Hematuria, characterized by the presence of blood in urine, represents a significant clinical finding that requires careful nursing assessment and intervention. This comprehensive guide explores the essential nursing diagnoses, care plans, and evidence-based interventions for managing patients with hematuria.
What is Hematuria?
Hematuria occurs in two forms: gross hematuria, where blood is visible in the urine giving it a pink, red, or cola-colored appearance, and microscopic hematuria, which is only detectable through laboratory testing. While hematuria itself isn’t typically painful, the underlying conditions causing it may produce significant discomfort and require immediate medical attention.
Common Causes of Hematuria
Several conditions can lead to hematuria, including:
- Urinary tract infections (UTIs)
- Kidney stones or bladder stones
- Benign prostatic hyperplasia (BPH)
- Glomerulonephritis
- Trauma to the urinary system
- Certain medications (anticoagulants)
- Kidney or bladder cancer
- Exercise-induced hematuria
- Polycystic kidney disease
Nursing Process Overview
The nursing process for hematuria focuses on:
- Comprehensive assessment of symptoms
- Identification of underlying causes
- Implementation of appropriate interventions
- Patient education and prevention strategies
- Monitoring and evaluation of outcomes
Nursing Care Plans for Hematuria
1. Risk for Infection
Nursing Diagnosis: Risk for Infection related to invasive procedures, compromised urinary tract defenses, and presence of blood in urine.
Related Factors:
- Invasive procedures (catheterization)
- Compromised urinary tract defenses
- Presence of microorganisms
- Chronic medical conditions
Nursing Interventions and Rationales:
Maintain strict aseptic technique during urinary procedures
- Prevents introduction of pathogens into the urinary tract
Monitor vital signs, especially temperature
- Early detection of infection development
Encourage adequate fluid intake
- It helps flush bacteria from the urinary tract
Teach proper perineal hygiene
- Reduces risk of ascending infection
Desired Outcomes:
- The patient will remain free from signs and symptoms of infection
- The patient will demonstrate an understanding of infection prevention measures
2. Anxiety
Nursing Diagnosis: Anxiety related to uncertainty about diagnosis and fear of serious underlying conditions.
Related Factors:
- Uncertainty about health status
- Fear of potential serious diagnosis
- Lack of knowledge about the condition
- Stress about diagnostic procedures
Nursing Interventions and Rationales:
Provide clear, accurate information about conditions and procedures
- Reduces fear of the unknown and promotes cooperation
Allow expression of concerns and feelings
- It helps identify specific anxiety triggers
Teach relaxation techniques
- It helps manage anxiety symptoms
Include family in teaching and support
- Strengthens support system and improves coping
Desired Outcomes:
- The patient will report decreased anxiety levels
- The patient will demonstrate effective coping strategies
3. Acute Pain
Nursing Diagnosis: Acute Pain related to inflammation, infection, or presence of urinary tract stones.
Related Factors:
- Inflammation of the urinary tract
- Presence of stones or blood clots
- Underlying infection
- Surgical procedures
Nursing Interventions and Rationales:
Assess pain characteristics using a standardized scale
- Provides a baseline for monitoring pain management effectiveness
Administer prescribed medications as ordered
- Controls pain and associated symptoms
Apply heat therapy as appropriate
- Promotes comfort and reduces muscle tension
Position patient for comfort
- Minimizes pressure on affected areas
Desired Outcomes:
- The patient will report pain reduction to acceptable levels
- The patient will demonstrate the use of non-pharmacological pain management techniques
4. Deficient Knowledge
Nursing Diagnosis: Deficient Knowledge related to lack of exposure to information about hematuria management and prevention.
Related Factors:
- Limited previous exposure to information
- Misinterpretation of health information
- Lack of interest in learning
- Language or cultural barriers
Nursing Interventions and Rationales:
Assess current knowledge level and learning needs
- Establishes baseline for education plan
Provide written materials at an appropriate reading level
- Reinforces verbal teaching
Demonstrate self-care techniques
- Promotes independence in management
Verify understanding through the teach-back method
- Ensures effective learning
Desired Outcomes:
- The patient will verbalize understanding of condition and management
- The patient will demonstrate appropriate self-care techniques
5. Impaired Urinary Elimination
Nursing Diagnosis: Impaired Urinary Elimination related to inflammation, infection, or obstruction.
Related Factors:
- Urinary tract inflammation
- Presence of blood clots
- Mechanical obstruction
- Neurological impairment
Nursing Interventions and Rationales:
Monitor intake and output
- Ensures adequate fluid balance and identifies problems
Assist with toileting as needed
- Promotes normal elimination patterns
Implement a bladder training program if appropriate
- Improves bladder control and function
Monitor for urinary retention
- Prevents complications from impaired emptying
Desired Outcomes:
- The patient will maintain adequate urinary elimination
- The patient will demonstrate improved bladder control
Prevention and Education
Effective patient education should focus on:
- Recognition of symptoms requiring medical attention
- Proper hydration techniques
- Medication compliance
- Lifestyle modifications
- Follow-up care importance
References
- Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2023). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
- Bolenz C, Schröppel B, Eisenhardt A, Schmitz-Dräger BJ, Grimm MO. The Investigation of Hematuria. Dtsch Arztebl Int. 2018 Nov 30;115(48):801-807. doi: 10.3238/arztebl.2018.0801. PMID: 30642428; PMCID: PMC6365675.
- Groninger H, Phillips JM. Gross Hematuria: Assessment and Management at the End of Life. J Hosp Palliat Nurs. 2012 May 12;14(3):184-188. doi: 10.1097/NJH.0b013e31824fc169. PMID: 24826082; PMCID: PMC4016967.
- Harding, M. M., Kwong, J., & Hagler, D. (2022). Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, Single Volume. Elsevier.
- Herdman, T. H., Kamitsuru, S., & Lopes, C. (2024). NANDA International Nursing Diagnoses – Definitions and Classification, 2024-2026.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Loo R, Whittaker J, Rabrenivich V. National practice recommendations for hematuria: how to evaluate in the absence of strong evidence? Perm J. 2009 Winter;13(1):37-46. doi: 10.7812/TPP/08-083. PMID: 21373244; PMCID: PMC3034463.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
