Symptom: Blood in the Urine

Initial Grading Reminder

CTCAE grading of blood in the urine:

Grade 1 (Mild): Asymptomatic; clinical or diagnostic observations only; intervention not indicated
Grade 2 (Moderate): Symptomatic; urinary catheter or bladder irrigation indicated; limiting instrumental ADLs
Grade 3 (Severe): Gross hematuria; transfusion, IV medications or hospitalization indicated; elective endoscopic, radiologic, or operative intervention indicated; limiting self-care ADLs
Grade 4 (Life-threatening): Life-threatening consequences; urgent radiologic or operative intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you ever had blood in the urine in the past? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Do you have a prior history of urinary tract infections? Any associated urinary symptoms (increased frequency, incontinence, or pain during urination)?

Grade the symptom

Ask the patient:

Can you see the blood in your urine? How red is the water in the toilet? Do you feel faint? Are you able to take care of yourself? Is it painful when you urinate?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Are you experiencing fever, chills, nausea, headache, shortness of breath, or dizziness?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?

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    Suggested Intervention

    Any new blood in the urine should be evaluated.

    Patients with any of the red-flag symptoms should be seen immediately.

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    Nursing Assessment of Potential Causes

    [tab category='Nephritis' header="Nephritis - Nursing Assessment" tab1='Look' tab2='Listen' tab3='Recognize']

    Differential Diagnosis

    What do you suspect is the cause of blood in the urine?