PRELIMINARY REPORT

URINE RESISTANCE IN SPACE

MELATI 4 DR. SOEKARJO GENERAL
HOSPITAL

By :
SUCI ILHAMI SOMANTRI
P20620523091
2A Applied Bachelor of Nursing and Nursing Profession

BACHELOR OF APPLIED NURSING AND

NURSING PROFESSION PROGRAM
NURSING DEPARTMENT
MINISTRY OF HEALTH POLYTECHNIC OF
HEALTH TASIKMALAYA
A. Theoretical Concept
1. Understanding Benign Prostatic Hyperplasia
Benign prostatic hyperplasia or benign prostate hyperplasia (BPH) is also
called Nodular hyperplasia, benign prostatic hypertrophy or Benign
enlargement of the prostate (BEP) which refers to an increase in the size of the
prostate in middle-aged and elderly men. Benign prostatic hypertrophy (BPH)
is an enlargement of the prostate gland and cellular tissue associated with
endocrine changes related to the aging process. The prostate is a gland covered
with a capsule weighing approximately 20 grams, located around the urethra
and below the bladder neck in men. If enlargement occurs, the middle lobe of
the prostate will press and the urethra will narrow.
Hyperplasia of the prostate gland and epithelial cells causes the prostate to
enlarge. When the prostate is large enough it will press the urethra causing
partial or total urethral obstruction. This can cause symptoms of urinary
hesitancy, frequent urination, increased risk of urinary tract infections and
urinary retention (Suharyanto, T. 2009)

2. Understanding Urinary Retention

Urinary retention is a condition when an individual experiences chronic
inability to urinate followed by involuntary urination (overflow incontinence)
(Carpenito, 2009). Urinary retention is defined as incomplete emptying of the
bladder (SDKI, 2017). Excessive bladder distension causes poor detrusor
muscle contractility, thus disrupting urination. Urinary retention is difficulty
urinating due to failure of urine from the urinary plexus (Arif, 2008). Urinary
retention is the retention of urine in the bladder, which can occur acutely or
chronically (Ministry of Health of the Republic of Indonesia Pusdiknakes
2008). Overflow or incontinence can occur in patients with urinary retention.

3. Anatomy
 The prostate is a male genital organ located below the bladder, in front of
the rectum and enveloping the posterior urethra. Its shape is like a candlenut
with a size of 4x3x2.5 cm and weighs approximately 20 grams (Purnomo,
2012). The prostate has a dense fibrous capsule and is covered by prostatic
connective tissue as part of the visceral pelvic fascia. The superior part of the
prostate is connected to the urinary bladder, while the inferior part rests on the
urogenital diaphragm. The ventral surface of the prostate is separated from the
pubic symphysis by retroperitoneal fat in the retropubic space and the dorsal
surface is bordered by the ampulla recti (Moore & Agur, 2002).
Anatomically, the prostate is closely related to the bladder, urethra, vas
deferens, and seminal vesicles. The prostate is located above the pelvic
diaphragm so that the urethra is fixed to the diaphragm, it can be torn along
with the diaphragm if injured. The prostate can be palpated on digital rectal
examination (Sjamsuhidajat et al., 2012). The prostate gland is divided into
several zones, including: peripheral zone, central zone, transitional zone,
anterior fibromuscular zone and periurethral zone. The peripheral zone is the
largest zone, consisting of 70% glandular tissue while the central zone consists
of 25% glandular tissue and the transitional zone consists of only 5% glandular
tissue. Most cases of BPH occur in the transitional zone, while the growth of
prostate carcinoma originates from the peripheral zone (Junqueira, 2007).
The prostate gland contains a fair amount of fibrous tissue and smooth
muscle tissue. This gland is penetrated by the urethra and both ejaculatory
ducts, and is surrounded by a venous plexus. Its regional lymph nodes are the
hypogastric, sacral, obturator, and external iliac lymph nodes (Sjamsuhidajat et
al., 2012).

