Management Gizi Pada Pasien Bedah

8/18/2019 Management Gizi Pada Pasien Bedah

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MANAGEMENT GIZIPADA PASIEN BEDAH

Dr AKHMAD MAKHMUDI SpB, SpBA


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TERMINOLOGI

NUTRISI=NUTRITION=NUTRIEN

TERAPI NUTRISI:ORAL, ENTERAL,

PARENTERAL

MALNUTRISI

PEM ( MARASMIK, MARASMIK-KWASHIORKOR, KWASHIORKOR ):

Skorin Si!"#$ M% L&r#n


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PENDAHULUAN

PADA UMUMNYA KELAINAN

DIBAGI ATAS :1. INFEKSI/ RADANG

2. KONGENITAL

3. NEOPLASMA4. TRAUMA

5. DEGENERATIF


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3

PENDAHULUAN

PASIEN KASUS NON BEDAH PASIEN KASUS BEDAH :

DIBEDAKAN: - KASUS EMERGENSI

- KASUS ELEKTIF

PASIEN KASUS BEDAH:PERIOPERATIF: PRE- DURANTE

POSTOPERATIF


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AKUT ABDOMEN ILEUS

STRANGULASI

PERITONITIS PERDARAHAN

KOMBINASI-TRAUMA

ILEUS: PROBLEMKOMPRESI-DEHIDRASIDAN INFEKSI


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EGACOLON

CONGENITAL

(HIRSCHSPRUNG DISEASE)


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PENDAHULUAN LUKA OPERASI BERHUBUNGAN

DENGAN HIPOALBUMINEMIA,

ANEMIA DAN MALNUTRISI BB TURUN PREOPERASI:

' * MORTALITAS ++*

* +,.*


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DASAR MANAGEMENT

TERAPI NUTRISI DASAR TERAPI NUTRISI:

STRESS METABOLIK:STAR/ASI,TRAUMA, LUKABAKAR, PEMBEDAHAN, RADIO0KHEMO TERAPI


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STAR/ASI:NUTRISI TERHENTI '12AM KEBUTUHAN ENERGI BASAL:

-.K3AL0KGBB0HARI TER2ADIGLUKONEOGENESIS (PROTEOLISIS T4U4ALANIN) 5. -5. GRAM0HARISETARA 6 + GRAM 2AR4OTOT

7ANG HILANG DALAM + 6 . HARI 3ADANGAN PROTEIN

MEN3APAI TITIK KRITIS (BILA TETAPTAK ADA MASUKAN ASAM AMINO)


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ALGORITME PEREN3ANAAN

TERAPI NUTRISIMENILAI STASUS GIZI DAN KONDISI KLINIK PENDERITA

IHITUNG KEBUTUHAN NUTRISI

(energi, proein, !e"#$, e!e$ro!i %!!&I

MEMILIH KOMPOSISI TERAPI NUTRISII

MENENTUKAN TEKNIK ' SKEMA PEMBERIANTERAPI NUTRISI

IMONITOR:

EFEK TERAPI NUTRISIKOMPLIKASI


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WH7 IS NUTRITION

IMPORTANT 8

ENERG7 O9 DAIL7 LI/ING

MAINTENAN3E O9 ALL BOD79UN3TIONS

/ITAL TO GROWTH ANDDE/ELOPMENT ( IN9ANT3HILDREN

THERAPEUTI3 BENE9ITS

- HEALING

- PRE/ENTION : IMMUN


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PROBLEM PERIOPERATI9 DAN

MALNUTRISI

STRESS METABOLIK (STAR/ASI, IN9EKSI,TRAUMA, 9EBRIS BEDAH), LUKA BAKAR

DIPUASAKAN : HIPOGLIKEMIA, DEHIDRASI KONDISI KLINIS PEN7AKIT (underlying

disease): ABDOMEN AKUT : ILEUS, STRANGULASI,

PERITONITIS DAN PERDARAHANILEUS : KOMPRESI, DEHIDRASI, IN9EKSI

TUMOR : cancer cachexia-anorexia PEM (Pro"#in En#ri $&;n


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TIGA 9AKTOR 7ANG HARUSDIKETAHUI PADA LUKA BAKAR :

ETIOLOGI : S&n&!( &>i,,&ir ),S


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PENANGANAN Pr# o!>i"&; :

- S"o> 6?ro> 6ro;;,$#ni;&nk&n #&"r#!"or#(@i;& $#ni")

R#!

r


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INDIKASI RAWAT INAP

L B D#r&&" II : ' 5.* D#&!&

' 5* An&k0 G#ri&"ri

LB D#r&&" III : ' 5* D#&!&

Li!"rik 0 Ki$i&

L B ?r& $#rin#&;

L B ?#n&n k#;&in&n ;&in0 "r&


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HOW TO SOL/E THE

PROBLEM 8 TO ORGANIZE NUTRITION 3ARE

TEAM:

