Hematuria Nursing Care Plans Diagnosis and Interventions
Hematuria NCLEX Review and Nursing Care Plans
Hematuria is a medical term used to describe the presence of blood in the urine. Moreover, hematuria is the presence of five or more red blood cells (RBCs) in three consecutive urine analyses taken one week apart.
The urinary tract continuously works together to filter waste products and RBCs thus, it is unusual for the blood cells to pass in the urine and could signify a serious health condition. Hematuria is becoming a concern as the prevalence of urinary tract carcinomas has been reported to be as high as 19%. Although this can be asymptomatic and usually found during a routine examination.
Types of Hematuria
The two types of hematuria are:
- Gross Hematuria. There is enough blood in the urine that causes red, pink, or tea-like discoloration seen by the naked eye.
- Microscopic Hematuria. There are small amounts of blood in the urine that can be seen only through a microscope.
Signs and Symptoms of Hematuria
Hematuria is also considered to be a sign of another condition. The following symptoms are usually associated with hematuria:
- Nausea, vomiting, or fever.
- Red, pink, or tea-colored urine.
- Passage of blood clots in the urine.
- Frequent or painful urgency to urinate.
- Flank lower abdominal or lower back pain.
- Early morning periorbital puffiness or edema.
- Urinary retention is an acute presentation of gross hematuria.
Causes of Hematuria
Hematuria may be caused by problems in any part of the urinary tract such as:
- Infection. Bacteria that enter the body and multiply and affect the bladder or kidneys can cause gross and microscopic hematuria.
- Stones. Large stones that cause blockage or smaller stones passing through the urinary tract can cause an injury to the tissues resulting in hematuria.
- Enlarged prostate. The anatomical position of the prostate gland compresses the urethra partially blocking urine flow and incomplete emptying of the bladder. This can result in urinary tract infections and prostatitis.
- Kidney disease. Glomerulonephritis or inflammation of the filtration system of the kidneys causes microscopic hematuria. Post-streptococcal glomerulonephritis is common in children.
- Cancer. Hematuria can be a sign of advanced bladder, kidney, or prostate cancer.
- Medications. Certain medications cause hematuria such as cyclophosphamide, penicillin, anticoagulants, and blood thinners.
- Inherited disorders. Sickle cell anemia and hemophilia are blood disorders that cause blood in the urine. Alport syndrome affects the filtering membranes of the kidneys. Polycystic kidney disease and inherited nephritis can also cause hematuria.
- Kidney injury. Trauma or a severe blow to the kidneys from an accident can cause gross hematuria. Procedures involving the urinary tract such as circumcision, catheterization, surgery, or kidney biopsy can also cause hematuria.
- Strenuous exercise. An intense workout may cause trauma to the bladder or dehydration. Sustained aerobic exercise can cause the breakdown of red blood cells causing hematuria.
- Mineral Imbalances. Individuals with high levels of calcium in the urine tend to have familial history of kidney stones which are likely to cause hematuria.
Risk Factors to Hematuria
Hematuria has increased risks in certain age groups and events such as:
- Individuals older than 40 years old – may have a higher risk due to other conditions in the genitourinary tract or malignancy
- Male – especially those with an enlarged prostate or prostate cancer may have occasional hematuria
- Smoking – studies reveal an increased incidence of hematuria
- Infection – a recent infection or a kidney inflammation after a viral or bacterial infection usually results in hematuria
- Prolonged use of indwelling catheters – increases the risk for hematuria and infection
- Individuals with high levels of calcium in the urine – they are more likely to have a family member with urinary stones increasing the risk for gross hematuria
- Intake of pain relievers, NSAIDs, anticoagulants, and blood thinners – these may likely cause urinary tract bleeding
- History of chronic cystitis or irritative lower urinary tract infections
- Familial history of kidney disease – this increases the risk of urinary bleeding
- Performing strenuous activities – long-distance runners tend to have an increased incidence of exercise-induced urinary bleeding
- Exposure to radiation or occupational and toxic chemicals such as benzene or aromatic amines – this may cause disruptions of the renal tubes and erosion of mucosal surfaces in the genitourinary tract increasing the risk of hematuria
Complications of Hematuria
Hematuria may be caused by different conditions and can cause serious complications if left untreated. These complications may include:
- Untreated infections may lead to sepsis or kidney failure.