4. Physiology
1) Seminal Vesicles
Throughout the seminal vesicles, which are convoluted sacs that empty
into the ejaculatory ducts, they produce 7a thick, alkaline fluid that is rich in
fructose that serves to protect and nourish sperm, which increases the pH of the
ejaculate and contains prostaglandins that cause spermatozoa to move faster, so
they reach the fallopian tubes faster. More than half of the seminal vesicle
secretion is semen (Wibowo, 2012).
Seminal fluid is the fluid in which spermatozoa swim. This fluid provides
nutrients (food) to spermatozoa and helps spermatozoa motility. After traveling
from the seminal vesicles and ejaculatory ducts to the urethra, prostate
secretions and secretions from the bulbourethral glands are added here. Finally,
this seminal fluid is ejaculated during sexual arousal. This prostate secretion is
the largest component of seminal fluid (Wibowo, 2012).
2) Prostate Gland
The prostate is a cone-shaped structure that is 4 cm long, 3 cm wide and
2 cm thick with a weight of approximately 8 grams. The prostate surrounds the
upper part of the urethra and is located in direct connection with the cervix of
the urinary bladder. The prostate is composed of glandular tissue and
involuntary muscle fibers and is contained within a fibrous capsule (Wibowo,
2012).
The prostate is a single doughnut-shaped gland about the size of a peach
pit. It surrounds the urethra only second to the bladder. It is enclosed by a thick
connective tissue capsule, consisting of 20-30 tubuloalveolar glandular
compounds embedded in a mass (stroma) of smooth muscle and dense
connective tissue (Wibowo, 2012).
The prostate muscle tissue functions to assist in ejaculation. Prostate
secretion is produced continuously and excreted into the urine. Approximately
1 ml is produced daily, but the amount depends on testosterone levels, because
this hormone stimulates the secretion. Prostate secretion has a pH of 6.6 and is
composed like plasma, but contains additional ingredients such as cholesterol,
citric acid and an enzyme hyaluronidase. Prostate secretion is added to sperm
and seminal fluid when sperm and seminal fluid pass through the urethra
(Wibowo, 2012).
Prostate gland secretions enter the prostatic urethra through several
prostatic ducts when smooth muscle contracts during ejaculation. It plays a role
in activating sperm and is responsible for as much as one-third of the volume
of semen. It is a milky, slightly acidic fluid containing citrate (source
nutrition),several enzymes (fibrinolysin, hyaluronidase, acid phosphatase), and
prostate-specific antigen (PSA). The prostate has a reputation as a health
wrecker (perhaps reflected in the common mispronunciation of "prostate")
(Wibowo, 2012).
The prostate is often enlarged in middle-aged or elderly men, and this
enlargement due to other pressure caused by anything on the urethral sphincter
or the urethra itself, will cause acute urinary retention. Such conditions can be
cured by inserting a catheter into the urinary bladder or performing a
prostatectomy in certain patients (Wibowo, 2012).

3) Glandula Bulbourethtalis (Cowper)

The bulbourethral (cowper) glands are a pair of glands that are about the
size and shape of peas. These glands secrete an alkaline fluid containing mucus
into the urethra of the penis to lubricate and protect it and are added to semen
(sperm + secretions) (Wibowo, 2012).
The prostate gland is located just below the bladder and surrounds the
urethra. The lower part of the prostate gland is attached to the urogenital
diaphragm or often called the pelvic floor muscle. This gland in adult men is
approximately the size of a hazelnut, with a length of about 3 cm, a width of 4
cm and a thickness of approximately 2.5 cm. It weighs about 20 grams.
 The prostate consists of glandular tissue, stromal tissue (support) and
capsule. The fluid produced by the prostate gland together with fluid from the
seminal vesicles and Cowper's glands is the largest component of all fluids.
Semen. The ingredients contained in semen fluid are very important in
supporting fertility, providing a comfortable environment and nutrition for
spermatozoa and protection against microbial invasion.
Prostate disorders that can interfere with the reproductive process are
inflammation (prostatitis). Other disorders such as abnormal growth (tumors)
both benign and malignant do not play an important role in the reproductive
process but play a greater role in the occurrence of urinary flow disorders. The
latter disorder usually manifests in elderly men (Indah, 2011).

