PART I

INTRODUCTION
1.1 BACKGROUND
Elimination requirement consists of two, namely the elimination of urine (pee) that is
part physiological needs and aims to remove waste material and we just discuss the
elimination of urine.
Kidneys are the organs retroperitoneal (behind the lining of the stomach), consisting of
the right and left kidneys punggung.ginjal acts as a regulator of bone composition and
volume of fluid in the body and blood filter to be disposed in the form of urine as waste
materials that are not needed by the body and keep him mixed with substances needed by the
body.
Bladder (bladder-bladder) is a bag that consists of over smooth muscle, bladder serves to
accommodate urine.dalam there are several layers of muscle tissue deepest, memamjang the
middle, and meligkar called the detrusor, serves to remove urine when contraction occurs.
It is the organ that functions ureter urine kabagian channel outside.
Urethral function in women is different from that contained in pria.pada men, the urethra
is used as a drainage of urine and reproductive system, a length of 13.7 to 16.2 cm, which
consists of three parts, namely prostate, membranes (membrane) and section the hollow
(space) .In women, the urethra 3.7 to 6.2 cm long and only serve as a channel gets urine out
of the body.

1.2 FORMULATION PROBLEM

a. How does the process of urination?
b. Any factor that affects the urinary elimination?
c. Any problem needs urinary elimination?
d.
1.3 PURPOSE OF THE PROBLEM
a. Readers can find out the function and role of the kidneys, bladder, and urethra.
b. Readers can memahai urination process.
c. The reader can understand the composition of urine.
d. Readers can find out what influences facto and the problem needs urinary elimination.

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 PART II
DISCUSSION
2.1 ELIMINATION URINE
System body that play a role in the elimination of urine
Body systems involved in the process of urinary elimination is renal, bladder and
urethra.
1. Kidney
Kidneys are the organs retroperitoneal (behind the lining of the stomach),
consisting of the right and left kidneys punggung.ginjal beperan as a regulator of bone
composition and volume of fluid in the body and blood filter to be disposed in the
form of urine as waste materials that are not needed by the body and keep him mixed
with substances needed by the body. In the kidney is the nephron (totaling
approximately one million) which is a unit of the kidney structures. Through the
nephron, urine is channeled into part of the renal pelvis, and then channeled through
the ureters to the bladder.
2. Bladder
Bladder (bladder-bladder) is a bag that consists of over smooth muscle, serves to
accommodate the urine. In the bladder, there are several layers of muscle tissue
deepest, memamjang the middle, and meligkar called the detrusor, serves to remove
the urine when there kontraksi.pada base of the bladder are the middle layer of muscle
tissue or the inside of the circle is called the circumference muscle function keeping
the channel between the bladder and urethra, urethral channel so that the urine from
the bladder out of the body.
Channeling stimulus to the bladder and motor stimulation to the muscle
circumference part in the system governed by simpatis.akibat of this stimulus,
otolingkar become loose and the inner sphincter contraction occurs so that urine
remains in the bladder kemih.sistem parasympathetic stimulation channel motor
bladder gets danrangsangan barrier in this lingkar.rangsangan muscles can cause
muscle contraction of the detrusor and sphincter Letting.
3. Urethral
The urethra is the organ that functions outside kabagian urine channel. Urethral
function in women is different from that contained in pria.pada men, the urethra is
used as a drainage of urine and reproductive system, a length of 13.7 to 16.2 cm,
which consists of three parts, namely prostate, membranes (membrane) and section

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 the hollow (space) .In women, the urethra 3.7 to 6.2 cm long and only serve as a
channel gets urine out of the body.
Urinal channels lined by mucous membrane, starting from the urethral meatus to
ginjal.meskipun microorganisms normally no one can pass through the urethra
bottom, mucous membranes, in pathological states, which continuously will make it a
good medium for the growth of some pathogens.
a. The process of urination
Micturition (mictio, mycturition, voiding or urination) is the process of
emptying pesika urinary (bladder). This process begins with the collection of urine
in the bladder which stimulates the sensory nerves in the bladder wall (part of the
receptor). The bladder can cause nerve stimulation when erisi approximately 250-
450cc (in adults) and the 200-250cc (in children).
Because the mechanism of micturition occur urinary vesicles containing urine
that can lead to stimulation, through the spinal cord delivered kepusat control
urination contained the cerebral cortex, the brain keudian give impulse / stimulus
via the spinal mmedulla nouromotoris to the sacral area, as well as the case
koneksasi deprusor muscle and relaxation of the internal sphincter muscle.

