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Dewi Susanti Febri
Terapi medik gizi klinik pada pasien kolestasis ekstrahepatik et causa keganasan dan non keganasan = Medical theraphy clinical nutrition for obstructive cholestasis et causa malignancies and non malignancies
"ABSTRAK
Latar Belakang : Kolestasis adalah penyumbatan atau terhambatnya aliran empedu dari hati ke duodenum, dibagi menjadi intra dan ekstrahepatik. Kolestatis ekstrahepatik terutama disebabkan oleh obstruksi. Pankreatikoduodenektomi merupakan terapi pembedahan pilihan, dapat menyebabkan perubahan anatomis dan fisiologis saluran cerna. Perubahan ini menimbulkan maldigesti dan malabsorpsi, menyebabkan malnutrisi, serta meningkatkan morbiditas dan mortalitas bila tidak mendapat dukungan nutrisi.Presentasi kasus : Empat kasus kolestasis ekstrahepatik, dengan keluhan ikterus di seluruh badan, nyeri perut. Tiga kasus 1 orang laki-laki dan 2 orang perempuan , disebabkan keganasan dan 1 kasus karena striktura CBD jinak. Semua pasien menjalani pembedahan, dengan lama operasi berkisar antara 3 sampai 9 jam. Pemenuhan protein dan asam amino terutama asam amino rantai cabang, diupayakan maksimal, yang diperoleh dari kombinasi makanan cair polimerik dan putih telur. Lemak dibatasi maksimal 30 dari energi yang diberikan, dengan kandungan medium-chain triglycerides MCT tinggi. Pankreatikoduodenektomi menimbulkan perubahan pada organ saluran cerna, dengan gejala mual dan perut begah setelah makan, dapat diatasi dengan penyesuaian cara pemberian, jumlah dan bentuk nutrisi tiap kondisi pasien. Selama perawatan di RS, secara umum asupan makanan dan kondisi klinis pasien membaik, serta pulang dengan perbaikan kondisi klinis.Kesimpulan: Terapi medik gizi klinik pada pasien dengan kolestasis, dapat membantu terapi bedah dan medikamentosa untuk memperoleh outcome pasca bedah dan memperbaiki kualitas hidup pasien.
"
"
ABSTRACT
Background Cholestasis is a blockage or obstruction of the flow of bile from the liver to the duodenum, divided into intrahepatic and extrahepatic. Extrahepatic cholestasis mainly due to the obstruction. Pancreaticoduodenectomy surgery is the treatment of choice, can cause anatomical and physiological changes in the gastrointestinal tract. These changes maldigesti and malabsorption, causing malnutrition, as well as increased morbidity and mortality if not received nutritional support.Case Presentation Four cases of extrahepatic cholestasis, jaundice throughout the body, abdominal pain. Three cases 1 male and 2 female , due to malignancy and 1 case for the CBD benign stricture. All patients underwent surgery, with long operating range from 3 to 9 hours. Fulfillment of protein and amino acids, especially branched chain amino acids, maximum effort, which is obtained from a combination of a polymeric liquid food and egg white. Fat is limited to maximum 30 of the energy supplied, containing medium chain triglycerides MCT high. Pancreaticoduodenectomy cause changes in the organs of the gastrointestinal tract, with symptoms of nausea and abdominal discomfort after eating, can be overcome by adjusting the mode of administration, the amount and form of nutrients each patient 39 s condition. During treatment in hospital, in general, food intake and clinical condition of the patients improved, as well as return to the improvement of clinical conditions.Conclusion The clinical nutrition medical therapy in patients with cholestasis, can help surgical and medical therapy to obtain post surgical outcomes and improve the quality of life of patients."
2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Felicia Deasy Irwanto
Peran Terapi Medik Gizi pada Kapasitas Fungsional, Status Nutrisi, dan Keluaran Klinis Pasien Kolestasis = The Role of Medical Nutrition Therapy on Functional Capacity, Nutritional Status, and Clinical Outcome in Patients with Cholestatic Disease
"Latar Belakang: Kolestasis adalah hambatan atau supresi sekresi empedu. Kolelitiasis dan obstruksi bilier akibat keganasan merupakan kasus kolestasis yang sering ditemui. Kolestasis dapat menyebabkan gangguan nutrisi dan berbagai komplikasi. Selain pembedahan, terapi nutrisi adalah pendekatan tata laksana pada pasien kolestasis untuk mempertahankan status nutrisi dan kapasitas fungsional.