5. Etiology of Benign Prostatic Hyperplasia

The exact cause of BPH is still unknown. However, what is certain is that
the prostate gland is very dependent on androgen hormones. Another factor that
is closely related to BPH is the aging process. There are several possible
causative factors, including (Ministry of Health of the Republic of Indonesia,
2019):
a. Dihydrotestosterone
b. Increased 5 alpha reductase and androgen receptors cause the epithelium
and stroma of the prostate gland to undergo hyperplasia.
c. Changes in the balance of estrogen - testosterone hormones
d. In the aging process in men, there is an increase in the hormone estrogen
and a decrease in testosterone which results in stromal hyperplasia.
e. Stromal - epithelial interactions
f. Increased epidermal growth factor or fibroblast growth factor and decreased
transforming growth factor beta cause stromal and epithelial hyperplasia.
g. Reduced dead cells
h. Increased estrogen causes an increase in the lifespan of the stroma and
epithelium of the prostate gland.
i. Stem cell theory
j. Increased stem cells result in transit cell proliferation.
6. Pathophysiology of Benign Prostatic Hyperplasia

Image of the conversion of testosterone to dihydrotestosterone by the

enzyme 5α-reductase (Roehrborn C et al, 2002).
BPH occurs in the prostate transition zone, where stromal cells and
epithelial cells interact. The growth of these cells is influenced by sex
hormones and cytokine responses. In the prostate, testosterone is converted to
dihydrotestosterone (DHT), DHT is an androgen considered the main mediator
of the emergence of BPH. In these patients, DHT hormone is very high in
prostate tissue. Cytokines affect prostate enlargement by triggering an
inflammatory response by inducing the epithelium. The prostate enlarges due
to hyperplasia so that there is narrowing of the urethra which results in
weakened urine flow and obstructive symptoms, namely: bladder hyperactivity,
inflammation, weak micturition (Skinder et al, 2016).

a. Normal prostate b. Benign prostate hyperplasia

 Picture of normal prostate and prostate with Benign prostate
Hyperplasia
Microscopic changes in the prostate have occurred in men aged 30-40 years.
If these microscopic changes develop, there will be pathological, anatomical
changes that exist in men aged 50 years. Hormonal changes cause hyperplasia
of the stromal supporting tissue and glandular elements in the prostate.
7. Pathway

8. Supporting investigation
a. Laboratory
1) Urinalysis / Urine Sediment
 Urine sediment is examined to look for possible infection or
inflammation in the urinary tract. Urine culture examination is useful for
finding the type of germ that causes infection and at the same time
determining the sensitivity of the germ to several antimicrobials tested and
can reveal the presence of leukocyturia and hematuria. Therefore, in
suspected urinary tract infection, urine culture examination is necessary,
and if there is suspicion of bladder carcinoma, urine cytology examination
is necessary. In BPH patients who have experienced urinary retention and
have used a catheter, urinalysis examination is not very useful because
there is often leukocyturia or erythrocyte due to catheter installation
(Purnomo, 2014).
a) Kidney function test
Intravesical obstruction due to BPH causes disorders in the lower or
upper urinary tract. It is said that kidney failure due to BPH occurs as
much as 0.3-30% with an average of 13.6%. Kidney failure causes
thinking of post-surgical complications (25%) more often than without
kidney failure (17%), and mortality is six times higher. Therefore, this
kidney function examination is useful as an indication of the need for
imaging examination of the upper urinary tract (Purnomo, 2014).
b) PSA (Prostate Specific Antigen) Examination
PSA is synthesized by prostate epithelial cells and is organ specific but
not cancer specific. Serum PSA can be used to predict the course of BPH;
in this case, if the PSA level is high, it means:
a) faster prostate volume growth.
b) complaints due to BPH/worse urine stream rate.
c) more likely to develop acute urinary retention.
Serum PSA levels can increase in inflammation, after prostate
manipulation (prostate biopsy or TURP), in acute urinary retention,
catheterization, prostate malignancy, and aging. The range of PSA levels
considered normal based on age is: a. 40-49 years: 0-2.5 ng/ml; b. 50-59
years: 0-3.5 ng/ml; c. 60-69 years: 0-4.5 ng/ml; d. 70-79 years: 0-6.5
ng/ml. Although BPH is not the cause of prostate carcinoma, the BPH age
group has a higher risk of developing prostate carcinoma. PSA
examination together with digital rectal examination is superior to digital
rectal examination alone in detecting prostate carcinoma. Therefore, at this
age, PSA examination becomes very important to detect the possibility of
prostate carcinoma. Most guidelines prepared in various countries
recommend PSA examination as one of the BPH examinations
(Association of Urologists Thinks (IAUI), 2015).
a. Imaging
1) Plain Abdomen Photo
Plain abdominal X-ray is useful for looking for stones in the urinary tract,
 prostate stones/calculi and sometimes can show the shadow of a bladder filled
with urine, which is a sign of urinary retention. PIV examination
(Intravenous Pyelography) can explain the possibility of: abnormalities in the
kidneys or ureters in the form of hydroureter or hydronephrosis, estimate the
size of the prostate gland as indicated by the presence of prostate indentation
(pressure of the bladder by the prostate gland) or the ureter distally, and
complications that occur in the bladder, namely trabeculation, diverticula, or
bladder sacculation. Imaging examination of BPH patients using PIV or USG,
it turns out that 70-75% do not show any abnormalities in the upper urinary
tract; while those who show abnormalities, only a small portion (10%) require
different treatment from the others. Therefore, upper urinary tract imaging is
not recommended as an examination for BPH, unless the initial examination
finds:

