Eliminasi Meliputi Informasi / Riwayat Pasien Pemeriksaan - Pola BAB, BAK

ELIMINASI
Meliputi Informasi / riwayat pasien Pemeriksaan

Pola BAB, BAK
bacteriuria
constipation
defecation
detrusor muscle
diarrhea
dysuria
extraurethral incontinence
fecal incontinence
flatulence
functional incontinence
hematuria
hemorrhoids
impaction
instability incontinence
nocturia
peristalsis
pyuria
specific gravity
stoma
stool
stress urinary incontinence
urge urinary incontinence
urinalysis
urinary incontinence
urinary retention
voiding
CTORS
AFFECTING ELIMINATION
Age
A clients age or developmental level will affect control
over urinary and bowel patterns. Infants initially lack a
pattern to their elimination. Control over bladder and
bowel movements can begin as early as 18 months of age
Diet
Adequate fluid and fiber intake are critical factors to a
clients urinary and bowel health. Inadequate fluid
intake is a primary cause of constipation, as is ingestion
of constipating foods such as certain dairy products.
Diarrhea and flatulence (discharge of gas from the rectum)
are a direct result of foods ingested, and clients

need to be educated as to which foods and fluids promote
healthy elimination and which foods may inhibit it.
Exercise
Exercise enhances muscle tone, which leads to better
bladder and sphincter control. Peristalsis is also aided
by activity, thus promoting healthy bowel elimination
patterns.
Medications
Medications can have an impact on a clients elimination
health and patterns and should be assessed during the
health history interview. Cardiac clients, for instance, are
commonly prescribed diuretics, which increase urine
production. Antidepressants and antihypertensives may
lead to urinary retention.
COMMON ALTERATIONS
IN ELIMINATION
Urinary Elimination
Urinary incontinence and urinary retention are the
most common causes of altered urinary elimination patterns.
Urinary incontinence is the uncontrolled loss of
urine that constitutes a social or hygienic problem.
Urinary retention is the inability to completely evacuate
urine from the bladder during micturition. There are
two primary types of urinary incontinence, acute and
chronic. In addition, chronic urinary incontinence can
be subdivided into several distinctive types. Because
each has its own etiology and management, it is important
to determine the type of incontinence before subjecting
the client to the expense, potential risks, and
rigors of a treatment program.
Acute Urinary Incontinence
Acute urinary incontinence is a transient and reversible

loss of urine. It may occur during an acute illness or
after an injury. Common causes of acute urinary incontinence
include urinary tract infection, atrophic vaginitis,
polyuria related to diabetes, acute confusion,
immobility, and sedation. Medications that increase or
decrease bladder or urethral sphincter tone also may
contribute to acute incontinence.
Chronic Urinary Incontinence
Acute incontinence is distinguished from established or

chronic incontinence. There are four predominant
types of chronic urine loss: stress urinary incontinence,
instability incontinence, functional incontinence, and
extraurethral incontinence.
TABLE 39-1
Common Causes of Stress Urinary Incontinence
Urethral hypermobility Multiple vaginal deliveries
Forceps-assisted deliveries
Pelvic muscle denervation
Estrogen deficiency
Obesity (exacerbating factor)
Intrinsic sphincter Iatrogenic
deficiency Multiple bladder suspensions
(women)
Radical prostatectomy (men)
Transurethral resection of prostate
(rare in men)
Y-V plasty surgery (both genders)
Neuropathic
Lesion of lumbosacral spine
Cauda equina syndrome
Pelvic fracture
TABLE 39-2
Common Causes of Instability Incontinence
Urge urinary Neuropathic (sensations
incontinence preserved)
Cerebrovascular accident
Brain tumor
Hydrocephalus
Organic brain syndrome (also
associated with functional urinary
incontinence)
Incomplete spinal lesions (when
sensations of bladder filling are
preserved)
Bladder inflammation
Bladder calculi
Bladder tumor (particularly
carcinoma in situ)
Cystitis (may exacerbate
subclinical instability)
Atrophic vaginitis
SUI (39% of women with SUI
experience instability and urge
incontinence; cause of
relationship unclear)
Bladder outlet obstruction
Idiopathic (may represent subtle
neuropathy or other undiagnosed
disorder)
Reflex incontinence Spinal lesions above neurologic
level S-2
Complete cord injury
Transverse myelitis
Multiple sclerosis
Urinary Retention
Urinary retention is caused by two conditions: bladder
outlet obstruction and deficient detrusor muscle contraction
strength.
TABLE 39-3
Common Causes of Urinary Retention
Bladder outlet Prostatic enlargement
obstruction Benign prostatic hyperplasia
Prostate cancer
Prostatitis
Bladder neck dyssynergia
(dyssynergia of the smooth
muscle of the sphincter
mechanism)
Detrusor sphincter dyssynergia
(typically indicates dyssynergia
between detrusor and striated
muscle of sphincter)
Urethral stricture
Urethral tumor (rare)
Deficient detrusor Transient conditions
contraction strength Fecal impaction
Acute immobility
Side effects of drugs including
anticholinergics, tricyclic
antidepressants
Side effect of recreational drugs
including hallucinogens
Herpes zoster of sacral
dermatomes
Established conditions
Lesions of sacral spine
Cauda equina syndrome
Diabetes mellitus (late stages)
Tabes dorsalis
Poliomyelitis
Bowel Elimination
Many diseases and conditions affect bowel function.
Although many alterations in bowel elimination patterns
may be observed, this discussion is limited to three
common alterations: constipation, diarrhea, and fecal
incontinence.
Constipation
Colonic constipation is the infrequent and difficult passage

