5 Vesicoureteral Reflux (VUR) Nursing Care Plans

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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): 

  1. Acute Pain
  2. Anxiety
  3. Deficient Knowledge
  4. Risk for Injury
  5. Risk for Infection
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Anxiety

Anxiety: Vague uneasy feeling of discomfort or dread accompanied by an autonomic response.

May be related to

  • Change in health status, change in environment (hospitalization for surgery)

Possibly evidenced by

  • Expressed apprehension and concern about surgery (ureteral reimplantation) and pre and postoperative procedures and care.

Desired Outcomes

  • Client/Parents will experience decreased anxiety.
Nursing InterventionsRationale
Assess source and level of anxiety and
need for information and measures that will allay it.
Provides data about anxiety level and need to relieve it; source for parent includes the procedure and care of child pre and postoperatively; source for child includes separation from parents, unfamiliar environment, and painful procedures.
Allow verbalization of concerns and time
to ask questions about the purpose  of surgery, procedure to be done,
pre and postop care.
Provides an opportunity to express feelings and fears and to feel secure in the environment.
Answer questions in a calm and honest manner; Use pictures, drawings, models and therapeutic play.Promotes trust and a calm and supportive environment.
Allow parents to have as much input into decisions regarding care and common routines.Allows for more control over situations and maintains a familiar routine for care.
Encourage parents to stay and assist the child during care.Provides an opportunity for parents to care and support the child and continue parental role and strengthens child’s comfort by having a familiar caretaker.
Orient and introduce the child to the surgical unit preoperatively.Lessens anxiety caused by fear of the unknown.
Reassure parents and child that surgery
and catheter will not have an impact on sterility or sexual orientation.
Provides information that may cause anxiety.
Teach parents and child about abnormal
functioning ureter and purpose for surgical repair, that the ureter will be reimplanted to prevent urine from backing up in the ureter and continuing problems with infections.
Provides information that will improve understanding about surgery to lessen anxiety.
Teach about and prepare for preoperative
procedures and exams necessary for visualization and diagnosis.
Allays anxiety and provides precise information of what to expect.
Teach parents and child that catheter
and/or stent will be in place and where they will be placed, that they will be irrigated and receive special care, that urine output will be monitored and measured for any abnormalities or complications, that a surgical dressing will be in place to protect the incision, and, in case of young child, restraints may be in place on arms and legs, and that medications will be given to control pain.
Provides information on what to expect postoperatively.
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See Also

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