 Hematuria.

 urinary tract infection.

 renal insufficiency (by performing an ultrasound examination).

 history of urolithiasis.

 history Once undergo surgeryon channelurogenitalia

(IAUI, in, Purnomo, 2014).
2) Transrectal Ultrasonography Examination (THINK)
This examination is intended to determine the size or volume of the
prostate gland, the possibility of malignant prostate enlargement, as a guideline
for performing aspiration biopsy of the prostate, determining the amount of
residual urine, and looking for other abnormalities that may be present in the
bladder. In addition, transrectal ultrasonography is able to detect
hydronephrosis or kidney damage due to long-term BPH obstruction
(Purnomo, 2014).
b. Other Checks
Obstruction Degree Examination (IAUI, in, Purnomo, 2014);
1) Residual urine is the amount of urine remaining after urination that can
be calculated by catheterization after urination or determined by
ultrasound examination after urination. The amount of residual urine in
normal people is 0.09-2.24 mL with an average of 0.53 mL. Seventy-
eight percent of normal men have residual urine less than 5 mL and all
normal men have residual urine no more than 12 mL.
2) Urine flow rate can be calculated simply by calculating the amount of
urine divided by the duration of urination (ml/second) or with a
uroflowmeter that displays a graphical representation of urine flow
 including the duration of urination, duration of flow, time required to
reach maximum flow, average flow, maximum flow, and volume of
urine voided. A more detailed examination is urodynamics.