Kasus: Pasien dalam serial kasus ini terdiri atas tiga pasien laki-laki dan satu perempuan, berusia 36-55 tahun dengan diagnosis kolestasis akibat keganasan dan postcholecystectomy syndrome (PCS) dengan riwayat kolelitiasis. Satu pasien dengan keganasan dan dua pasien dengan PCS menjalani operasi bypass biliodigestif dan rekonstruksi, sedangkan satu pasien menjalani perbaikan kondisi klinis sebelum pembedahan. Terapi nutrisi yang diberikan meliputi diet tinggi protein dan rendah lemak dengan nutrien spesifik berupa MCT dan BCAA. Pada kasus pertama terapi nutrisi diberikan pascabedah. Selama perawatan ada kecurigaan leakage anastomosis, tetapi keluaran klinis membaik. Pasien kedua mendapat terapi nutrisi prabedah dan mengalami perbaikan kondisi klinis. Kedua pasien tidak mencapai target nutrisi walaupun toleransi makanan cair baik. Kasus ketiga dan keempat mendapat terapi nutrisi pra dan pascabedah dan pada akhir masa pemantauan, dapat mempertahankan status nutrisi. Pada keempat pasien, kapasitas fungsional dapat dipertahankan, bahkan mengalami perbaikan.
Kesimpulan: Terapi nutrisi yang optimal dapat memberikan keluaran klinis yang baik pada pasien kolestasis. Pemberian nutrien spesifik berupa MCT dan BCAA diperlukan untuk meningkatkan toleransi asupan, mempertahankan status nutrisi, dan memperbaiki kapasitas fungsional pasien kolestasis.
Background: Cholestatis is obstruction or suppression of bile secretion. Cholestasis may cause nutritional disturbance and other complication. Besides surgery, nutritional therapy is needed in cholestasis patient for maintaining nutritional status and functional capacity.
Cases: Four cases (three male and one female) of cholestasis with range of age between 36-55 years old are included in this case series. They were diagnosed with cholestasis because of cancer and post-cholecystectomy syndrome (PCS) with cholelithiasis history. One patient with cancer and two patients with PCS had the biliodigestive bypass surgery and reconstruction, while one patient was restoring her clinical condition before surgery. All patients were given high protein and low fat diet, with specific nutrient such as MCT and BCAA. The first patient received nutrition therapy during postoperative phase. During monitoring, he was suspected with leakage anastomosis, but in the end the outcome was good. Second patient got nutritional therapy in preoperative phase and got better clinical condition. Both patients couldnt reach the nutritional target although their tolerance of ONS was good. The third and the fourth patient got nutritional therapy in pre and postoperative phase and had maintained their nutritional status. In all patients, the functional capacity could be maintained and improved.
Conclusion: Optimal nutritional therapy is needed in cholestasis patients to get better clinical outcomes. Specific nutrients such as MCT and BCAA improve the nutritional tolerance, maintain the nutritional status, and improve the functional capacity."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2019
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UI - Tugas Akhir  Universitas Indonesia Library
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Alavoe Talivin Makhfudya
Pemantauan Terapi Obat pada Pasien Obstruktif Dyspnea et causa Tumor Paru dengan Riwayat Tuberkulosis di RSUP Fatmawati = Monitoring of Drug Therapy in Patients with Obstructive Dyspnea et causa Suspected Lung Tumors with a History of Tuberculosis at RSUP Fatmawati
"Praktek Kerja Profesi Apoteker (PKPA) di rumah sakit bertujuan untuk memahami peran dan tanggung jawab Apoteker di rumah sakit, baik dalam hal pelayanan farmasi klinis maupun pengelolaan sediaan farmasi. Pemantauan terapi obat (PTO) adalah salah satu kegiatan farmasi klinik oleh Apoteker di rumah sakit untuk mengetahui keberhasilan ataupun kegagalan terapi obat. Berdasarkan hal tersebut, PTO dipilih sebagai tugas khusus PKPA di RSUP Fatmawati. Kegiatan ini dilakukan degan tujuan calon Apoteker dapat mengkaji pemilihan obat, dosis dan cara pemberian obat, respons terapi, reaksi obat yang tidak dikehendaki (ROTD), memantau efektivitas dan efek samping obat, dan memberikan rekomendasi penyelesaian masalah terkait obat atau DRP. Pemantauan obat dilakukan pada pasien dyspnea et causa suspek tumor paru dengan riwayat tuberkulosis di unit rawat inap gedung Teratai RSUP Fatmawati. PTO dilaksanakan dengan menganalisis DRP sesuai pedoman PCNE V9.0 dengan metode SOAP. Pada kasus ini, ditemukan beberapa DRP yang perlu dievaluasi kembali.
Pharmacist Professional Work Practice (PKPA) in hospitals aims to understand the roles and responsibilities of pharmacists in hospitals, both in terms of clinical pharmacy services and management of pharmaceutical preparations. Therapy drug monitoring (TDM) is one of the clinical pharmacy activities by pharmacists in hospitals to determine the success or failure of drug therapy. Based on this, TDM was chosen as a PKPA special assignment at Fatmawati Hospital. This activity is carried out with the aim that prospective pharmacists can review drug selection, dosage and method of drug administration, therapeutic response, unwanted drug reactions, monitor drug effectiveness and side effects, and provide recommendations for solving drug-related problems or DRP. Drug monitoring was carried out in patients with dyspnea et causa suspected lung tumors with a history of tuberculosis in the inpatient unit of the Teratai building at Fatmawati General Hospital. TDM is carried out by analyzing the DRP according to PCNE V9.0 guidelines using the SOAP method. In this case, several DRPs were found that needed to be re-evaluated."