- PH7SI3IAN

- NURSE

- DIETITIAN

- PHARMA3IST


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HOW TO SOL/E THE

PRBLEM 8 TO PER9ORM NUTRITION 3ARE

A3TI/ITIES

NUTRITIONAL ASSESSMENT

NUTRITIONAL REUIREMENTS

ROUTES O9 DELI/ER7

9ORMULA 0 I/9 SELE3TION

MONITORING


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INDIKASI TERAPI NUTRISI

PARENTERAL (TNPE )

TIDAK MAU MAKAN

TIDAK 3UKUP MAKAN TIDAK BISA MAKAN

TIDAK BOLEH MAKAN


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KONTRA INDIKASI TNPE

KRISIS HEMODINAMIK: S7OK,DEHIDRASI ( k0I MUTLAK)

GAGAL NA9AS TANPA

RESPIRATOR DAN PASIENKEGANASAN TUMOR PADA9ASE TERMINAL (k0I RELA- TI9)


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Nasogatric tube

AH, boy, 16 monthsW 3.6 kg L 65 cm

9 monthslater

W 10.7 kgs


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Gastrostomy


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When children need tube feeding

& how to choose route ofdelivery ? Children with acute conditions

and increased requirements. E.g.Brns !e"ere trama, #a$orsrgery an% !e&s's.

Children unable to eat due to

mental/physical disability. E.g.mental retar%at'on, (erebral &alsyan% congen'tal anomal'es.

Children with chronic illnesses

who require long term nutritionalsupport. E.g. (ancer, )n*lammatorybo+el %'sease, (yst'c *'bros's an%congen'tal heart %'sease

Nasogastric NG! an%"rogastric "G! sally *orshort term - 3 months/

Gastrostomy -!rg'cal orerctaneos En%osco&'castrostomy/ *or long term

#ranspyloric $eedings

those +ho are at h'gh r'sk *oras&'rat'on2

'n &ancreat't's &at'ents bestto *ee% naso$e$nally beyon%the l'gament o* re't4


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arenteral tr't'on er'&heral -/

!hort term &arenterals&&ort -& to +eeks/

Hy&erton'c solt'ons - 900m8smL/ may case &hleb't's2ths mst l'm't solt'on:sosmolar'ty

Energy an% &rote'n &ro"'%e%by are l'm'te% becase%e;trose an% am'no ac'%scontr'bte s'gn'*'cantly toosmolar'ty

Electrolytes also contr'bteto osmolar'ty

(entral or otal -/


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KOMPLIKASI PARENTERAL

NUTRISI HIPERGLIKEMI

HIPOGLIKEMI

UREMI PRERENAL GANGGUAN 9UNGSI HATI

GANGGUAN 3AIRANELE3TROLIT

DE9ISIENSI TRA3E ELEMEN0/ITAMIN HIPER3APNI : 3O '


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%ediatric parenteral amino acid

solution )n*ant

r'mene 5= -Ba;ter/ Am'noster'l )n*ant -


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%arenteral ccess er'&heral Access

Access by &lac'ng catheter 'nto a &er'&heral

"e'n er'&heral arenteral tr't'on -/

(entral Access Access by catheter 'nto "e'n *ee%'ng 'nto the

s&er'or "ena ca"a otal arenteral tr't'on -/


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#on'tor'ng )n%'cators Bo%y +e'ght )ntakeot&t Bo+el *nct'on Bloo% glcose !erm electrolytes

Bloo% rean'trogen, creat'n'ne

!erm &hos&hors L'"er *nct'on tests

!erm calc'm an%magnes'm !erm trans*err'n ? hor r'nary

n'trogen !erm albm'n


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TERAPI NUTRISI PARENTERAL EBB PHASE : )AIRAN RESUSITASI RL* ASERING

FLO+ PHASE : )AIRAN NUTRISI KH : D, D. PROTEIN : ASAM AMINO /,0, 0,.0 LEMAK : LIPID /.0

ELEKTROLIT


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DASAR PEMBERIAN NUTRISI

PARENTERAL IMBANG PROTEIN POSITIP

PERHITUNGAN ENERGI:

RUMUS HARRIS BENEDI3T: (k%&;0&ri)

BEE Pri& =,.5+,JFBB(k)T(%$)-,JFU(")

BEEW&ni"&=.4.,.FBB(k)54JFT(%$)-1,FU("

MALNUTRISI : AEE = 5, BEE

STRESS 9AKTOR : PUASA = ,J.-54

AEE = BEE STRESS 9AKTOR 5,.

BEE=Basic Energy Expenditure

AEE= Actual Energy Expenditure


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PROGRAM CAIRAN :

1.JUMLAH CAIRAN

2.JENIS CAIRAN3.CARA PEMBERIAN

4.MONITORING


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TOTAL BODY WATER ( ASHCRAFT )

UMUR %

Gestasi!a" # 12 $i!& '4

12 $i!& # 32 $i!& (

Ate*$

3+, -a*i ( +3 # ,

Ne!at&s , +

(

C-i"/*e! 0, +,

&! Ma! 0

&! $a! ,

Oe* 0 ea*s $a! ,

Oe* 0 ea*s 5$e! 4,


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MAINTENANCE ( ASHCRAFT ) 6 7ai" 8"&i/ Re9&i*e$e!ts

We!"# $%&'(e

P)e(*#')e +, 2! 15 (& / !