 The composition of urine

1. Water (96%)
2. Solution (4% 0
a. Organic solvents
Urea, ammonia, keratin, and urine acid.
b. Inorganic solution
Sodium (sodium), chloride, potassium (potasim), sulf

2.2 FACTORS AFFECTING THE URINE ELIMANASI

1. Diet and intake
The amount and type of food is a major factor affecting the output or the amount
of urine. Protein and sodium may determine the amount of urine that is formed. In
addition, coffee can also increase the formation of urine.
2. Response Package, Amenities beginning to urinate
The habit of ignoring the initial desire to void urine can cause a lot of stuck in the
bladder that affects the size of the bladder and the amount of urine.
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3. Lifestyle
Perubahab lifestyle can affect the fulfillment of elimination, in relation to the
availability of toilet facilities.
4. Stress psychology
Increase the frequency of stress can lead to frequent desire to urinate. This is due
to the increased sensitivity to the desire to urinate and Urune amount produced.
5. The level of activity
Elimanasi Urune requires muscle tone urinary vesicles good for sfinter function.
The loss of muscle tone of the bladder causing urinary control capabilities and the
ability to decrease muscle tone obtained by the move.
6. The level of development
Rate of growth and development may affect the pattern of urination. It can be
found in children, the more smoothly the tendency to menegalami mengentrol
difficulty urinating. But with age, the ability to control a small buangair increased.
7. Conditions of disease
Certain disease conditions, such as diabetes mellitus, can affect the production of
urine.
8. Sociocultural
Culture can affect the urinary elimination needs, such as prohibiting the public
kultul to urinate certain place.
9. Habits someone
Someone who has a habit of urinating toilet may have difficulty urinating through
urinals or urine pot when ill.
10. Muscle tone
Muscle tone which has an important role in helping the process of urination is
kamdung bladder, muscles of the abdomen, and pelvis. The trio was instrumental
in pengontral contraction of urine.
11. Surgery
The effects of surgery may decrease glomerular filtration which can cause a
decrease in the amount of urine output due to the impact of the administration of
anesthetic
12. Treatment
Memyebabkan treatment effect an increase or decrease in the amount of urine. For

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 example, the provision of diureik can increase the amount of urine, sedamngkan
anticholinergic or antihypertensive medication can menyabakan urinary retention.
13. Examination of diagnostic
Prosedut diagnostic-related measures such as urinary tract examination
intravenous pyelogram (IVP), by limiting the amount of intake can affect the
production of urine. Then, sistokopi action can cause local edema of the urethra
which can interfere with the expenditure of urine.
2.3 PROBLEM NEEDS OF URINE
1. Retention of urine
An accumulation of urine in the bladder due to an inability content kemihv bladder
to empty its contents, causing distention of the bladder. The content of normal urine
in the bladder is of 250-450ml, and samapi limit the amount of urine stimulated to
urinate, in a state dispensi, the bladder can hold as much urine 3000-4000ml.
a) Clinical signs in retention:
 Discomfort pubic area
 visika urinary distension
 inability to urinate
 Frequent urination when the bladder contains little urine uriaria (25-
50ml)
 Imbalance amount of urine released with intake
 Increased restlessness and keinganan urination.
 The total 3000-4000 ml of urine in the bladder.
b) Causes
 Operations on the lower abdominal region, pelvic bladder.
 Traumatic spinal cord.
 high urethral pressure caused by a weak detrusor muscle.
 Strong sphincter.
 Obstruction (structures of the urethra and prostate gland enlargement).
2. Incontinence of urine
Urinary incontinence is the inability of the external sphincter muscle to control the
temporary or permanent urinary excretion. In general, the causes of incontinence:
the process of aging, the prostate gland enlargement, loss of consciousness, and the
use of narcotic drugs or sedatives. Urinary incontinence comprising:

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1. Urge incontinence
Urge incontinence is a condition where a person experiences of urine
involuntarily, occurred immediately after feeling a strong urge to urinate.
a) Possible causes:
 Decreased bladder capacity.
 Irritation of the receptor strain that causes spasms of the bladder (urinary
tract infection).
 Drinking alcohol or caffeine.
 Increased fluid
 Increased urinary tracts
 bladder distension excessive bladder
b) Signs urge incontinence:
 Frequent micturition (micturition more than 2 hours).
 bladder spasm.
 Nocturia
 Treatment of incontinence unsuccessful
2. Stress Incontinence
Stress incontinence is a condition sesoeorang who experience loss of urine less
than 50 ml, occur with increased abdominal pressure.
a) Possible Cause:
 Degenerative changes in the muscles of the pelvic muscles and supporting
structures associated with aging.
 high intra-abdominal pressure (obesity)
 bladder distension
 pelvic muscles and supporting structures weak
b) Signs of Stress Inkonensial:
 The urine dripping with increased abdominal pressure
 The drive to urinate
 Frequent micturition (over 2 hours)