Depok: Fakultas Farmasi Universitas Indonesia, 2022
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UI - Tugas Akhir  Universitas Indonesia Library
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Widya Puspita Dewi
Pemantauan terapi obat pada pasien dengan asites masif dan ikterus obstruktif akibat choledocholithiasis di RSUP Persahabatan = Monitoring drug therapy in patients with massive ascites and obstructive icterus et causa choledocholithiasis at RSUP Persahabatan
"Pemantauan terapi obat (PTO) adalah kegiatan apoteker dalam meningkatkan efektivitas obat dan meminimalkan risiko yang tidak diinginkan. PTO dilakukan dengan mengidentifikasi identitas, data, masalah terkait pengobatan, penyelesaian terhadap masalah, rencana, dan tidak lanjut pengobatan. PTO dilakukan terhadap pasien yang memenuhi kriteria, salah satunya adalah pada pasien geriatri dengan gangguan organ. Diagnosa klinis pasien adalah asites masif yang disebabkan gangguan hati kronis dengan ikterus obstruktif akibat choledocolelithiasis yang dirawat di ruang perawatan RSUP Persahabatan. PTO dilakukan untuk mengidentifikasi dan merekomendasi penyelesaian drug related problem (DRP). Pemantauan dilaksanakan dengan melakukan visite, meninjau data klinis, dan daftar pengobatan yang diterima pasien selama perawatan. Dari PTO yang dilaksanakan ditemukan DRP berupa ada obat tanpa indikasi, ada indikasi tanpa obat, dan pasien gagal menerima obat. Identifikasi masalah ada obat tanpa indikasi didasari atas penggunaan fitomenadion ketika parameter perdarahan pasien sudah mencapai nilai normal. Selama perawatan pasien merasakan keluhan dengan derajat nyeri 3 namun belum diberikan obat untuk mengatasinya. Pasien gagal menerima obat disebabkan karena ketidaktersediaannya Curcuma suplemen obat non formularium nasional di rumah sakit dan keluarga pasien belum membelinya namun pada akhir masa perawatannya nilai SGOT/SGPT pasien sudah mengalami perbaikan. Rekomendasi penyelesaian DRP adalah menghentikan obat yang tidak sesuai dengan kondisi klinis pasien, menambahkan obat untuk mengatasi keluhan pasien, dan memberikan salinan resep untuk mendapatkan obat di luar rumah sakit.
Monitoring Drug Therapy (MDT) is a pharmacist's activity aimed at improving drug effectiveness and minimizing undesirable risks. MTM is carried out by identifying patient information, data, medication-related problems, resolving these issues, planning, and following up on the treatment. MDT is performed for patients who meet specific criteria, including geriatric patients with organ disorders. In this case, the patient's clinical diagnosis is massive ascites caused by chronic liver impairment with obstructive jaundice due to choledocholithiasis, and they are being treated in the inpatient ward of RSUP Persahabatan. MDT is conducted to identify and recommend solutions for drug-related problems (DRPs). The monitoring is done by visite, reviewing clinical data, and the patient's medication history during their treatment. From the MDT conducted, the following DRPs were identified the use of phytonadione (fitomenadion) without indication, indication without medication while the patient experienced a pain level of 3 but was not given medication to alleviate it, and failure of drug administration while the non-availability of Curcuma supplement, a non-formulary drug, at the hospital, which the patient's family had not purchased, although by the end of the treatment, the patient's SGOT/SGPT levels had improved. The recommended solutions for these DRPs are to discontinue inappropriate medications for the patient's clinical condition, add medication to address the patient's complaints of pain, and provide a prescription copy for obtaining medications outside the hospital."
Fakultas Farmasi Universitas Indonesia, 2023
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UI - Tugas Akhir  Universitas Indonesia Library
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Nani Utami Dewi
Terapi medik gizi klinik pasien stroke iskemia dengan penyulit disertai komorbiditas = Medical therapy in clinical nutrition for ischemic stroke with complications and comorbidities
"Latar Belakang: Stroke iskemia merupakan disfungsi neurologik area tertentu atau menyeluruh akibat gangguan aliran darah ke otak yang dapat menyebabkan kerusakan jaringan. Berbagai faktor risiko yang tidak dapat dimodifikasi dan dapat dimodifikasi seperti usia, jenis kelamin, riwayat keluarga, hipertensi, diabetes melitus, obesitas berperan menyebabkan pembentukan aterosklerosis, iskemia serebral selanjutnya menyebabkan stroke iskemia. Stroke iskemia dan sejumlah penyulit akan menimbulkan defisit neurologi yang menyebabkan malnutrisi, dehidrasi, keluaran yang buruk dan kualitas hidup menurun. Terapi medik gizi klinis berperan memberi nutrisi optimal, membatasai natrium, mengontrol glukosa darah dan memperhatikan volume cairan yang diberikan sehingga status nutrisi tetap terjaga, memperbaiki keluaran, dan mencegah rekurensi.
