Symptom: Pain with Urination

Initial Grading Reminder

CTCAE grading of pain upon urination:

Grade 1: Mild pain
Grade 2: Moderate pain; limiting instrumental ADLs
Grade 3: Severe pain; limiting self-care ADLs

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Have you had any pain associated with urination in the past?

Grade the symptom

Ask the patient:

How would you rate the pain you are experiencing with urination: is it mild, moderate, or severe? Are you holding back urinating because of the pain/burning feeling? How much fluid do you drink per day? Have you had any fever?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Any blood in the urine? Any change in the color of the urine? Do you feel like you have to urinate frequently? Back pain? Are you nauseated? Do you have a headache? Do you feel sick? Have you had any shortness of breath?

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

    Patients with newly emergent moderate or worse (or worsening) pain upon urination should be evaluated.

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

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    Nursing Assessment of Potential Causes

    After ruling out infectious causes.

    Nephritis - Nursing Assessment

    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Look
    • Listen
    • Recognize
    • Does the patient appear uncomfortable?
    • Does the patient look ill?
    • Has there been change in urination?
      • Urine color?
      • Frequency?
    • How much fluid is the patient taking in?
    • Are associated symptoms present?
      • Nausea?
      • Headache?
      • Malaise?
      • Lung edema?
    • Are there symptoms indicative of:
      • Urinary tract infection?
      • Pyelonephritis?
      • Worsening CHF?
    • Are symptoms limiting ADLs?
    • Current or recent use of nephrotoxic medications (prescribed and OTC), other agents?
      • NSAIDs
      • Antibiotics
      • Contrast media or other nephrotoxic agents (contrast dye, aminoglycosides, PPI)?
    • Laboratory abnormalities (elevated creatinine, electrolyte abnormalities)
    • Urinalysis abnormalities (casts)
    • Abdominal or pelvic disease that could be causing symptoms
    • Prior history of renal compromise?
    • Other immune-related adverse effects?
    • Presence of current or prior immune-mediated toxicities, including rhabdomyolysis
    • Is patient volume depleted?

    Differential Diagnosis

    What do you suspect is the cause of painful urination?