B. Nursing Care Concept

1. Assessment
Assessment is the basic idea of the nursing process which aims to collect
information or data about patients, in order to identify and recognize
problems, health and nursing needs of patients, both physical, mental, social
and environmental (Dermawan, 2012).
Data collection
a) Patient identity: Includes name, age, gender, occupation, address, place
of residence
b) History of present illness:In BPH patients, the complaints that exist are
frequency, nocturia, urgency, dysuria, weakened stream, feeling of
dissatisfaction after urination, hesitancy (difficulty starting urination),
intermittency (intermittent urination), and prolonged urination time
which eventually becomes urinary retention.
c) Past medical history: Assess whether there is a history of urinary tract
infection (UTI), whether there is a history of prostate cancer. Whether
the patient has ever had prostate surgery.
d) Family history of illness: Are there any family members who have the
same illness as the patient, are there any family members who have
other chronic illnesses?
e) Psychosocial and spiritual history: How is the patient's relationship with
other family members and the surrounding environment before and
during the illness, does the patient experience anxiety, pain, due to the
illness he is suffering from, and how does the patient use coping
mechanisms to solve the problems he is facing.
2. Bio-psycho-social-spiritual history
a. Nutritional Pattern
What are your daily eating and drinking habits, what types of food do
you often consume, what foods do you like the most, and how often do
you eat?
b. Elimination Pattern
Elimination pattern assess the pattern of urination, including frequency,
hesitancy, dribbling, number of times the patient must get up at night to
 urinate (nocturia), strength of the urinary system. Ask the patient if he
strains to start or maintain the flow of urine. The patient is asked about
defecation, whether there is difficulty such as constipation due to
protrusion of the prostate into the rectum.
c. Personal hygiene patterns
Habits in a clean lifestyle, bathing, using soap or not, brushing teeth.
Rest and sleep patterns
How many hours of sleep do you usually sleep?
What habits do you do before going to bed?
Q: QuaLity-quantity: How are the symptoms felt, to what extent are the
symptoms felt?
R: Region – radiation: Where are the symptoms felt? Are they
spreading?
S: Scale – severity: How severe is the severity felt? On what scale?
Q: Time: When did the symptoms start? How often did the symptoms
occur? Suddenly or gradually? How long did the symptoms last?
3. Physical examination
a) General condition moderately ill, consciousness compos mentis,
temperature 37.5 C, pulse 60
b) 100X/ minute, RR 16-20x/minute, blood pressure 120/80 mmHg.
c) Head to toe examination
Head and neck: Using inspection and palpation techniques:
Hair and scalp: Bleeding, flaking, sores, pressure
Ears: Injury, blood, fluid, odor?
Eyes: Injury, swelling, pupillary reflex, eyelid condition, foreign body,
white sclera?
Nose: Injuries, blood, fluid, nasal discharge, anatomical abnormalities
due to trauma?
Mouth: Foreign body, teeth, cyanosis, dry? Lips: Injury, bleeding,
cyanosis, dry? Jaw: Injury, stability?
Neck: Venous congestion, tracheal deviation, thyroid gland
enlargement
4. Chest examination
 Inspection: Symmetrical shape of right and left, inspiration and
 expiration of breathing, rhythm, movement of nostrils, additional breath
sounds heard, chest shape?
 Palpation: Symmetrical right and left movements, the tactile premitus is
the same between the right and left chest walls.
 Percussion: There are sonorous sounds in both lungs, dull sounds at the
border of the lungs and hip.
 Auscultation: Viscular sounds are heard in both layers of the lungs,
rhonchi and wheezing sounds.
5. Cardiovascular
a) Inspection: Chest shape is symmetrical
b) Palpation: Pulse rate,
c) Parcusi: Deaf sound
d) Auscultation: Regular rhythm, systole/murmur.
6. Digestive system / abdomen
a) Inspection: During inspection, it is necessary to look at whether the
abdomen is bulging or flat, whether the stomach is protruding or not,
whether the lembilicus is protruding or not, whether there are lumps /
masses.
b) Palpation: Is there any abdominal tenderness, is there a mass (tumor,
testes) abdominal skin turgor to determine the degree of patient's biliary
tract, is the palpable tupar, is the palpable spleen?
c) Percussion: Normal abdomen is tympanic, the presence of solid or fluid
masses will cause a dull sound (liver, ascites, urinary bladder, tumor).
d) Auscultation:In terms of intestinal peristalsis, the normal value is 5-35
times per minute.
7. Examination of the upper and lower extremities includes:
a) Skin color and temperature
b) Distal pulse palpation
c) Depornitas extremitas alus
d) Active and passive extremity movements
e) Unusual extremity movements, including cramps
f) Degree of pain in the injured area
g) Edemanone, fingers complete and intact
h) Patellar reflex
 8. Pelvic/genital examination
a) Hygiene, hair growth.
b) Cleanliness, pubic hair growth, catheter in place, presence of lesions or
not.
2. Nursing Diagnosis
Nursing diagnosis is a clinical assessment of an individual, family, or
community's experience or response to a health problem, to thinking about
health problems, or to life processes. Nursing diagnosis is a vital part of
determining appropriate nursing care to help patients achieve optimal health
(PPNI, 2016):
1. Acute pain (D.0077)
1. Definition
Sensory or emotional experience associated with actual or functional tissue
damage, with sudden or slow onset and ranging in intensity from mild to
severe and lasting less than 3 months.
2) Reason
Physiological injuring agents (e.g. inflammation, ischemia, neoplasm)
3) Major Symptoms and Signs
 Subjective
 Complaining of pain
 Objective
• Looks grimacing
• Be protective (e.g. be aware of pain-avoiding positions)
• Nervous
• Increased pulse rate
• Difficulty sleeping
4) Minor Symptoms and Data
 Subjective
Not available
 Objective
1) Increased blood pressure
2) Breathing pattern changes
3) Appetite changes
4) Disturbed thought process
5) Withdraw
6) Focus on yourself
5) Associated clinical conditions
2. Urinary Elimination Disorders (D.0040)
1. Definition
Urinary elimination dysfunction
2. Reason
Decreased urinary capacity
• Bladder irritation
• Decreased ability to recognize signs of bladder problems
• Effects of media and diagnostic procedures (e.g. kidney surgery, urinary
tract surgery, anesthesia, and medications)
• Pelvic muscle weakness
• Inability to access toilet (e.g. immobilization)

