Kebutuhan EliminasiUrine

Functions of Urinary System

• Mengeluarkan produk sisa dari darah dan dibuang melalui urine

• Mengeluarkan sisa metabolisme (nitrogen)

• Mengatur keseimbangan asam dan basa dan cairan

Nephron = unit fungsional ginjal , bertugas membentuk urine

Goal of Urinary System

• To maintain chemical homeostasis of the blood. – Filtration by the Nephrons

• H2O, glucose, amino acids, urea, creatinine, major electrolytes

• Not normally large proteins or blood cells– Proteinuria is a sign of glomerular injury

• Normal adult 24hr output = 1500 -1600ml.

Overview of Urinary System

• Kidneys– Bean shaped organs– Either side of vertebral columns T12 – L3– Right kidney lower due to liver– Urine produced with filtration of blood through

nephrons– Major role in fluid & electrolyte balance

• Ureters– Connect kidneys to bladder– 10 -12 in length, ½ in diameter in adult– Peristaltic waves

• Renal colic

• Micturition

• Bladder– Distensible, muscular sac– Reservoir for urine ( approx. capacity =

600mls)– Organ of excretion ( norm. voiding= 300mls)– Lies in pelvic cavity behind symphysis pubis

• Urethra– Short, muscular tube– Urine from bladder to meatus and from the body– Female 4-6.5cm (1 ½ - 2 ½ in.) length– Male 20cms ( 8 in.)

• Urinary and reproductive systems

• Meatus– External opening of the urethra, male & female

• The need to void is a conscious awareness

Life Cycle Changes

• Infants & children– Unable to concentrate urine b/c kidneys are

immature– Urine is light yellow– Void frequently– Voluntary control @ 24mos. when

neuromuscular structures develop

• Adult

– 1500 – 1600 mls urine/24hrs– Berkemih setiap 4-6 kali perhari.– Setelah bangun tidur pagi hari– Setiap berkemih jumlah urine 200ml-500ml– Concentrates urine – normal is amber colored– Nocturia

• Not usually• Decreased renal blood flow during rest• Ability to concentrate urine

• Elderly– Micturition impaired– mobility – Diseases, alzheimer’s, CVA– Physiological age related changes

• Bladder loses muscle tone and capacity

• Kidneys lose ability to concentrate urine

• Bladder loses muscle strength

Rentang normal urine output perhari

• BBL – 2 = 500-600

• 2-5 = 500-800

• 5-8 = 600-1200

• 6-14 =100-1500

Karakteristik Urine Normal

• Volume = 30ml/jam

• Warna = kuning terang

• Kepekatan = transparan

• Bau= aromatik/amoniak

• Berat jenis =1.010-1.020

• pH= 4,5-7,5

Komposisi air kemih

• 95% air

• Zat sisa Nitrogen dari metabolisme asam urea, protein, amoniak dan kreatinin

• Pigmen (bilirubin, urobilin)

• Toksin

• Hormon

Proses miksi

Mikturisi merupakan gerak reflek yang dapat dikendalikan dan ditahan oleh pusat-pusat

persarafan , gerakannya oleh otot abdominal yang menambah tekanan didalam rongga dan berbagai organ yang menekan kandung kemih

membantu mengosongkannya

Faktor yang mempengaruhi eliminasi

• Intake cairan• Kehilangan cairan

tubuh• Nutrisi• Posisi tubuh• Faktor psikologis• Obstruksi aliran urine• Infeksi saluran kemih

• Hipotensi• Cedera saraf• Penurunan tonus otot• Kehamilan• Pembedahan• Pengobatan• Urinart diversion

Common Problems

• Urinary Retention– Accumulation of urine in the bladder– Inability to empty– Pressure, discomfort and tenderness

• Residual Urine = urine retained in the bladder after voiding

• Incontinence– Loss of voluntary control to void

• Infection, nerve damage to bladder or brain, spinal cord injury, or aging process

• Total incontinence = no control• Stress incontinence = sm. amts. Urine

excreted involuntarily with coughing or laughing

• Frequency & Urgency• Nocturia• Enuresis – involuntary discharge of urine• Nocturnal Enuresis

– During sleep– Bed-wetting children 5yrs and older

• Oliguria– 30mls/hr or 720 mls/24hrs

• Renal anuria– cessation of urine production 100mls/24h

Nursing Interventions to Encourage Normal Urinary Elimination

Promoting Healthy Urinary Elimination

• Urinate as soon as the urge is felt– Avoids stasis and distention– Prevents urgency, infection, and incontinence

• Drink about 2liters fluid/day

• Limit Na, caffeine, and alcohol

• For people with Nocturia– fld. Intake in the p.m.– caffiene and alcohol– Void before bedtime

• For Women – Wipe perineum front to back– Void soon after intercourse– Wash hands– Pelvic – floor strengthening exercises (Kegel

Exercises)

Client Education

• S & S of infection

• Fluid intake ( if no restrictions 2-5 L/day )

• Perineal hygiene

• Meds. & side effects on urination, color, and volume

Facilitating Micturition

• Nursing Measures to promote voiding in people who are having difficulty:

1. Privacy and natural position

2. Providing commode or bathroom

3. Running water

4. Warm water to dangle fingers

5. Warm water over perineum ( measure if on In/Out )

6. Gently stroking inner thighs or pressure to symphysis pubis

7. Pain relief Warmth to the bladder & perineum

relaxes muscles & facilitates voiding. ( Sitz bath or warm tub )

If unsuccessful- urinary catheterization may be indicated

• Promoting complete bladder emptying

• Prevention of infection

– Good perineal hygiene

– Adequate fld. Intake

• Dilutes urine & flushes urethra

– Acidifying urine ( inhibits microorganisms)

• Cranberry juice, whole grain breads, meats, eggs, prunes and plums.

Fluid Intake

• Increasing fluid intake increases urine production.

• A normal, average daily intake of 1200 to 1500 ml of fluids is adequate for most patients.

• Dilute urine helps prevent urinary tract stones and infection.

Fluid Intake

• Immobilized patients may require fluid intakes of 2000 to 3000 ml per day to prevent calculi formation.

• Limited fluid intakes may be necessary for patients on fluid restrictions such as those with renal impairment or congestive heart failure.

Fluid Intake

• Fluid intake can also be increased by encouraging the patient to eat plenty of raw fruits and vegetables, which have a high water content.

Voiding Habits

• Hospital routines and prescribed medical therapies can interfere with a patient’s normal voiding habits.

• Assist patient with bedpans or with getting to the bedside commode or toilet, if needed.