Metode: Serial kasus ini memaparkan empat kasus stroke iskemia pada pasien perempuan dan laki-laki dengan rentang usia 53 ndash;66 tahun, dengan penyulit seperti disfagia, perdarahan GIT dan pneumonia, disertai komorbiditas yaitu DM tipe 2, hipertensi, dan chronic kidney disease,. Keempat pasien membutuhkan dukungan nutrisi akibat komplikasi stroke iskemia yaitu disfagia dengan risiko terjadinya malnutrisi, dehidrasi dan ketidakseimbangan elektrolit. Satu pasien dengan berat badan normal, 1 pasien BB lebih, dan 2 pasien obes I. Masalah nutrisi yang dihadapi keempat pasien ini adalah asupan makro dan mikronutrien yang tidak optimal, jalur pemberian nutrisi, kebutuhan nutrisi yang tidak terpenuhi selama sakit, anemia, hiperglikemia, dislipidemia, gangguan fungsi ginjal dan keseimbangan cairan. Terapi medik gizi klinik diberikan sesuai rekomendasi stroke iskemia dan disesuaikan dengan komorbidnya. Pemantauan pasien meliputi keadaan umum, hemodinamik, analisis dan toleransi asupan, monitoring terhadap kadar glukosa darah, fungsi ginjal, keseimbangan cairan, elektrolit dan kapasitas fungsional.
Hasil :Ketiga pasien pada serial kasus menunjukkan perbaikan klinis, berupa tekanan darah terkontrol, kadar glukosa darah terkontrol, dan kapasitas fungsional yang membaik. Satu pasien meninggal pada hari perawatan ke-35 akibat sepsis.
Kesimpulan:Terapi medik gizi klinik yang optimal dapat memperbaiki kondisi klinis pada pasien stroke iskemia dengan DM tipe 2 dan penyulitnya.
Background: Ischemic stroke is a partial or comprehensive neurological disfunction caused by cerebral blood flow disturbance as basis of tissue damages. A diversity of non modified and modified risk factors such as age, sex, family history, hypertension, diabetes mellitus, and obesity act as underlying causes to atherosclerosis, ischemia cerebral, that lead to ischemic stroke. Ischemic stroke with accompanying comorbidity will inflict neurological deficit causing malnutrition, dehydration, bad outcome and the diminution quality of life. The role of nutritional medical therapy is pivotal for optimal nutritional support, sodium intake restriction, and glycemic control with the goal to maintain nutrition status, improve outcome and prevent recurrence.
Methods: The case series describes four ischemic stroke cases with complications such as dysphagia, gastrointestinal bleeding, and pneumonia, and aggravated by DM type II, hypertension, and chronic kidney disease comorbidity, in males and females aged 53 ndash 66 years old. Due to risk of malnutrition, dehydration and electrolyte imbalance caused by dysphagia, nutrition support was required by all patients to treat this ischemic stroke complication. One patient was normoweight, while three other cases included one overweight and two obese I patients. The nutritional problems faced by these four patients laid on the non optimal macro and micro nutrient intake, route of nutrient intake, nutrition composition imbalance during ill period, anaemia, hyperglycaemia, dyslipidemia, decrease of renal function, and fluid imbalance. Nutritional medical therapy was given according to recommendations for ischemic stroke and adjusted with its comorbidity. Patients rsquo monitoring was done including their general condition, hemodynamic, intake analysis and tolerance, monitoring in blood glucose, kidney function, fluid balance, electrolyte and functional capacity.
Result: Three patients in the case series showed positive changes in clinical conditions, shown by improvement in blood pressure, blood glucose, and functional capacity. One patient died on the 35th treatment day due of sepsis.
Conclusion: Optimal nutritional medical therapy plays important role in improving clinical conditions of ischemic stroke patient with DM type 2 and other complications."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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Ngesti Mulyanah
Terapi medik gizi klinik pada kanker kepala dan leher dengan kaheksia dalam terapi radiasi = Medical therapy in clinical nutrition for head and neck cancer with cachexia on radiotherapy
"Latar belakang: Risiko kaheksia pada pasien kanker kepala dan leher KKL meningkat akibat tumor itu sendiri, letak tumor, dan pemberian terapi medis. Penurunan berat badan akibat efek samping radioterapi atau kemoradioterapi dapat menurunkan angka kesintasan dan kualitas hidup, serta meningkatkan angka morbiditas dan mortalitas. Terapi medik gizi klinik bertujuan mencegah malnutrisi bertambah berat, memperbaiki kualitas hidup, dan mendukung outcome terapi yang baik. Terapi medik gizi klinik berupa konsultasi individu, meliputi pemberian nutrisi adekuat sesuai kebutuhan energi, makronutrien, mikronutrien, dan nutrien spesifik, serta terapi medikamentosa dan edukasi.