- Benign prostatic hypertrophy may progress to severe pain and discomfort or even cancer if left untreated.
- Advancement of cancer may result from ignoring symptoms such as blood in the urine.
Diagnosis of Hematuria
The primary care provider will perform the following test and examinations to determine the cause of hematuria, and this usually includes:
- Medical History. This will help in determining the level of risk and the main problem causing the hematuria. The primary care provider will be looking for past and present medical conditions, family history, medications being taken, smoking history, recent trauma, and activities.
- Physical Exam. The primary care provider will ask for symptoms and perform a physical examination of the abdomen and back for tenderness. A pelvic exam and digital rectal exam may also be done to assess for any problems and prostate glands in male patients respectively.
- Urine Analysis. This is the primary test done using a urine sample collected from the patient, the laboratory may use the following methods:
- Urine dipstick. This gives instant results and tests for the presence of hemoglobin in the urine.
- Urine microscopy and sensitivity (Urine MC&S). This test rules out the presence of infection and determines the source of hematuria.
- Urine cytology. This test checks for any abnormal appearing cells and has the greatest sensitivity to bladder carcinomas followed by cystoscopy.
- Blood test. A complete blood count may be done to determine the level of blood loss or the presence of infection. Creatinine level and estimated glomerular filtration rate to determine kidney function. A prostate-specific antigen may also be done in male patients as a differential diagnosis for prostate cancer, UTI, urinary retention, and benign prostatic hypertrophy.
- Imaging. This is usually done to determine the cause of hematuria.
- X-ray. This detects renal stones and calculi in the kidneys, ureter, and bladder.
- Intravenous pyelogram. Sensitivity is used in detecting urinary tract lesions through injection of contrast and another imaging test.
- Ultrasound. This can help determine renal tumors, cystic lesions, hydronephrosis, and stones, especially in pregnant and children.
- CT scan. This test diagnoses obstructions, infections, cysts, tumors, and traumatic injuries involving the urinary tract.
- MRI. This test can focus on the individual internal organ to determine the cause of hematuria.
- Cystoscopy. This visualizes the entire bladder for biopsy and diagnosis of urethral and bladder pathology.
Treatment for Hematuria
Most episodes of hematuria resolve conservatively without any intervention. Hematuria is a sign and not a disease itself, so the treatment should focus on the cause of hematuria such as:
- Acute urinary retention secondary to blood clots is usually managed by catheter insertion and continuous irrigation.
- Urinary tract infection should be treated with a specific antibiotic according to the urine culture and sensitivity. A repeat urinalysis should be done to determine the effectiveness of the antibiotic therapy.
- Renal stones can be treated with NSAIDs or opioids for pain. Alpha-blockers may be used to aid in the passage of stones. Extracorporeal shock wave lithotripsy (ESWL) may be done to facilitate the breaking of stones into small pieces.
- Renal, ureteric, and bladder tumors can be treated with cystoscopy or removal of tumors through surgery.
- Benign prostatic hypertrophy can be treated with alpha-blockers and 5-alpha-reductase inhibitors to reduce symptoms and urinary retention. Prostate cancer should be referred to a urologist for a biopsy.
- Surgery may be necessary with certain anatomic abnormalities, obstructions, tumors, or urolithiasis.
- Monitoring of patients with persistent microscopic hematuria along with signs and symptoms should be done every 6-12 months as this may be an indication of a progressive renal disease.
- Continuous monitoring of patients receiving anticoagulant or antiplatelet therapy should be done.
- Avoid exposure to toxic chemicals that can cause hematuria. Use protective equipment to limit exposure to radiation and chemicals.
- Avoid strenuous activities or overexertion of the body to reduce the incidence of hematuria.
- Referral to a urologist or nephrologist may be needed in patients with persistent microscopic hematuria, gross hematuria, recurrent urinary tract infections, abnormal urine cytology, and irritative lower urinary tract symptoms.
