Nursing Care Plans

5 Vesicoureteral Reflux (VUR) Nursing Care Plans

May 4, 2018

Vesicoureteral reflux (VUR) is the abnormal backflow of urine from the bladder into the ureter and up to the kidney. The diagnosis of VUR rarely occurs after five years of age. There are two types of VUR, primary and secondary reflux. Primary reflux which is present at birth, is caused by an inadequate valvular mechanism at the ureterovesical junction. The inadequate valve in primary reflux is caused by the shortened submucosal tunnel that shortens bladder filling. Secondary reflux is associated with obstruction (50% of cases in infants are caused by posterior urethral valves) or damage to the nerves that control normal bladder emptying (neurogenic bladder).

Voiding cystourethrogram (VCUG), radionuclide cystogram (RNC), and abdominal ultrasound are done to diagnose VUR. Risk factors related with the condition include age, familial history, bladder and bowel dysfunction (BBD), urinary tract infection (UTI), and reflux.

The following effects of unrepaired reflux have been identified: urine concentration ability is inversely proportional to the grade of reflux; kidney scarring; lower-weight percentiles (in physical growth); hypertension; proteinuria; and those with bilateral scarring and an increased risk of developing end-stage renal failure. Most of the children affected, the problem will disappear on its own without surgical intervention if the infection is controlled. Management of reflux includes antibacterial therapy for infection control.

Nursing Care Plans

Treatment of vesicoureteral reflux (VUR) is based on its severity. Nursing care planning goals for a patient with vesicoureteral reflux (VUR) may include relief of pain and discomfort, prevention of infection and trauma, and increased knowledge of the surgical procedure, expected outcomes, and postoperative care.

The following are five (5) nursing care plans (NCP) and nursing diagnosis (NDx) for Vesicoureteral Reflux (VUR):

Acute Pain

Acute Pain: Unpleasant sensory and emotional experience arising from actual or potential tissue damage or described in terms of such damage; sudden or slow onset of any intensity from mild to severe with anticipated or predictable end and a duration of <6 months.

May be related to

Surgery

Possibly evidenced by

Flank pain
Bladder spasms
Communication of pain descriptors
Crying
Ureteral edema from surgery
Irritability, restlessness
Withdrawal

Desired Outcomes

Client will experience decreased pain.

Nursing Interventions	Rationale
Assess verbal and nonverbal cues, type, location and severity of pain depending on age.	Provides information about pain as a basis for analgesic therapy.
Place client in a position of comfort; avoid unnecessary movement or manipulation of the suprapubic catheter.	Facilitates comfort and reduces bladder spasms that cause pain.
Demonstrate distraction techniques and provide reassurance during spasms and stay with the child when they occur to inform the child that the pain is temporary.	Decreases anxiety which tends to increase pain.
Maintain patency of the catheter by ensuring placement, observing flow and presence of kinks or obstruction.	Decreases pain caused by bladder distention due to catheter clogging or displacement.
Administer antispasmodic as prescribed.	Reduces bladder spasms caused by irritation of suprapubic catheter.
Administer analgesic based on pain assessment and before the pain becomes severe.	Lessens pain and promotes rest to decrease stimuli and restlessness.
Educate parents and child that pain will subside 24 to 48 hours following surgery and teach measures taken to control pain.	Provides knowledge about duration of pain and causes of pain.