Metode: Pasien pada serial kasus ini berjumlah empat orang, berusia 32 ndash;53 tahun. Satu orang pasien dengan diagnosis karsinoma lidah dan 3 orang dengan kanker nasofaring. Dua dari 4 pasien menjalani kemoradioterapi. Semua terdiagnosis kaheksia pada awal pemeriksaan. Kebutuhan energi total dihitung menggunakan persamaan Harris-Benedict untuk kebutuhan basal dikalikan faktor stres 1,5. Pemantauan meliputi keluhan subjektif dan pemeriksaan objektif tanda vital, kondisi klinis, antropometrik, massa otot, massa lemak, kekuatan genggam tangan, Karnofsky Performance Status, analisis asupan, dan laboratorium . Pemantauan dilakukan secara berkala setiap minggu untuk menilai pencapaian target pemberian nutrisi.
Hasil: Terapi medik gizi klinik pada keempat pasien meningkatkan asupan energi, protein, dan nutrien spesifik asam amino rantai cabang dan eicosapentaenoic acid . Penurunan BB, massa otot, dan kapasitas fungsional yang terjadi pada pasien hanya minimal.
Kesimpulan: Terapi medik gizi klinik pada pasien KKL dengan kaheksia dalam radioterapi atau kemoradioterapi dapat meningkatkan asupan nutrisi dan meminimalkan penurunan status gizi pasien lebih lanjut.
Introduction: The risk of cachexia of head and neck cancer HNC is increased because of the tumor itself, site of the tumor, and side effects of cancer treatment. Weight loss during radiotherapy or chemoradiotherapy will decrease the survival rates and quality of life, and increase morbidity and mortality rates. The purpose of medical therapy in clinical nutrition is to prevent further malnutrition during therapy, improve quality of life, and support the good outcome of cancer treatment. Individual medical therapy in clinical nutrition include adequate energy, macro and micronutrient, and specific nutrients requirements, pharmacotherapy and education.
Methods: Four HNC patients in this case series aged between 32 and 53. One patient diagnosed squamous cell carcinoma of the tongue and 3 patients with nasopharyngeal cancer. Two of four patients received chemoradiotherapy. Total energy requirement was calculated using Harris Benedict equation for basal energy need multipled by stress factor of 1,5. Monitoring include subjective complaints and objective examination vital sign, physical examination, anthropometric, muscle mass, fat mass, handgrip strength, Karnofsky Performance Status, dietary analysis, and laboratory. Monitoring was performed routinely every week to assess achievement of the nutrition therapy target.
Results: Medical therapy in clinical nutrition to four patients can increase the intake of energy, protein, and specific nutrients branched chain amino acid and eicosapentaenoic acid. The decreased of weight, muscle mass, and functional capacity during radiotherapy or chemoradiotherapy were only minimal.
Conclusion: Medical therapy in clinical nutrition for HNC patients with cachexia on radiotherapy or chemoradiotherapy can increase nutrition intake and minimalized further malnutrition."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
T55637
UI - Tugas Akhir  Universitas Indonesia Library
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Siska Wiramihardja
Terapi medik gizi klinik pada Intestinal Failure dengan berbagai etiologi = medical therapy of clinical nutrition for Intestinal Failure with several etiologies
"[ABSTRAK
Latar belakang: Intestinal failure (IF) merupakan masalah pascabedah dengan
outcome yang buruk. Saat ini telah terdapat rekomendasi terapi gizi pada IF
berdasarkan etiologinya, namun belum ada laporan serial kasus yang memaparkan
aplikasinya.
Presentasi Kasus: Pasien dalam serial kasus ini terdiri dari 3 perempuan dan 1
laki-laki, berusia 21?42 tahun. Terhadap pasien ditegakkan diagnosis IF dengan
berbagai etiologi, yaitu 3 pasien dengan fistula enterokutan (FEK) dan 1 pasien
dengan short bowel syndrome (SBS) end jejunostomy. Terapi gizi pada pasien IF
berdasarkan etiologinya. Pada pasien FEK high output, kebutuhan energi 1,5?2
kali resting energy requirement (RER) atau 37?45 kkal/kg BB/hari, protein 1,5?2
g/kg BB/hari. Pada FEK low output kebutuhan energi 1?1,5 kali KEB (25?30
kkal/kg BB/hari), protein 1?1,5 g/kg BB/hari. Pada pasien FEK yang mendapat
terapi konservatif, didapat outcome peningkatan kadar albumin serum dan berat
badan, serta produksi fistel yang berkurang. Pasien FEK dengan persiapan
rekonstruksi usus halus terdapat perbaikan keadaan umum dan peningkatan kadar
albumin serum. Pada pasien SBS, terkait kondisi pascabedah maka terapi gizi
sesuai rekomendasi Enhanced Recovery After Surgery (ERAS), dengan
kebutuhan energi 25?30 kkal/kg BB/hari dengan komposisi makronutrien yang
seimbang. Pada pasien ini dilakukan distal feeding dan pengaturan laju tetesan
kimus untuk mencegah sindrom dumping. Pasien SBS didapat outcome
peningkatan kadar albumin dan berat badan selama masa perawatan.