Nursing Diagnosis for Hematuria
Nursing Care Plan for Hematuria 1
Nursing Diagnosis: Acute Pain related to hematuria secondary to urinary tract infection as evidenced by fever, frequent urination of small amounts, and burning pain upon urination.
- The patient will be able to maintain a normal body temperature.
- The patient will be able to report minimal pain on a 3 to 4 scale on a 0 to 10 pain scale.
- The patient will be able to urinate in normal amounts without frequent urgency.
Nursing Care Plan for Hematuria 2
Nursing Diagnosis: Impaired Urinary Elimination related to hematuria secondary to benign prostatic hypertrophy as evidenced by dysuria.
- The patient will be able to achieve a normal elimination amount and pattern.
- The patient will verbalize techniques to prevent urinary retention.
|Hematuria Nursing Interventions||Rationale|
|Assess the patient’s current elimination pattern and compare it with the patient’s normal elimination pattern before the manifestation of symptoms.||Differences in the patient’s elimination pattern may help in determining the progress of symptoms and the effectiveness of treatment.|
|Monitor patient’s intake and output||To determine adequate urinary function, determine the patient’s hydration status and check for urinary retention.|
|Palpate the bladder and perform a digital rectal exam.||Palpating the bladder will confirm bladder distention and urinary retention. A digital rectal exam should be done to check the enlarged prostate.|
|Observe the urinary stream and note the force and amount.||This will determine the degree of obstruction to planning appropriate intervention.|
|Encourage an increase in oral fluid intake unless contraindicated.||Adequate fluid intake helps in adequate renal perfusion. Take note that adequate urinary flow must be established first before increasing fluid intake to prevent bladder distention.|
|Encourage the patient to void every 2 to 3 hours.||This will establish a regular elimination pattern and facilitates emptying of the bladder to reduce distention and stasis.|
|Assist the patient in performing a sitz bath.||Sitz bath promotes muscle relaxation in the perineal area relieving edema and enhancing voiding.|
|Insert a straight or indwelling catheter as ordered.||A catheter will facilitate the draining of the bladder to relieve bladder distention and prevent stasis.|
|Educate the patient about the proper catheter and perineal care.||To minimize the risk of infection.|
|Educate on bladder training and pelvic floor exercises.||Kegel exercises help strengthen the pelvic muscles. Bladder training helps regulate elimination patterns and complete emptying of the bladder preventing stasis.|
|Administer medications as ordered.||Alpha-blockers and 5-alpha-reductase inhibitors help in reducing symptoms and urinary retention.|
Nursing Care Plan for Hematuria 3
Nursing Diagnosis: Hyperthermia related to hematuria secondary to urinary tract infection as evidenced by chills, flushed and warm skin.
- The patient will maintain a normal core temperature with non-pharmacological interventions.
- The patient will verbalize adequate information about reducing the risk of acquiring an infection.
|Hematuria Nursing Interventions||Rationale|
|Assess and monitor vital signs frequently along with other signs and symptoms that can be associated with hyperthermia.||Documentation of the patient’s vital signs will alert the nurse for status changes and appropriately plan the intervention.|
|Assess the patient’s elimination pattern taking note of the amount and characteristics of urine.||To determine the progression of hematuria and check for adequate urinary function, hydration status, and urinary retention.|
|Assess the patient for any signs of dehydration such as dry mucous, decrease perfusion, or decrease urine output.||Hyperthermia can cause sweating and affect skin integrity.|
|Instruct the patient to remove unnecessary clothing and regulate room temperature and humidity.||Excessive constrictive clothing may cause the body temperature to increase. Hot and humid environments affect body heat too.|
|Assist the patient in a tepid sponge bath or an ice bath as tolerated.||Decrease the body temperature and should be discontinued once the patient’s core temperature reaches 39 degrees Celsius.|
|Provide the patient with a cooling blanket or hypothermal blanket.||Help decrease the body temperature while providing comfort to the patient.|
|Encourage the patient to increase oral fluid intake.||Adequate fluid intake increases urine production and dilution. Adequate fluid intake maintains adequate tissue perfusion and body temperature.|
|Administer antipyretics and antibiotics as ordered.||The cause of infection must be treated to prevent hyperthermia. Antipyretics immediately lowers body temperature.|
|Educate the patient and significant others about signs of hypothermia.||Instruct the significant others to discontinue cooling intervention once the body temperature reaches 38 degrees Celsius.|
Nursing Care Plan for Hematuria 4
Nursing Diagnosis: Disturbed Sleeping Pattern related to hematuria secondary to frequent urgency to urinate as evidenced by nocturia and dissatisfaction with sleep.