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 3. Reflex Incontinence
Reflex incontinence is a condition where a person experiences are not
perceived urine output, occurs at intervals that can be expected when the
bladder volume reaches a certain julmah.
a) Possible Cause:
 neurological damage (spinal cord lesions)
b) Signs Inkontenensia reflex:
 There is no urge to urinate
 Feeling that the bladder is full
 contractions or spasms of the bladder is not inhibited at regular intervals.

3. Enuresis
An inability to restrain urinary enuresis (bedwetting) caused by not being able to
control the sphincter eksternal.enuresis usually occurs in children or the elderly,
generally at night.

Enuresis Causes:
 Capacity vesica urinary larger than normal conditions.
 Children who sleep voiced and signs of a desire to urinate unknown
indications, which resulted in delays in getting out of bed to use the
bathroom
 Vesica urinary sensitive excitatory and so can not be menempung urine in
large amounts
 Unpleasant emotional atmosphere at home
Parents who have the idea that his son would cope without assistance to educate
habit.
 Urinary tract infection or physical or neurological changes in the urinary
system.
 Foods that contain lots of salt and minerals, or eat pemedas.
 Children who are afraid of the dark road to to the bathroom

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 4. Ureterotomi
Ureterotomi is surgery to create a stoma on the abdominal wall or drainage of urine.
This operation is performed because of the presence of disease or dysfunction in the
bladder.

2.4 ELIMINATION PATTERN CHANGES IN URINE

Changes in the pattern of urinary elimination is a state of a person who has a defect of
urinary elimination, caused by multiple (anatomical obstruction), sensory motor
impairment, urinary tract infection. In the elimination pattern consists of:
1. Frequency
Frequency is the number of urination during the day. Increasing the frequency of
urination due to increased amount of fluid intake. A high frequency without the
pressure of fluid intake can be caused by cystitis. High frequency found in a state of
stress or pregnancy.
2. Urgency
Urgency is the feeling of a person to urinate, fear experiencing urinary incontinence
otherwise. In general, young children have a poor ability to control the external
sphincter and feeling immediately wanted to urinate normally happen to them
3. Polyuria
Polyuria is an abnormal urine production by the kidney in large quantities without an
increase in fluid intake. It is usually found in people with diabetes mellitus, the anti
dieuretik hoemon deficiency (ADH), and chronic kidney disease.
4. urinary Suppression
Urinary suppression is the sudden cessation of urine production. Normally, urine
produced by the kidneys continuously at a speed of 60-120 ml / hour.

2.5 HELPING PATIENTS SMALL WASTE WATER (BAK) WITH URINALS

Help patients urinate using a urinal action in patients who are unable to urinate own
small dikamar by using the tool shelter (urinal). This is done to accommodate the urine
and urinary disorders know (color and number).
a) Preparation tools and materials:
1. Urinal
2. Pengalas
3. Tissue

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 4. sampiran / mosquito net
b) How the implementation of:
1. Wash hands.
2. Explain the procedure to the patient.
3. Install sampiran, netting or door closed.
4. Attach the urinal pad under the patient.
5. Remove the bottom of the patient's clothing.
6. Attach the urinal under the gluteal / pelvic or between both thighs.
7. Instruct the patient to urinate.
8. When finished, trim tool.
9. Wash hands, note color, and the amount of urine production.
c) Attitude:
1.Polite
2.Patient
3.Thorough
4. Communicative

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 PART III
CLOSING
3.1 Conclusion
Body systems involved in the process of urinary elimination is renal, bladder and
urethra.
Kidneys are the organs retroperitoneal (behind the lining of the stomach),
consisting of the right and left kidneys punggung.ginjal beperan as a regulator of bone
composition and volume of fluid in the body and blood filter to be disposed in the
form of urine as waste materials.
Bladder (bladder-bladder) is a bag that consists of over smooth muscle, serves to
accommodate the urine.
The urethra is the organ that functions outside kabagian urine channel.

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 BIBLIOGRAPHY

Hidayat, A. Aziz Alimul H, 2009. Kebutuhan Dasar Manusia II. Jakarta: Selemba Medika.

Uliyah, Musrifatul & Hidayat, A. Aziz Alimul, 2008. Keterampilan Dasar Praktik Klinik.
Jakarta: selemba Medika.

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