Kesimpulan: Terapi medik gizi klinik yang adekuat memberikan outcome yang baik pada pasien IF.ABSTRACT Background: Intestinal failure (IF) is a postoperative complication with poor
outcome. Nowadays, many of nutritional management recommendations based on
etiologies of IF, but no report about those application.
Case Presentation: Three female and one male patients were included in this case
series, aged 21?42 years old. Nutritional needs in IF patients are determined by
their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)
and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on
their fistula production. In patients with high output ECF, energy requirement is
in 1.5?2 resting energy requirement (RER) or 37?45 kcal/kg BW/day, protein
1,5?2 g/kg BW/day. In low output ECF, energy requirement is 1?1.5 RER or 25?
30 kcal/kg BW/day hari, protein 1?1.5 g/kg BW/day. In ECF patients given
conservative therapy, serum albumin and body weight increased, while the fistula
production decreased. In patients with preoperative of intestine reconstruction
surgery, there were improvement in general condition with the increase of serum
albumin. In SBS patients, related to the postoperative condition, energy was given
according to Enhanced Recovery after Surgery (ERAS) recommendation 25?30
kkal/kg BW/day with balance of macronutrient composition. In SBS end
jejunostomy patient the food was given through distal feeding with adjusted
chymus drip to prevent dumping syndrome. There were increased in serum
albumin and body weight of the patients.
Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. , Background: Intestinal failure (IF) is a postoperative complication with poor
outcome. Nowadays, many of nutritional management recommendations based on
etiologies of IF, but no report about those application.
Case Presentation: Three female and one male patients were included in this case
series, aged 21–42 years old. Nutritional needs in IF patients are determined by
their etiologies. IF in this case series caused by enterocutaneous fistula (ECF)
and short bowel syndrome (SBS). Nutritional needs on ECF patients depend on
their fistula production. In patients with high output ECF, energy requirement is
in 1.5–2 resting energy requirement (RER) or 37–45 kcal/kg BW/day, protein
1,5–2 g/kg BW/day. In low output ECF, energy requirement is 1–1.5 RER or 25–
30 kcal/kg BW/day hari, protein 1–1.5 g/kg BW/day. In ECF patients given
conservative therapy, serum albumin and body weight increased, while the fistula
production decreased. In patients with preoperative of intestine reconstruction
surgery, there were improvement in general condition with the increase of serum
albumin. In SBS patients, related to the postoperative condition, energy was given
according to Enhanced Recovery after Surgery (ERAS) recommendation 25–30
kkal/kg BW/day with balance of macronutrient composition. In SBS end
jejunostomy patient the food was given through distal feeding with adjusted
chymus drip to prevent dumping syndrome. There were increased in serum
albumin and body weight of the patients.
Conclusion: Adequate support medical therapy of clinical nutrition in IF patients give good outcome. ]"
Fakultas Kedokteran Universitas Indonesia, 2015
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UI - Tugas Akhir  Universitas Indonesia Library
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Anna Maurina Singal
Tatalaksana komprehensif terapi medik gizi klinik perioperatif pasien anak dengan pembedahan intraabdomen = Comprehensive management of perioperative medical clinical nutrition therapy in intraabdominal pediatric surgery
"[Latar Belakang: Lama puasa prabedah mempengaruhi outcome pascabedah. Saat ini, pasien bedah anak masih dipuasakan lebih lama dari yang direkomendasikan. Sementara itu, belum ada rekomendasi dimulainya pemberian nutrisi enteral pascabedah.
Metode: Dilakukan penilaian pada pasien anak yang menjalani pembedahan intraabdomen. Hal yang dinilai meliputi skrining gizi dengan berbagai metode, status gizi prabedah, lama puasa prabedah, jenis pembedahan, dimulainya nutrisi enteral pascabedah, pencapaian kalori total dan asupan protein, serta perbaikan kapasitas fungsional.
Hasil: Pembedahan terdiri atas nonreseksi dan reseksi usus, masing-masing 2 kasus. Status gizi prabedah pasien pertama dan kedua malnutrisi ringan, sementara pasien ketiga dan keempat malnutrisi sedang. Rerata lama puasa prabedah berturut-turut 16 dan 7,5 jam untuk nonreseksi usus serta 17 dan 7 jam untuk reseksi usus. Semua pasien berada memiliki ASA 2. Pemberian nutrisi enteral dimulai berturut-turut 6 dan 4 jam pascabedah pada nonreseksi, serta hari ke-3 pascabedah pada kasus reseksi usus. Asupan kalori total tercapai berturut-turut pada hari ke-5 dan ke-9 pascabedah pada kasus nonreseksi, serta hari ke-5 dan ke-7 pada reseksi usus. Kebutuhan protein para pasien tercapai berturut-turut pada hari ke-3, 5, 7, dan 9 pascabedah untuk pasien terakhir. Perbaikan kapasitas fungsional pasien terjadi berturut-turut pada hari ke-6, 3, 6, dan ke-8 pascabedah pada pasien pertama, kedua, ketiga, dan keempat.