3. Major symptoms and signs

 Subjective
• Urgency (urgency)
• Dribbling urine
• Nocturia
 Objective
a) Bladder distension
b) Incomplete urination (hesitancy)
c) Residual urine volume increased

4. Minor symptoms and signs

 Subjective
-
 Objective
-
5. Associated Clinical Conditions
a) Urinary tract

3. Sleep pattern disturbance (D.0055)

1. Definition
Disturbances in the quality and quantity of sleep due to external factors.
 2. Reason
Lack of sleep control
3. Major Symptoms and Signs
 Subjective
• Complaining of difficulty sleeping
• Complaining of frequent awakening
• Complaining of changed sleep patterns
• Complaining about not getting enough rest
 Objective

4. Minor Symptoms and Data

 Subjective:
• Complaining of decreased ability to perform activities
 Objective:

5. Associated clinical conditions

Acute disease

4. Knowledge deficit (D.0111)

1. Definition
lack or absence of cognitive information related to a particular topic.
2. Reason
Lack of exposure to information
3. Major symptoms and signs
Subjective
1) Ask about the problem you are facing
Objective
1) Demonstrates behavior that is not in accordance with
recommendations
2) Shows a wrong perception of the problem

4. Minor symptoms and signs

 Subjective
-
 Objective
1. Undergoing an improper examination
 2. Showing excessive behavior (eg: apathy, hostility, agitation,
hysteria).
5. Associated clinical conditions
a) New clinical conditions faced by the client
b) Acute and chronic diseases

5. Anxiety (D.0080)
1. Definition
an individual's emotional condition and subjective experience towards an
object that is unclear and specific due to anticipation of danger which
enables the individual to take action to face the threat.

2. Reason
Situational crisis.

3. Major Symptoms and Signs

 Subjective
 Feeling worried about the consequences of the condition
faced.
 Difficulty concentrating.
 Objective
 Looks restless
 Difficulty sleeping
4. Minor Symptoms and Data
 Subjective:
 Complaining of a headache
 Feeling helpless
 Objective:
 Increased breathing rate
 Increased pulse rate
 Increased blood pressure
 Face looks pale
 Frequent urination
5. Associated clinical conditions
 Acute disease

3. Intervention
No. Nursing Diagnosis Objectives and Result Intervention
Criteria

1. Acute pain due to After nursing actions are Pain management (DI
physiological injury carried out for ..x.. it is 08238)
agents expected that the pain will Observation
decrease with the
(Eg. Neoplasm) 1. Identification of
following outcome
location,
( D.0077) criteria:
characteristics,
(DL 08066) duration,
frequency, quality,
1. The patient's ability to
intensity of pain
complete activities
decreases 2. Identification of
pain scale
2. Complaints of pain
decreased 3. Identify non-
verbal pain
3. The patient appeared to
responses
be grimacing and was
seen to be grimacing. 4. Identify factors
that aggravate and
4. Pulse rate improves
relieve pain
5. Breathing pattern
5. Identification of
improves
knowledge and
6. Blood pressure beliefs about pain
improves
6. Identify the impact
7. Urinary function of pain on quality
improves of life

