Hematuria is the term used to describe the presence of blood in the urine. Gross hematuria is urine that appears pink, red, or cola-colored. Sometimes the blood cannot be visualized but is found through a urinalysis called microscopic hematuria. Hematuria itself is not painful; however, other associated symptoms and causes can cause pain.
Blood in the urine can result from infections, trauma, menstruation, medications, and medical conditions such as:
- Urinary tract infection
- Kidney infection
- Kidney or bladder stone
- Enlarged prostate
- Kidney disease or injury
- Rhabdomyolysis
- Cancer
Hematuria is diagnosed through a physical exam and urine test. An imaging test like a CT scan, MRI, or an ultrasound and a cystoscopy may be performed to help visualize the urinary system and determine the cause of the bleeding.
In this article:
- Nursing Process
- Nursing Care Plans
- Deficient Knowledge
- Impaired Urinary Elimination
- Risk for Imbalanced Fluid Volume
- Risk for Urinary Tract Injury
Nursing Process
Hematuria is often a symptom of an underlying medical condition, and its management will vary depending on the causative condition. Treatment typically includes diagnostic testing, monitoring of related symptoms, antibiotic therapy to treat an underlying infection, and patient education.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for hematuria, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for hematuria.
Acute Pain
Inflammation of the urethra, bladder, kidney, or prostate may cause hematuria and painful urination. Trauma to the ureters from renal stones may also cause hematuria and pain.
Nursing Diagnosis: Acute Pain
Related to:
- Disease process
- Inflammatory process
- Presence of blood clots
- Renal calculi
- Urinary tract infection
As evidenced by:
- Dysuria
- Diaphoresis
- Expressive behavior
- Guarding behavior
- Positioning to ease the pain
- Frequent urination
- Hesitancy with urination
- Fever
Expected outcomes:
- Patient will report significant improvement in pain relief when urinating.
- Patient will demonstrate interventions that can help improve pain symptoms.
Assessment:
1. Assess pain characteristics.
If the patient feels pain with urination, it may prevent them from wanting to urinate, which can lead to further problems. Assess the characteristics of dysuria, like burning, itching, urgency, and more.
2. Assess the location of the patient’s pain.
Painful hematuria may be described as flank pain, lower abdominal/suprapubic pain, or pain when urinating. Knowing the location of the pain can help determine possible causes and allow the nurse to monitor the effectiveness of interventions.
Interventions:
1. Encourage the use of non-pharmacologic pain interventions.
The use of heat pads in the lower back and abdomen can help relax the muscles and relieve discomfort associated with dysuria and hematuria.
2. Administer pain and antibiotic medications as indicated.
Analgesics are often prescribed for patients with renal calculi to help relieve discomfort. Antibiotics will treat an underlying infection.
3. Encourage the patient to increase clear fluid intake.
Increasing fluid intake while avoiding beverages like coffee, soda, and alcohol can help increase urine production and facilitate the flushing out of bacteria without irritating the urinary tract system.
4. Encourage frequent voiding.
Urinating frequently facilitates emptying of the bladder, reducing urine stasis, re-infection, and distention.
Deficient Knowledge
Hematuria may or may not be serious, and educating patients on causes and complications is a necessary component of nursing care.
Nursing Diagnosis: Deficient Knowledge
Related to:
- Unfamiliarity of condition
- Inadequate information
- Inadequate interest in learning
- Inability to recall information
As evidenced by:
- Inaccurate follow-through of instructions
- Inaccurate statements about hematuria
- Development of worsening complications
- Missed follow-up appointments
Expected outcomes:
- Patient will verbalize understanding of hematuria, possible complications, and interventions.
- Patient will verbalize when to seek care for hematuria and related symptoms.
Assessment:
1. Assess the patient’s experience with hematuria.
Assess if the patient has ever had hematuria and what the reason was at that time. The patient may already be aware of causes and treatment and can direct further teaching.
2. Assess the patient’s health literacy and readiness to learn.
Health literacy can vary depending on the patient’s situation, complexities of hematuria, and underlying health condition. The patient’s readiness to learn can impact the patient’s adherence to the treatment regimen and health outcomes.
Interventions:
1. Educate on preventing urinary infections.
Hematuria is often the result of a urinary or bladder infection. Instruct the client to maintain perineal hygiene by wiping front to back, urinating after sexual intercourse, not wearing tight clothing, and drinking plenty of water.
2. Educate on diagnostic tests.
Hematuria can signal a malignancy of the bladder, prostate, or kidney cancer. The nurse can prepare the patient for tests and labs that assess for cancer.
3. Teach the patient signs and symptoms that need immediate medical attention.
Hematuria can develop into complications if the underlying cause is left untreated. Encourage the patient to seek medical consultation for fever, changes in urination, foul urine odor, weight changes, or flank pain.
4. Educate about normal instances of hematuria.
Hematuria is expected in some cases. Educate the patient that hematuria is normal after lithotripsy treatment for a kidney stone. A male patient who undergoes a TURP (transurethral resection of the prostate) may notice blood in the urine that will decrease.
Impaired Urinary Elimination
Hematuria is a symptom of another medical condition, like an enlarged prostate or infection, causing impaired urinary elimination.
Nursing Diagnosis: Impaired Urinary Elimination
Related to:
- Disease process
- Inflammatory process
- Obstruction
- Infectious process
- Prostatic hypertrophy
- Trauma
As evidenced by:
- Dysuria
- Frequent voiding
- Urinary hesitancy
- Urinary retention
- Urinary incontinence
- Urinary urgency
- Nocturia
Expected outcomes:
- Patient will be able to achieve a normal elimination pattern without dysuria, incontinence, or urgency.