- The patient will report adequate rest and sleep after 2 days of nursing intervention.
- The patient will verbalize ways to prevent nocturia and hematuria from recurring.
|Hematuria Nursing Interventions||Rationale|
|Assess the patient’s current sleep pattern and take note of the amount of sleep, bedtime routine, sleeping position, and depth.||Documenting the patient’s sleeping pattern will assist in determining changes and factors that affect rest and sleep.|
|Provide a dark, quiet, and comfortable environment.||To facilitate a restful environment and good sleep.|
|Assess for signs of sleep-wake problems.||Determine factors that affect the patient’s sleep and properly address the problem.|
|Educate the patient about avoiding heavy meals during dinner, smoking before bedtime, and drinking caffeinated or alcoholic beverages.||Heavy meals before bedtime may induce indigestion or upset stomach. Caffeinated drinks activate the nervous system and have diuretic effects that may alter sleep and cause nocturia.|
|Educate about increasing oral fluid intake during the day and limit during bedtime.||This will reduce events of nocturia while still being hydrated during the day to relieve hematuria.|
|Encourage the patient to have a consistent bedtime routine and schedule.||A consistent bedtime schedule helps in regulating circadian rhythm promoting adequate rest.|
|Encourage a warm bath, massage, and warm milk before bedtime.||A warm bath promotes relaxation of muscles and warm milk promotes sleep due to the L-tryptophan component. Massage relieves muscle tension and spasm.|
|For persistent sleep disturbance referral to a sleep specialist may be needed.||Professional help will be needed for appropriate medications and a more complex evaluation of sleep disturbance.|
Nursing Care Plan for Hematuria 5
Nursing Diagnosis: Deficient Knowledge related to unfamiliarity with hematuria as evidenced by asking questions about the condition and apparent anxiety of the patient.
- The patient will verbalize understanding of hematuria and the conditions that may be associated with hematuria.
- The patient will participate and comply with the treatment plan with an accurate understanding and execution.
|Hematuria Nursing Interventions||Rationale|
|Assess the patient’s current knowledge and understanding of his/her condition.||The treatment approach and plan must be aligned with the patient’s level of knowledge and understanding.|
|Educate the patient about hematuria, risk factors, prevention, and treatment in a language that the patient can easily understand.||Information about the condition will help the patient understand the treatment plan and avoid recurrence. Avoid using medical terms and explain them in simple language that the patient can understand because this may cause confusion and further questions from the patient and significant others.|
|Assess the patient’s willingness to learn and motivations that may help.||Open-mindedness will help in achieving the treatment goal. Explaining the purpose and result will greatly motivate the patient to be involved.|
|Assess learning needs including support that may help during the treatment course.||This will help the nurse in prioritizing and planning appropriate care without wasting each other’s effort and time.|
|Involve the patient in goal setting and treatment planning.||Goal setting and treatment plans will be more attainable if it will be based on the patient’s ability to participate.|
|Educate the patient and significant others using visualization materials such as structural models, images, or videos.||Visualization materials are an effective medium to explain the condition properly without confusing the patient and significant others.|
|Educate the patient about self-care management.||Hematuria can result in a more serious condition, educating the patient about signs and prevention will prevent progression and complications.|
|Instruct the patient to repeat the given information about his/her condition.||This will serve as an evaluation of the patient’s understanding of the information given.|
|Encourage the patient to ask questions and clarifications.||This facilitates open communication allowing verification of information given.|
|Encourage verbalization of feelings and difficulties that the patient experiences during the treatment.||Promoting trust can help the patient gain a sense of control to his/her condition increasing self-esteem. Treatment should start on the patient’s awareness with expected support from the nurse and caregiver.|
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2022). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2020). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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