8. Behavior improves 7. Monitor the

success of
9. Sleep patterns complementary
improved therapy that has
been given
8. Monitor side
effects of
analgesic use
Therapeutic
1. Provide non-
pharmacological
techniques to
reduce pain.
(eg TENS, hypnosis,
acupressure, music
therapy,
biofeedback,
massage therapy,
aromatherapy,
 guided imagery
techniques,Compr
esswarm/cold,
play therapy)
2. Control
environmental
factors that
aggravate pain
(e.g. room
temperature,
lighting, noise)
3. Rest
facilitiesConsider
the type and
source of pain in
selecting Pain
relief strategies
Education
1. Explain the
causes, periods
and triggers of
pain. Explain
strategy relieve
pain
2. Encourage self-
monitoring of pain
3. Recommend using
analgesics
appropriately
4. Teach non-
pharmacological
techniques to
reduce pain.
Collaboration
1. Collaboration in
providing
analgesics, if
necessary
2. Elimination After nursing actions have Urinary elimination
disorders been carried out for …x… management &
it is expected that the urinary
urine due to
elimination pattern will catheterization
decreased bladder
capacity (D.0040) return to normal with the (l.04148)
following outcome
observation
criteria (L.03019):
1. Identify the signs
1) Increased urination
and symptoms of
sensation
urinary retention or
2) Decreased bladder incontinence
urgency
2. Identify factors that
3) Decreased bladder cause urinary
distension retention or
incontinence
4) Urinating
Nocomplete decline 3. Monitor urine (e.g.
frequency,
5) Nocturia decreased
consistency, odor,
6) Dysuria decreased volume, and color)
Therapeutic
1. Note the times
Andurinary output
2. Limit intake fluid,if
necessary
Education
1. Teach the signs and
symptoms of
urinary tract
infections.
2. Teach adequate
drinking if there are
no
contraindications.
3. Explain the purpose
and procedure for
inserting a urinary
catheter.
4. Encourage deep
breathing during
 urinary tube insertion.

collaboration
1. Collaboration in
administering
suppositories
urethra, if necessary

3. Sleep pattern After taking action for … Sleep support

disturbance due to x…nursing Patients are (l.05174)
pain/colic expected to have improved
Observation
(D.0055) sleep patterns with outcome
criteria (L.05045): 1. Identify activity and
sleep patterns
1. Complaints of difficulty
sleeping improved 2. Identify sleep-
disturbing factors
2. Frequent complaints t (physical and/or
tguard psychological)

3. Complaints of 3. Identify foods or

dissatisfied sleep drinks that disturb
sleep
4. Complaints of decreased
sleep patterns Therapeutic

5. rest complaint not 1. Environmental

enough modification
2. Provide stress relief
if necessary
3. Perform procedures
to increase comfort
4. Adjust the
medication schedule
and actions to
support the sleep-
wake cycle
Education
1. Explain the
importance of
getting enough
sleep during illness
2. Teach autogenic
 muscle relaxation or
other
nonpharmacological
methods.

4. Knowledge deficit After carrying out nursing Health education

black of exposure to actions for …x… it is (l.12383)
information expected that the level of Observation
(D.0111) knowledge increases with
1. Identify readiness
result criteria (L.12111) :
and ability to
1) Appropriate behavior receive
Information
increased
recommendation 2. Identify safety
hazards in
2) ability to explain
environment (e.g.
knowledge about a
physical,
topic increased biological, and
chemical)
3) questions about the
problem that Therapeutic
faceddecrease
1. Provide health
4) questions about the education
problems faced materials and
increase media

5) behavior improves 2. Schedule

education
Health
3. Give an
opportunity to ask
questions
Education
1. Explain the risk
factors that can
affect health
2. Teach healthy
living behavior
3. Teach strategies
that can be used
to improve clean
and healthy living
 7

behavior

5. Anxiety due to After carrying out nursing Anxiety reduction

situational crisis actions for …x… it is (l.09314)
(D.0080) expected that the patient
Observation
will not be anxious with the
outcome criteria (L09093): 1. Identify when
anxiety levels
1) Restless behavior
change (e.g.
decrease
Conditions, time,
2) Tense behavior stressors)
decrease
2. Identify decision
3) Decreasd respiratory making skills
rate 3. Monitor
4) Pulse rate Improve signsanxiety (verbal
decline and non verbal)

