Nursing Care Plan for Circumcision

Circumcision is a surgical procedure in which the prepuce (foreskin) of the penis is separated from the glans, and a portion is excised. This elective procedure is performed in the United States based on parental choice for reasons related to hygiene, religion, tradition, social norms, and culture. It is usually performed at 12–24 hr of age or when the infant is considered physically stable. Frequency of this procedure has declined in recent years to approximately 62%.


NURSING PRIORITIES
1. Provide parents with sufficient information to make an informed choice.
2. Promote comfort and healing.
3. Identify and minimize postoperative complications.
4. Instruct parent(s) in proper care of circumcised infant.

DISCHARGE CRITERIA
1. Void appropriately past procedure.
2. Free of complications.
3. Parent(s) understand care needs and signs/symptoms requiring further evaluation.

Nursing diagnosis: Acute pain related to trauma to/edema of tender tissues possibly evidenced by crying, irritability, changes in sleep pattern, refusal to eat

Desired Outcome:
1. Appear relaxed, appropriately consolable.
2. Resume normal sleeping and eating patterns.

Nursing intervention with rationale
1. Provide pacifier (dipped in sugar, if desired), stroke lightly, and talk gently to infant during procedure. Observe infant response.
Rationale: Provides distraction and sense of reassurance to soothe the infant

2. Remove infant from restraints immediately following procedure. Calm infant by holding, cuddling, dressing, and talking to him. Encourage parents to feed and cuddle infant.
Rationale: A sense of uneasiness occurs because of positioning and restraint. Acute pain occurs at the time of surgical procedure, because the foreskin contains numerous nerve endings. Change of position, freedom of movement, and tactile activities refocus infant’s attention and comfort infant. Feeding may promote relaxation. Note: Infant’s turning head away, increased restlessness, hiccuping suggest overstimulation, which may further distress the infant.

3. Apply petroleum jelly and gauze dressing loosely around glans, as appropriate. Leave in place for at least 24 hr.
Rationale: Protects against adherence to diaper and direct contact with urine.

4. Position infant on side or back, not on abdomen. Loose diaper or use no diaper at all for 24–72 hr following procedure. Note continued placement of plastic rim following circumcision with plastic bell.
Rationale: Prevents friction or pressure on the penis. Plastic rim remains in place for 5–7 days. Plastic bell falls off by itself when glans is healed. Note: Removal of the bell by the healthcare provider may be

5. Avoid use of soaps on penis; clean with clear water.
Rationale: Soap may cause irritation, increasing discomfort, and may cause plastic bell to fall off prematurely.

6. Protect the surgical site from alcohol when caring for umbilicus.
Rationale: Alcohol may cause stinging, adding to infant’s discomfort.

7. Note infant’s behavior following procedure.
Rationale: Acute pain following the procedure may last approximately 30 min, whereas discomfort related to trauma, edema, and irritation from clothing may last for up to 7 days until healing is completed.

8. Assist with dorsal penile nerve block with 1% lidocaine without epinephrine or chloroprocaine (Nesacine).
Rationale: Although it is not used routinely, anesthesia abolishes the pain and distress manifested in the

9. Apply topical agents, e.g., EMLAcream (lidocaine and prilocaine) to penis.
Rationale: Topical agent applied 1-2 hr before procedure may be as effective as nerve block without associated risks.

10. Administer acetaminophen drops as indicated.
Rationale: Helps ease acute pain, enhances effects of calming behaviors.