Ne%0*#' 0*0# +2-1 ! 1(&/! %) )# 1!

I0*0# "&)e0 +1-2! 1(&65(&/! %7e) 1 !

8"&)e0 + 9 2 ! 15(&62(&/! %7e) 2 !


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'(&*" *)*0 :

1. 7eisit ;ai*a! < /e-i/*asi

a. 7e-i/*asi Ri!a! : ,% = ,$"?? @ TB )

? . 7e-i/*asi Se/a! : 1% =1$"?? @ TB )

;. 7e-i/*asi Be*at : 1,% =1,$"??? @ TB )6 T!isitas /a*a-:Hit!isist!is-ie*t!is

2. Mai!te!a!;e

Ne!at&s: 24 a$ st e*ati /i>&*a!i 3%

3. Pe*>i*aa! ;ai*a! -i"a! /a"a$ 24 a$

= ! i! "ss )

2D3 $/ii;ati! t 8"&i/ i!ta>e = see ta?"e )


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Useful Intravenus Slut!ns C""er#!all$

Ava!la%le

S"&ti! 7e@t*se Na C" La;tate Ca

$


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NAMA PRODUK OSMOLARITAS N*6 8&- K6 8*66 Ae#*#e L*#*#e- G&'%* K*&%) KEMASAN

(O(/L K*&/LK*eN 1 B 2;2 3;.5 3;.5 3 5 1 2 2< 1; 5

K*eN 3 B 2= 5 5 2 2 2< 1; 5

K*eN MG3 >=5 5 5 2 2 1 4 5

5/1

Ae)0! 2


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)ONTOH KASUS Seor#ng !#$i-!#$i, 12i# . #31n BB 4.

$g, inggi 5#%#n . 6" Pen%eri#

%ir#7# $#ren# !1$# 5#$#r /.0 Deng#n r1"12 H#rri2 Bene%i6:

BEE 8 99

(;

(9


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SUMBER ENERGI KARBO HIDRAT / >;. K)AL*KGBB*HARI

(ASPEN @@;&

GLUKOSE*DETROSE FISIOLOGIS: 9 -,GRAM*KGBB*HARI, BILA BERLEBIHANMERUGIKAN SEBAB RESPIRATORC

U.TIENT DAN PRODUKSI )O/ NAIK RASIO ENERGI : KH : LEMAK 8 .:;.

( 9.:4.&


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KEBUTUHAN PROTEIN KEBUTUHAN PROTEIN= KONSUMSI

NITROGEN 4. KONSUMSI NITROGEN (MG01 2AM=

UREUM URIN01 2AM J 1MGMMOL0L

TANPA STRESS METABOLIK:

PROTEIN(AA)= 5 GR0KGBB0HARIKALORI = + K3AL0KGBB0HARI DENGAN STRESS METABOLIK:

KALORI = 1 K3AL0KGBB0HARI

PROTEIN (AA) = GR0KGBB0HARI


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Ber# 5#%#n p#2ien . $g T#np# 2re22 "e#5o!i$:

$#!ori 8 .=;. $6#!8 .. $6#!

$e5 A2#" A"ino 8 .= gr#" *3#ri Dg 2re22 "e#5o!i$:

K#!ori 8 .=4. $6#!8 /... $6#!*3#ri

A2" A"ino8 .=/8 .. gr#"*3#ri


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Ke5113#n !e"#$ Un1$ "e"en13i $e5113#n $#!ori,

6#ir#n e"1!2i !e"#$ %i5eri$#n -;

gr#"*$g55 ##1 propor2i /0-4.0%#ri o#! $#!ori per3#ri Pe"5eri#n!e5i3 %#ri 9.0 %#ri $#!ori o#!

%#p# "ene5#5 $#n $eo#2i%o2i2 Lipi% i%#$ %i5eri$#n p#%# $#%#r

rig!i2eri% !e5i3 %#ri 4.. "g*%!


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KASUS ANAK L#$i-!#$i 1"1r #31n BB 9 $g, TB 9.6" D=: I!e12 %eng#n

De3i%r#2i 5er#, ?e5ri2 4.o) %#n "#!n1ri2i 5er# Per3i1ng#n: (& G#ngg1#n ; 2#5i!i#2: ebb phase (RL/ ASERING)

Progr#" 6#ir#n 9 #": $6#! 8 "! $e5113#n 6#ir#n - 1"!#3 6#ir#n: "#inenen2 8 . "! %e3i%r#2i 0 8 (.=9=.0& 8 9;. "!

?e5ri2 4.o) 8 /9 "! - To#! re212i#2i 6#ir#n 8 @@9 "!

(/& Bi!# $on%i2i 2#5i! (fow phase): 6#ir#n n1ri2i $en#i$#n5er#3#p

- KH : KAEN ;A 8 "!- PROTEIN : AMINOFUSIN 0 8 "!

- LEMAK : LIPID /.0 8 "! (;& M#!n1ri2i 5er# : / = BEE 8 .. $6#!*3#ri


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Management Gizi Pada Pasien Bedah

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