Kesimpulan: Dengan tatalaksana komprehensif terapi medik gizi klinik perioperatif pasien bedah anak, dapat mencegah komplikasi bedah dan mempercepat pemulihan kapasitas fungsional.
Background: Presurgery fasting time affects the surgery outcome. Nowadays, fasting in pediatric surgery patients are longer than recommended. However, there is no recommendation of the enteral feeding initiation after surgery.
Method: The serial case assessed pediatric intarabdominal surgery patients. They were reviewed for nutritional scorings, presurgery nutritional status, presurgery fasting time, type of surgery, the time the enteral feedings intiatiation, the time to meet the requirement of total calories and protein intake, and the improvement of functional capacity.
Results: Four cases were divided to non- and intestinal resection, 2 cases each. The nutritional status of the first and second patient were mild malnutrition, while the third and the fourth were moderate malnutrition. Mean fasting time were 16 and 7.5 hours in nonresection, while the other were 17 and 7 hours. All patients had 2 ASA scores. The enteral feeding were initiated at 6 and 4 hours after surgery in nonresection, and at day 3 and 4 after surgery in resection case. The total calories were fulfilled at day 5 and 9 after surgery in nonresection, at day 5 and 7 in the other case. The protein intake met total requirement in patients at day 3, 5, 7, and 9 after surgery, respectively. The improvement of maximal functional capacity occured at day 6, 3, 6, and, respectively.
Conclusion: Comprehensive perioperative medical clinical nutrition management results in improving wound healing process and the functional capacity.;Background:
Presurgery fasting time affects the surgery outcome. Nowadays, fasting in
pediatric surgery patients are longer than recommended. However, there is no
recommendation of the enteral feeding initiation after surgery.
Method:
The serial case assessed pediatric intarabdominal surgery patients. They were
reviewed for nutritional scorings, presurgery nutritional status, presurgery fasting
time, type of surgery, the time the enteral feedings intiatiation, the time to meet
the requirement of total calories and protein intake, and the improvement of
functional capacity.
Results:
Four cases were divided to non- and intestinal resection, 2 cases each. The
nutritional status of the first and second patient were mild malnutrition, while the
third and the fourth were moderate malnutrition. Mean fasting time were 16 and
7.5 hours in nonresection, while the other were 17 and 7 hours. All patients had 2
ASA scores. The enteral feeding were initiated at 6 and 4 hours after surgery in
nonresection, and at day 3 and 4 after surgery in resection case. The total
calories were fulfilled at day 5 and 9 after surgery in nonresection, at day 5 and
7 in the other case. The protein intake met total requirement in patients at day 3,
5, 7, and 9 after surgery, respectively. The improvement of maximal functional capacity occured at day 6, 3, 6, and, respectively., Background:
Presurgery fasting time affects the surgery outcome. Nowadays, fasting in
pediatric surgery patients are longer than recommended. However, there is no
recommendation of the enteral feeding initiation after surgery.
Method:
The serial case assessed pediatric intarabdominal surgery patients. They were
reviewed for nutritional scorings, presurgery nutritional status, presurgery fasting
time, type of surgery, the time the enteral feedings intiatiation, the time to meet
the requirement of total calories and protein intake, and the improvement of
functional capacity.
Results:
Four cases were divided to non- and intestinal resection, 2 cases each. The
nutritional status of the first and second patient were mild malnutrition, while the
third and the fourth were moderate malnutrition. Mean fasting time were 16 and
7.5 hours in nonresection, while the other were 17 and 7 hours. All patients had 2
ASA scores. The enteral feeding were initiated at 6 and 4 hours after surgery in
nonresection, and at day 3 and 4 after surgery in resection case. The total
calories were fulfilled at day 5 and 9 after surgery in nonresection, at day 5 and
7 in the other case. The protein intake met total requirement in patients at day 3,
5, 7, and 9 after surgery, respectively. The improvement of maximal functional capacity occured at day 6, 3, 6, and, respectively.]"
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2015
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Widia Sandy
Analisis praktik klinik keperawatan kesehatan masyarakat perkotaan pada pasien Post Operasi Laparatomi Apendiktomi Et Causa Apendisitis Perforasi di RSUP Fatmawati Obat = Analysis clinical practice of urban health nursing in patient with Post Surgery Lapparotomy Appendectomy Cause of Perforation Appendicitis at RSUP Fatmawati Hospital
"Angka kejadian apendisitis di Negara maju khususnya daerah perkotaan meningkat. Apendisitis dapat terjadi karena pola konsumsi makanan rendah serat yang menjadi kebiasaan masyarakat urban perkotaan. Komplikasi apendisitis antara lain perforasi. Komplikasi ini menimbulkan berbagai efek, salah satunya anak mengalami peningkatan suhu tubuh di atas normal. Karya ilmiah ini bertujuan untuk menggambarkan asuhan keperawatan anak post operasi laparatomi apendiktomi hari ke empat. Karya ilmiah ini juga menerapkan terapi komplementer berupa terapi tepid sponge. Didapatkan kesimpulan bahwa suhu tubuh pada anak dapat turun 0.9°C setelah 60 menit dengan mengaplikasikan terapi tepid sponge disertai antipiretik pada anak yang mengalami peningkatan suhu tubuh.
