Hydronephrosis is a condition characterized by the swelling and dilation of the renal collecting system due to obstruction or blockage in the urinary tract, leading to impaired urine flow and potential kidney damage. This nursing diagnosis focuses on identifying symptoms, preventing complications, and managing patient care effectively.
Causes (Related to)
Hydronephrosis can develop due to various factors affecting the urinary system:
- Urinary tract obstruction from:
- Kidney stones
- Ureteropelvic junction obstruction
- Tumors
- Blood clots
- Pregnancy
- Structural abnormalities include:
- Congenital defects
- Retroperitoneal fibrosis
- Enlarged prostate
- Other contributing factors:
- Previous urinary tract surgery
- Neurogenic bladder
- Vesicoureteral reflux
- Trauma to the urinary system
Signs and Symptoms (As evidenced by)
Subjective: (Patient reports)
- Flank pain
- Lower back pain
- Abdominal discomfort
- Urinary frequency or urgency
- Decreased urine output
- Nausea and vomiting
- General malaise
Objective: (Nurse assesses)
- Increased kidney size on imaging
- Elevated blood pressure
- Abnormal urinalysis results
- Elevated creatinine levels
- Signs of infection
- Palpable abdominal mass
- Changes in urine characteristics
Expected Outcomes
- Patient will maintain adequate urine output
- Patient will demonstrate improved kidney function
- Patient will report decreased pain levels
- Patient will avoid complications
- Patient will understand condition management
- Patient will comply with the treatment plan
Nursing Assessment
Monitor Vital Signs
- Check blood pressure, pulse, and temperature
- Monitor for signs of infection
- Assess pain levels
- Document urine output
Evaluate Urinary Function
- Monitor intake and output
- Assess urine characteristics
- Document frequency and urgency
- Note any difficulty urinating
Assess Pain Status
- Location and intensity
- Aggravating factors
- Relief measures
- Impact on daily activities
Monitor for Complications
- Signs of infection
- Kidney function deterioration
- Uremic symptoms
- Mental status changes
Review Risk Factors
- Medical history
- Previous surgeries
- Family history
- Current medications
Nursing Care Plans
Nursing Care Plan 1: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to kidney distention and urinary tract obstruction as evidenced by reported flank pain and guarding behavior.
Related Factors:
- Increased kidney pressure
- Tissue inflammation
- Urinary obstruction
- Muscle tension
Nursing Interventions and Rationales:
- Assess pain characteristics
Rationale: Establishes baseline for intervention effectiveness - Administer prescribed pain medications
Rationale: Provides comfort and reduces inflammation - Teach pain management techniques
Rationale: Empowers patient in pain control
Desired Outcomes:
- Patient will report decreased pain levels
- Patient will demonstrate improved comfort
- Patient will use effective pain management strategies
Nursing Care Plan 2: Impaired Urinary Elimination
Nursing Diagnosis Statement:
Impaired Urinary Elimination related to urinary tract obstruction as evidenced by changes in urination pattern and decreased output.
Related Factors:
- Mechanical obstruction
- Structural abnormalities
- Neurological impairment
- Infection
Nursing Interventions and Rationales:
- Monitor urine output hourly
Rationale: Identifies changes in kidney function - Maintain patent urinary catheter if present
Rationale: Ensures continuous drainage - Monitor for infection signs
Rationale: Enables early intervention
Desired Outcomes:
- Patient will maintain adequate urine output
- Patient will demonstrate normal urination patterns
- Patient will remain infection-free
Nursing Care Plan 3: Risk for Infection
Nursing Diagnosis Statement:
Risk for Infection related to urinary stasis and possible instrumentation as evidenced by risk factors present.
Related Factors:
- Urinary stasis
- Invasive procedures
- Compromised urinary flow
- Weakened immune system
Nursing Interventions and Rationales:
- Implement sterile technique
Rationale: Prevents introduction of pathogens - Monitor temperature and white blood cell count
Rationale: Detects early infection signs - Educate about infection prevention
Rationale: Promotes patient compliance
Desired Outcomes:
- Patient will remain free from infection
- Patient will demonstrate proper hygiene
- Patient will identify infection signs
Nursing Care Plan 4: Deficient Knowledge
Nursing Diagnosis Statement:
Deficient Knowledge related to unfamiliarity with condition and management as evidenced by questions and expressed concerns.
Related Factors:
- Lack of exposure
- Complex medical terminology
- Information misinterpretation
- Anxiety about condition
Nursing Interventions and Rationales:
- Provide condition education
Rationale: Increases understanding and compliance - Demonstrate care techniques
Rationale: Enhances learning through observation - Verify understanding
Rationale: Ensures effective learning
Desired Outcomes:
- Patient will verbalize understanding
- Patient will demonstrate proper care techniques
- Patient will participate in treatment decisions
Nursing Care Plan 5: Anxiety
Nursing Diagnosis Statement:
Anxiety related to uncertain prognosis and treatment outcomes as evidenced by expressed concerns and increased tension.
Related Factors:
- Diagnostic uncertainty
- Treatment concerns
- Lifestyle changes
- Fear of complications
Nursing Interventions and Rationales:
- Provide emotional support
Rationale: Reduces anxiety levels - Explain procedures thoroughly
Rationale: Increases sense of control - Teach coping strategies
Rationale: Helps manage stress
Desired Outcomes:
- Patient will report decreased anxiety
- Patient will use effective coping strategies
- Patient will verbalize concerns appropriately
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.
- 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.
- Hosny M, Chan K, Ibrahim M, Sharma V, Vasdev N. The Management of Symptomatic Hydronephrosis in Pregnancy. Cureus. 2024 Jan 11;16(1):e52146. doi: 10.7759/cureus.52146. PMID: 38222991; PMCID: PMC10784716.
- Ignatavicius, D. D., Rebar, C., & Heimgartner, N. M. (2023). Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care. Elsevier.
- Lee HS, Jo SB, Hwang W, Kim JW, Oh MM, Park HS, Moon DG, Ahn ST. The Degree of Hydronephrosis as an Indicator of the Necessity for Ureteric Dilatation during Ureteroscopic Lithotripsy. J Clin Med. 2023 Jul 10;12(14):4591. doi: 10.3390/jcm12144591. PMID: 37510710; PMCID: PMC10380207.
- Silvestri, L. A. (2023). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.
- Sinha A, Bagga A, Krishna A, Bajpai M, Srinivas M, Uppal R, Agarwal I. Revised guidelines on management of antenatal hydronephrosis. Indian J Nephrol. 2013 Mar;23(2):83-97. doi: 10.4103/0971-4065.109403. PMID: 23716913; PMCID: PMC3658301.
