Hi, I'm Cathy with Level Up RN. In this video, I'll be discussing vesicoureteral reflux as well as exstrophy of the bladder. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And if you have our Level Up RN pediatric nursing flashcards, go ahead and pull out your flashcards so you can follow along with me and pay close attention to the bold red text on the back of the cards because those are the things that you are likely to get tested on in nursing school.
So as a review, urine goes from the kidneys into the ureters, then into the bladder, and then out through the urethra. With vesicoureteral reflux, urine backflows into the ureters and sometimes into the kidneys. This can be caused by an anatomic abnormality as well as nerve damage that allows for the backflow of urine. And in turn, this can cause a urinary tract infection as well as pyelonephritis, which is a kidney infection. Signs and symptoms include frequent UTIs and/or episodes of pyelonephritis, which can cause signs and symptoms such as fever, painful urination, frequent urination, and malodorous urine. In babies, signs and symptoms may just include fussiness, poor feeding, and vomiting and/or diarrhea. Diagnosis of vesicoureteral reflux may include the use of an abdominal ultrasound as well as a voiding cystourethrogram. So during this procedure, the child's bladder is filled with a special kind of dye, and X-rays are taken before, during, and after urination to see if urine backflows into the ureters. Treatment depends on the severity of the reflux. So for less severe cases, treatment may include continuous low-dose antibiotics to prevent UTIs until the child gets older and reflux resolves on its own. However, for severe cases due to an anatomic abnormality, surgery may be indicated to correct the abnormality. And then the provider may request that urine cultures be provided every two to three months and whenever the child has a fever.
Let's now talk about exstrophy of the bladder. This is a congenital abnormality that causes the baby's bladder to be inside out. And then a defect in the abdominal wall causes the bladder to be exposed to the external environment, so babies with bladder exstrophy will also frequently have related problems with their genitalia, pelvic bones, and/or bowel. So for example, baby boys with bladder exstrophy will also have epispadias, which is an abnormality where the urethral opening is on top of the penis as opposed to the tip of the penis. Other abnormalities that may be present include an undescended testicle as well as an inguinal hernia. Bladder exstrophy can be diagnosed with a prenatal ultrasound in many cases. If it is not identified prior to birth, then it will be visibly obvious after birth. Treatment includes surgical repair, and in many cases, multiple surgeries may be required. So prior to surgery, it's going to be essential that you protect the exposed bladder with a sterile non-adherent dressing. After surgery, immobilization of the lower extremities is required for several weeks. So as the nurse caring for a baby following this surgery, you want to keep the child calm, you want to provide pain medication, and you want to closely monitor intake and output. And then it's going to be essential that you take measures to prevent the formation of pressure injuries, which can easily occur due to prolonged immobilization.
All right. It's quiz time, and I've got three questions for you.
Question number one. Why does vesicoureteral reflux cause pyelonephritis?
The answer is reflux causes urine to back up into the ureters and then back into the kidneys in many cases, causing pyelonephritis.
Question number two. Before surgery to correct bladder exstrophy, how do you protect the exposed bladder?
The answer is you would protect the exposed bladder by applying a sterile, non-adherent dressing.
Question number three. What key complication of the integumentary system can result from prolonged immobility after surgical treatment of bladder exstrophy?
The answer is pressure injuries.
All right. That is it for this video. I hope you found it to be helpful. Take care and good luck with studying.