5) Concent ationsleep Therapeutic

patterns improved 1. Create a therapeutic
6) Urinary pattern get atmosphere to foster
better trust, accompany
the patient to reduce
anxiety, if possible
use a calm and
reassuring
approach,
motivation
2. Identifying
situations that
trigger anxiety
 NEEDHUMAN BASICS
IN PATIENTS WITH URINARY RETENTION
A. Basic Concept of Human
Humans are living beings consisting of a complete and unique bio-
psycho-social-spiritual. Humans are higher beings that come from lower
beings, so that eventually all living things can be returned to some of their
original forms (Darwin). As for needs, they are something that is very
important, beneficial, or necessary to maintain homeostasis in life itself.
Abrahan Maslow, an American psychologist, developed a theory about basic
human needs which is better known as Maslow's Hierarchy of Basic Human
Needs. The hierarchy includes five categories of basic needs, namely:
1. Physiological needs
Physiological needs have the highest priority in Maslow's hierarchy.
Generally, a person who has several unmet needs will fulfill their
physiological needs first compared to other needs. Humans have eight
types of needs, namely:
a. Oxygen requirements and gas exchange
b. Fluid and electrolyte needs
c. Food needs
d. Urine and fecal elimination needs
e. The need for rest and sleep
f. Activity needs
g. Body temperature health needs
h. Sexual needs, these needs are not necessary to maintain a person's
survival but are important to maintain the continuity of humanity.

2. Safety and security needs The safety and security needs referred to are safe
from various aspects, both physiological and psychological. These needs
include:
a. The need for self-protection from cold, heat, accidents and infections
b. Free from fear and anxiety
c. Free from feelings of threat due to new or unfamiliar experiences
3. The need for love, belonging and being owned (Love and belonging needs)
These needs include:
a. Giving and receiving affection
b. Feelings of belonging and meaningful relationships with others
c. Warmth
d. Friendship
e. Getting a place or being recognized in the family, group and social
environment
4. Self-esteem needs
These needs include:
a. Feelings of irresponsibility towards others
b. Competent
c. Respect for yourself and others

5. Needs for Self Actualization

These needs include:
a. Be able to know yourself well (know and understand your potential)
b. Learn to meet your own needs
c. Not emotional
d. Have high dedication
e. Creative
f. Having high self-confidence, and so on.

The basic needs that are disrupted in adults with disorders in fulfilling
basic needs of the digestive system: Urinary retention includes:
1. Acute Pain
Assessment: Ask the patient about the intensity and characteristics of pain,
especially in the abdominal area or the area around the surgical procedure,
and monitor vital signs.
Intervention:
o Teach relaxation and deep breathing techniques to reduce pain.
 o Assist the patient into a comfortable position that reduces pressure on the
painful area.
o Administer analgesics as directed by the physician and monitor response
to medication.
Evaluation: Check the patient's pain scale after the intervention and note
changes in pain level.

2. Urinary Elimination Disorders

Assessment: Observe for signs of urinary retention, such as bladder
distension, and ask if there is an urge to urinate or pain when urinating.
Intervention:
o Advise patients to drink sufficient fluids, according to post-operative
medical restrictions.
o If the patient has difficulty urinating, teach an upright or semi-Fowler
position to facilitate elimination.
o Discuss with your medical team about placing a temporary catheter if
retention is not resolved.
Evaluation: Monitor the patient's elimination pattern, the amount of urine,
and whether the patient feels more comfortable.

3. Sleep Pattern Disorders

Assessment: Ask whether the patient has difficulty sleeping or wakes up
frequently, as well as factors that interfere with sleep.
Intervention:
o Create a comfortable and quiet sleeping environment, away from noise.
o Advise patients to rest during the day to get enough rest.
o Discuss with the medical team if the patient requires a mild sedative.

Evaluation: Check the patient's sleep quality by asking whether their sleep
is more comfortable after the intervention.
4. Knowledge Deficit About Condition and Post-Operative Care

Assessment: Ask the patient about their understanding of post-operative

recovery and how to manage urinary retention at home.

Intervention:

o Explain to the patient about the causes of post-operative urinary

retention, as well as the treatments that can be done, such as the correct
position for urinating.
o Provide information about signs to watch for, such as excessive pain or
difficulty urinating, and when to contact the medical team.
 Evaluation: Check the patient's understanding by asking again for some
important information that has been explained.

5. Anxiety

Assessment: Identify the patient's level of anxiety and invite discussion

regarding the main concerns felt.

Intervention:

o Take time to listen to patient concerns and provide emotional support.

o Encourage the patient to do deep breathing techniques to help calm
down.

Evaluation: Observe changes in the patient's attitude, and ask if there is a

feeling of calmer after being given support.
 REFERENCE
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