- Patient will verbalize interventions that can help prevent urinary retention.
Assessment:
1. Assess the patient’s usual elimination patterns.
Assessing the patient’s baseline elimination pattern can help determine the possible causes of the current impairment, developing complications, and the effectiveness of treatment.
2. Assess and review the results of urinalysis.
Urinalysis can reveal the presence of bacteria, blood, casts, protein, ketones, and more, which can lead to the diagnosis of an acute or chronic condition.
3. Monitor kidney function labs.
BUN, creatinine, and GFR results should be monitored for altered kidney function causing impaired urinary elimination.
Interventions:
1. Monitor the patient’s intake and output.
Documentation of the patient’s intake and output can help determine and monitor hydration status and urinary function.
2. Insert a urinary catheter.
If the patient is unable to void and is experiencing distention, the nurse can insert an indwelling catheter. This can allow for accurate output measurement and visualization of urine color and concentration.
3. Encourage bladder training.
Establishing a regular elimination pattern by voiding every 2-3 hours (even when the urge isn’t felt) can train the bladder to empty.
4. Consult with urology.
The nurse may consult with the urology team for further instructions. Diagnostic tests such as uroscopy or kidneys/ureters/bladder (KUB) ultrasound may be necessary.
Risk for Imbalanced Fluid Volume
Hematuria may be caused by severe or prolonged dehydration, placing the patient at risk for imbalanced fluid volume.
Nursing Diagnosis: Risk for Imbalanced Fluid Volume
Related to:
- Altered fluid intake
- Disease process
- Inflammatory process
- Dehydration
- Bleeding
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will maintain urine output within the normal range of 0.5-1.5 ml/kg/hr.
- Patient will remain free from symptoms of dehydration, as evidenced by stable vital signs, good skin turgor, and moist mucous membranes.
Assessment:
1. Assess the possible factors that contribute to the cause of hematuria.
Various factors and diseases like infection or injury of the bladder, urethra, and kidneys, cancer, calculi, or severe cases of dehydration can cause hematuria. It is vital to determine the cause to plan an appropriate treatment regimen.
2. Assess and monitor the patient’s intake and output.
Since dehydration can contribute to hematuria, it is important to assess and monitor the patient’s intake and output and current hydration status.
3. Assess urinalysis.
Hematuria may be easily observable or found through microscopic examination. A complete urinalysis can indicate signs of dehydration, such as a high specific gravity, dark urine color, and the presence of crystals (stones).
Interventions:
1. Monitor the patient’s kidney function.
Kidney function is evaluated through the serum BUN and creatinine levels. Since the kidneys are integral to urine output, it is important to monitor renal perfusion and function for any complications such as kidney disease.
2. Encourage adequate fluid intake.
Adequate fluid intake will prevent dehydration and help flush out the urinary system. Severe and frequent dehydration can damage the kidneys and further aggravate hematuria. IV fluids may be necessary if dehydration is severe.
3. Insert a urinary catheter as ordered.
For patients with gross hematuria and difficulty urinating, a urinary catheter may be inserted to aid urination and irrigation and to closely monitor urine output.
4. Prepare and assist in blood transfusion as indicated.
Severe injury or trauma to the kidneys or urinary tract may result in blood loss, requiring transfusion.
Risk for Urinary Tract Injury
Hematuria may be caused by trauma or injury from urinary catheters.
Nursing Diagnosis: Risk for Urinary Tract Injury
Related to:
- Latex allergy
- Trauma or injury
- Catheter insertion
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred. Nursing interventions are aimed at prevention.
Expected outcomes:
- Patient will remain free of any urinary tract injury.
- Patient will experience normal urinary elimination patterns without pain or blood.
Assessment:
1. Assess the patient’s elimination patterns and characteristics.
Evaluating the patient’s elimination patterns and characteristics, including frequency, consistency, volume, and color, can help determine existing urinary tract injuries and evaluate any complications that arise.
2. Assess and review imaging studies.
Cystoscopy is a diagnostic imaging test that can help visualize the bladder for injury or other causes of hematuria.
3. Review the indication of an indwelling urinary catheter.
Hematuria may be caused by the insertion or the presence of a urinary catheter. It is important to determine the appropriateness of continuing catheterization.
Interventions:
1. Select the correct size and type of catheter.
If catheterization is necessary, reduce the risk of injury by selecting the correct size and type of catheter and insert using sterile technique.
2. Take caution with patients who are confused.
Patients who are confused or do not understand the presence of the catheter are at risk for pulling on the catheter and causing injury and bleeding. Keep the catheter out of view, such as under blankets, provide constant staff supervision, keep the patient distracted, or apply mitten restraints as a last resort.
3. Closely monitor and secure the placement of the urinary catheter.
Properly secure the catheter to the leg to reduce friction from movement. Ensure the catheter remains unobstructed without kinks below the level of the bladder.
4. Discontinue the catheter as soon as possible.
Once the patient is cleared to void normally, discontinue the catheter to reduce the risk of CAUTI and further injury.
References
- Hematuria (Blood in the Urine). NIDDK. Reviewed: October 2022. From: https://www.niddk.nih.gov/health-information/urologic-diseases/hematuria-blood-urine
- Hematuria. Urology Care Foundation. 2022. From: https://www.urologyhealth.org/urology-a-z/h/hematuria
- Hematuria. Cleveland Clinic. Reviewed: August 1, 2022. From: https://my.clevelandclinic.org/health/diseases/15234-hematuria
- Blood in Urine (Hematuria). WebMD. Reviewed: February 18, 2021. From: https://www.webmd.com/digestive-disorders/blood-in-urine-causes
