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):
Risk for Injury
Risk for Injury: Vulnerable for injury as a result of environmental conditions interacting with the individual’s adaptive and defensive resources, which may compromise health.
May be related to
- Catheter displacement
- Internal factor of complications of surgical trauma
Possibly evidenced by
- [not applicable]
- Client will not experience injury as evidenced by absence of blood or clots in the urine, bladder is not distended and the client is able to urine after catheter removal.
|Assess output via catheter and observe|
characteristics of urine, passage of blood clots, color of urine and return to clear color; and if clots or return to red color occurs after a period of normal characteristics.
|Provides data regarding the possible complication of bleeding or obstruction.|
|Immobilize arms and legs with restraints, remove occasionally; use bed cradle following surgery.||Avoids accidental catheter dislodgement or removal.|
|Encourage increase in fluid intake based on age requirements.||Facilitates voiding and avoid dehydration.|
|Notify physician immediately if a bright red color is observed in the urine.||Allows for immediate interventions to treat|
|Measure I&O every hour for an output of 1 ml/kg/hr and notify the physician if less.||Provides information to ensure adequate output via catheters.|
|Note first voiding after catheter removed, time of voiding and amount, difficulty, presence of abdominal distention.||Provides information about the return of urinary pattern, presence of retention.|
|Support and provide privacy during first voiding; Encourage warm water over perineum, sitting or standing position.||Prevents embarrassment and promotes voiding.|
|Secure catheter to abdomen or leg with tape stents to catheter and avoid placing tension on the catheter when in place by gently holding it when performing care.||Avoids unnecessary movement or manipulation of the catheter that may cause displacement.|
|If catheter becomes displaced, inform|
physician for an immediate replacement (have a suprapubic catheter ready at all times).
|Ensures continued flow and drainage of urine.|
|Encourage the child to void frequently after removal of the catheter.||Prevents urinary stasis resulting to urinary|
|Inform parents and child that the physician should be informed if there is a change in urinary pattern or characteristics or if unable to void after catheter removal.||Allows for early interventions if needed.|
|Educate parents about measures taken to|
ensure that catheters remain in place and patent (use of restraints, anchoring catheters, irrigations) and that this is a
|Informs parents of the need for measures to prevent displacement of the catheter.|
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