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.
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):
Deficient Knowledge: Absence or deficiency of cognitive information related to specific topic.
May be related to
- Lack of exposure to information about disorder
Possibly evidenced by
- Expressed need for information about continuous medical regimen to control renal/bladder infection and measures to prevent infection
- Parent will obtain information about child’s illness and treatment.
|Assess parents’ and child’s understanding of vesicoureteral reflux. Provide sufficient information and allow time for inquiries. Use teaching aids if needed.||Provides basic understanding of the condition without restating information the clients already know.|
|Educate parents and child of a need to get urine cultures by midstream and taking to a laboratory or use of dip-slide or strip to use at home.||Shows presence of urinary infection and assists to regulate antibacterial therapy.|
|Teach parents and child in the administration of antibiotic including action, dose, form, time, frequency, how to take, side effects to report.||Facilitates comprehension of the medication regimen for long-term therapy to avoid recurrent or relapse of urinary infection.|
|Educate parents and child to come up with strategies for administration of medications including the development|
of an organized plan using pill dispensers, alarms on a clock or watch, check-off list, reminder notes to avoid omissions.
|Allows the parents and child to take control of medication administration on a long-term basis.|
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