The incidence of appendicitis in rich countries, especially at the urban areas increased. Appendicitis can occur due to low fiber food consumption patterns urban communities that became their habit. One of complications appendicitis is perforated appendicitis. This complication cause some effects, one of the effects is increasing child body temperature above normal. This paper aims to describe the nursing care children laparotomy appendectomy postoperative day four. This paper is also implementing a complementary therapy treatment tepid sponge. The conclusion is the child's body temperature dropped to 0.9 ° C after 60 minutes by applying tepid sponge with antipyretic therapy in children who experienced an increase in body temperature."
Depok: Fakultas Ilmu Keperawatan Universitas Indonesia, 2013
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Trismiyanti
Terapi medik gizi klinik pada anak leukemia limfositik akut dengan kemoterapi = Medical therapy in clinical nutrition for acute lymphocytic leukemia children undergoing chemotherapy
"Latar Belakang: leukemia limfositik akut LLA merupakan keganasan terbanyak pada anak dengan terapi utama kemoterapi, yang akan memicu respon hormonal dan inflamasi sehingga menyebabkan berbagai komplikasi, di antaranya gangguan pada saluran cerna dan penurunan status nutrisi. Diperlukan intervensi nutrisi agar status nutrisi dapat terjaga dan masa pertumbuhan serta perkembangan anak dapat berjalan optimal. Beberapa rekomendasi tata laksana nutrisi anak dengan leukemia yang menjalani kemoterapi telah dipublikasikan, namun belum semua rekomendasi tersebut dapat diterapkan karena keterbatasan sarana dan prasarana, sehingga diperlukan modifikasi agar tata laksana menjadi optimal.
Metode: serial kasus ini membahas empat pasien LLA anak yang menjalani kemoterapi dengan berbagai komplikasi terkait nutrisi. Identifikasi pasien berisiko malnutrisi dilakukan dengan melaksanakan skrining nutrisi pada saat pasien masuk perawatan. Tata laksana nutrisi diberikan secara bertahap sesuai kondisi pasien, dengan target pemenuhan energi sesuai BB ideal berdasarkan tinggi badan yang dihitung dengan menggunakan persamaan Schofield. Pemenuhan protein diberikan minimal sebesar 1,5 g/kg BB/hari, dengan target maksimal 3 g/kg BB ideal, karbohidrat 40 - 60 , dan lemak 10 - 30. Mikronutrien diberikan sesuai dengan angka kecukupan gizi, berupa multivitamin dan mineral. Edukasi nutrisi diberikan terhadap pasien dan keluarga saat pasien diperbolehkan pulang.
Hasil: dua orang pasien dalam serial kasus ini mengalami malnutrisi sedang saat dilakukan skrining nutrisi, dan seorang pasien yang menjalani kemoterapi fase konsolidasi mengalami penurunan BB yang diakibatkan komplikasi saat pemberian kemoterapi. Lama rawat pasien berkisar 8 - 14 hari, keempat pasien pulang dalam kondisi baik.
Kesimpulan: tata laksana nutrisi yang optimal dapat menurunkan risiko komplikasi terkait nutrisi pasien LLA anak yang menjalani kemoterapi.
Background acute lymphocytic leukemia ALL is the highest malignancy in children with primary therapy of chemotherapy, which would trigger a hormonal response and inflammation that cause a variety of complications, including disorders of the gastrointestinal tract and decreased nutritional status. Nutritional intervention is needed so that the nutritional status can be maintained and the period of growth and development of children can run optimally. Some child nutritional care recommendations with leukemia who undergo chemotherapy have been published, but not all of these recommendations can be implemented due to limited facilities and infrastructure.
Method this case series discusses four children ALL patients undergoing chemotherapy with various nutrition related complications. Identification of patients at risk of malnutrition was conducted through nutritional screening on admission. Nutritional managements given in stages according to the condition of the patient, with the fulfillment target of energy corresponding ideal body weight based on height were calculated using the equation Schofield. Fulfillment of the protein is given at least equal to 1.5 g kg BW day, with a maximum target of 3 g kg ideal body weight, 40 - 60 carbohydrate and 10 - 30 fat. Micronutrients given in accordance with the Dietary Allowances, in the form of multivitamins and minerals. Nutrition education given to patients and families when the patient is allowed to go home.
Results two malnutrition patients are being currently conducted nutritional screening, and a patient who underwent consolidation phase chemotherapy experienced a weight loss caused complications during chemotherapy. Hospitalized patients ranges from 8 - 14 days, four patients go home in good condition.
Conclusions optimal nutritional care can reduce the risk of complications related to nutrition child ALL patients undergoing chemotherapy."
Jakarta: Fakultas Kedokteran Universitas Indonesia, 2017
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UI - Tugas Akhir  Universitas Indonesia Library
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