newborn boys: babycenter.com. Retrieved (09/02/2021) from https://www.babycenter.com/baby/newborn-baby/circumcision-in-newborn-boys_10419911

Morris, B. J., Kennedy, S. E., Wodak, A. D., Mindel, A., Golovsky, D., Schrieber, L., … & Ziegler, J. B. (2017). Early infant male circumcision: systematic review, risk-benefit analysis, and progress in policy. World journal of clinical pediatrics, 6(1), 89.

Newman, T. (2020, April 24). Benefits and Risks of Circumcision:MedicalNewsToday.com. Retrieved (09/13/2021) from Circumcision: Possible benefits, recovery, and risks (medicalnewstoday.com)

ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS

References Cont’

Tobian, A. A. R., & Gray, R. H. (2011, October 5). The medical benefits of male circumcision. JAMA. Retrieved October 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3684945/.

Tobian, A. A. R., Gray, R. H., & Quinn, T. C. (2010, January). Male circumcision for the prevention of acquisition and

transmission of sexually transmitted infections: The case for neonatal circumcision. Archives of pediatrics & adolescent medicine. Retrieved October 4, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907642/.