of hardened stool. (Perceived constipation, influenced
by psychological and emotional stress, is not
included in this discussion.)
Dietary factors may contribute to constipation.
Dehydration causes drying of the stool as the body
increases the reabsorption of water and sodium from
the bowel. Inadequate dietary bulk also dehydrates the
stool. Diverticular disease, a common problem in the
elderly, also reduces colonic transit, further increasing
the risk of constipation
Constipation
Colonic constipation is the infrequent and difficult passage

of hardened stool. (Perceived constipation, influenced
by psychological and emotional stress, is not
included in this discussion
Diarrhea
Diarrhea is the passage of liquefied stool that, because of

its increased frequency and consistency, represents a
change in the persons bowel habits. The primary causes
of diarrhea include infectious agents, malabsorption disorders,
inflammatory bowel disease, short bowel syndrome,
side effects of drugs, and laxative or enema
misuse.
Fecal Incontinence
Fecal incontinence is the involuntary loss of stool of sufficient

magnitude to create a social or hygienic problem.
The primary mechanisms that predispose the adult
to incontinence of stool are dysfunction of the anal
sphincter, disorders of the delivery of stool to the rectum,
disorders of rectal storage, and anatomic defects.
ASSESSMENT
Health History
Physical Examination
frekwensi karakter BAB, BAB terakhir
frekwensi, karakteristik ekskresi urin, kesulitan BAK, penyakit ginjal / liver
penggunaan laksative / diuretic
penggunaan alat Bantu ekskratory, missal : colostomy, ureterostomy
derajat berkeringat
tempat ekskratory lain missal; drain, Water Seal Drainage, NGT, muntah
hasil lab termasuk : urinalisis, feses, rutin, kultur feses, test fungsi ginjal, test fungsi liver,
OBGYN catat adanya kelainan, mual, konstipasi, hemoroid, sering kencing, stress
inkontinensia
PEDIATRIK catat penggunaan popok atau rutinitas toileting, catat kata-kata khusus yg
digunakan Periksa jika ada indikasi, warna konsistensi, karakter, frekwensi dan kualitas
feses dan urine
Periksa jika ada indikasi, warna, karakter dan kualitas output dari tempat ekskratori lain
Pengkajian abdomen, termasuk suara usus, flatus, softnes, distensi, massa, hemoroid, drain
atau alat Bantu pengumpulan lain
Diagnostic and Laboratory Data

When significant urinary or fecal elimination problems
are observed, further testing is needed to evaluate
the underlying cause of the condition and to determine
treatment options. When urinary incontinence
exists, a dipstick urinalysis is obtained and evaluated
for nitrites, leukocytes, hemoglobin, glucose, and specific
gravity. When nitrites or leukocytes are present, a
microscopic analysis is completed to determine the
presence of white blood cells in the urine (pyuria) and
bacteria in the urine (bacteriuria). Urine culture and
sensitivity testing are completed and the client is
treated for a urinary tract infection. If glucose is noted
in the urine, the patient may undergo further evaluation
for diabetes mellitus, or methods of glucose control
may be reviewed and adjusted in the client with
known diabetes. If the specific gravity (weight of urine
compared with weight of distilled water) of the urine is
abnormally low (below 1.010), the volume of fluid
consumed by the client over a 24-hour period is evaluated
further. Hematuria (blood in the urine) may be
noted.
DOMAIN 3. ELIMINATION/EXCHANGE
CLASS 1 : URINARY SYSTEM
00016. Kerusakan eliminasi urine
00023. Retensi urine
00020. Inkontinensia urine fungsional
00017. Inkontinensia urine stress
00019. Inkontinensia urine urgensi

00018. Inkontinensia urine refleks
00022. Risiko Inkontinensia urine urgensi
00166. Kesiapan untuk meningkatkan eleminasi urine
00176. Inkontinensia urine overflow
CLASS 2 : GASTROINTESTINAL FUNGTION
00014. Inkontinensia usus
00013. Diare
00011. Konstipasi
00015. Risiko untuk konstipasi
00012. Konstipasi dirasakan
00196. Disfungsi motilitas gastrointertinal
00197. Risiko disfungsi motilitas gastrointertinal

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ELIMINASI

Meliputi Informasi / riwayat pasien Pemeriksaan

are a direct result of foods ingested, and clients

Acute Urinary Incontinence

Acute urinary incontinence is a transient and reversible

Chronic Urinary Incontinence

Acute incontinence is distinguished from established or

Colonic constipation is the infrequent and difficult passage

Colonic constipation is the infrequent and difficult passage

Diarrhea is the passage of liquefied stool that, because of

Fecal incontinence is the involuntary loss of stool of sufficient

Diagnostic and Laboratory Data

00019. Inkontinensia urine urgensi

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