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.