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 Infection
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
May be related to
- Urinary tract infection [acute, chronic or postoperative]
- Invasive postoperative drainage tubes (i.e., Silastic stents, urethral
Foley or suprapubic tube
Possibly evidenced by
- [not applicable]
- Client’s surgical incision will remain clean and dry without redness, edema, odor, or drainage.
|Assess wound for redness, swelling,|
purulent drainage on dressing, healing.
|Reveals presence of infectious process or poor healing.|
|Assess catheter site for redness, edema, irritation; urine collected in drainage system for cloudiness and foul odor.||Indicates infectious process at catheter site or in the urinary bladder.|
|Collect urine for culture and sensitivities.||Determines presence of urinary infection and sensitivity to a specific antibacterial agent.|
|Administer antibacterial as ordered.||Treats specific microorganism or prevents infection when the catheter is in place.|
|Maintain catheter and collection bag below|
level of bladder and maintain a closed, patent system free of kinks or obstructions.
|Prevents backflow of urine into bladder or retention of urine which contributes to infection.|
|Use sterile technique when changing dressings, giving catheter care or|
emptying drainage bag.
|Avoids contamination of wound or urinary tract by the introduction of microorganisms.|
|Change dressings when soiled or wet|
24 hours following surgery.
|Promotes comfort and allows for wound assessment.|
|Provide suprapubic catheter care by|
cleansing with peroxide solution after removing any meatal crusting, catheter care by washing perineum with mild soap and water, rinsing and applying an antiseptic ointment.
|Promotes comfort and avoids infection at the suprapubic or meatal site.|
|Encourage increased fluid intake daily|
depending on age requirements
when parenteral fluids are allowed.
|Promotes dilution of urine to prevent infection and promotes voiding after the catheter removal.|
|Teach and demonstrate catheter care, irrigation, draining of catheter using sterile technique and allow for return demonstration.||Provides information and skill in caring for and maintaining catheter patency to prevent infection if the child is to be discharged with the catheter in place.|
|Teach parents of signs and symptoms of|
infection to report.
|Allows for immediate intervention if an infection is observed.|
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