tk. gizi buruk november 2011

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  • Gizi Buruk

    Bag.I.kesehatan AnakFakultas Kedokteran Universitas YarsiDr.Wan Nedra K. Sp.A

  • Penerapan I.Gizi Klinik :Pada setiap tahap penanganan pasien :1. mengerjakan ANAMNESIS2. mengerjakan PEM.FISIK3. menentukan PEM.PENUNJANG4. menegakkan DIAGNOSIS5. memberikan TERAPI6. mempertimbangkan PROGNOSIS7. mengusahakan PREVENSI

  • 1. Anamnesis :8Riwayat makanan : - jangka pendek : sblm sakit - jangka panjang: sejak bayi8Nafsu makan : baik / kurang / buruk ?8Masukan makanan : jumlah dan jenis mak. yang dikonsumsi --> dapat utk menilai / kesan ttg :X kwalitas : baik / kurang, berdasarkan :- jenis mak.- komposisi nutrien- distribusi kaloriX kwantitas : cukup / kurang / lebih --.> thd. RDA - energi / protein / vitamin / mineral dll.

  • 2. Pemeriksaan fisik 2.1. Tanda / gejala penyakit gizi :- MEP : wajah, rambut, otot, jar.lemak subkutis, edema, dsb.- KVA ( Xerophthalmia ) : bercak Bitot, xerosis konyungtiva, ulkus kornea, dst.- Anemia defisiensi : pucat ( organomegali - )- GAKI : kel.tiroid >, kretin, dll.- def.vit B1 : beri-beri / edema, polineuritis, refleks fisiol. 12.5 cm: gizi baik (hijau)Bila LLA /kan dgn umur:85-100%: gizi baik/normal70-85%: gizi kurang< 70%: gizi buruk

  • Bila umur tidak diketahui, digunakan indeksLLA/TB> 85%: gizi baik/normal80-85%: borderline/KKP-I75-80%: gizi kurang/KKP-II< 75%: gizi buruk/KKP-IIIInterpretasi BB/TB: - > 120 %: kegemukan/obesitas110-120%: overweight90-110%: normal70-90 %: gizi kurang < 70 %: gizi buruk

  • Defisiensi vit A (Xerophthalmia)BitotspotUlcuscorneaXerosis conyunctiva & corneaKeratomalacea

  • 2. Pemeriksaan fisik 2.2. Membuat KESAN KLINIS tentang status gizi :- gizi lebih ( overweight --> obesitas )- gizi baik ( wellnourished )- gizi kurang ( undernourished )- gizi buruk ( severe malnutrition) Kesan klinis dibuat berdasarkan tanda / gejala klinis.

    2.3. Menentukan status gizi secara ANTROPOMETRIS :- BB/U- BB/TB- TB/U- LILA, dsb.

  • ANTROPOMETRIS :

    - BB/U:- TB/U- BB/TB- LILA,

  • Anaemia

  • Severe PEM : Kwashiorkor hairfaceOedemaPuffy

  • Severe PEM : KwashiorkorCrazy pavementdermatosisoedemaHepatomegaly

  • Severe PEM : Marasmusface hairRibsMuscles atrophySC fat
  • Severe PEM : Marasmus + KP

    lymphadenopathy

  • Severe PEM : Marasmus + KPCaverne6 weeks after th/Destroyed lung

  • Kwashiorkor & MarasmusIga gambangRambutHepar >>EdemaAtrofi ototLemak SC
  • Marasmic-KwashiorkorBaggy pantsEdemaIga gambangAtrofi ototJar.lemak SC
  • DehydrationSunken eyes

  • DehydrationTurgor :

  • 3. Pem. Penunjang :3.1. Pem. Laboratoris :- Hb- protein serum, albumin, globulin- profil lipid ( lipid total, triglserida, kolesterol, LDL, HDL)- BUN, dll3.2. Pem.radiologis : - usia tulang- osteoporosis/osteomalasia3.3. Pem.antropometris: - BB, TB/PB, LILA, LK, TLK.

  • 4. Diagnosis :4.1. Sehat : - status gizi baik - T-K normal / optimal - + kriteria sehat lain

    4.2. Penyakit gizi :- defisiensi : MEP, Vit - Min.- kelebihan : Obesitas, intoksikasi vit-min.

  • 5. Terapi :5.1. Terapi nutrisi : - oral / enteral / parenteral- dukungan thd. penyakit utama : ginjal, sal.cerna, DM, IEM, dsb.- Gizi Kurang: tidak perlu dirawat, cari penyebab dan berikan suplementasi dan Gizi BURUK: DIRAWAT 5.2. Menentukan dosis obat

    5.3. Pemantauan respons th/ keseluruhan

  • PEM.

    5 ASPECTS in the MANAGEMENT of Severe PEM :

    A. 10 main steps

    B. Treatment of underlying diseases

    C. Failure to respond to treatment

    D. Discharge before recover

    E. Emergency

  • PEM. A : 10 main steps No Interven- Stabilization Transition Rehabilitation Follow-uption d.1-2 d.3-7wk-2 wk 3-6 wk 7-26 1. Treat/prevent hypoglycaemia 2. Treat/prevent hypothermia 3. Treat/prevent dehydration 4. Correct electr. imbalance 5. Treat infection 6. Correct micro- without Fe+ Fe nutrients defic. 7. Begin feeding 8. Increase feeding 9. Stimulation10. Prepare for discharge

  • PEM. B. Treatment of underlying diseases / infection : Bacterial infection : - no apparent signs of infection/no complication: cotrimoxazole ( 5 mg TMP/kg, 2x/d, 5 days )

    - signs of infection / complications / sepsis :- ampicilline 50 mg/kg/6 hrs, IM/IV, for 2 days oral (ampi / amoxy)- gentamycin 7.5 mg/kg, IM/IV, 7 days- KP + anti-TB drugs

    Viral infection : no specific th/- all PEM should receive measles vaccine

  • PEM. C. Failure to respond to treatment :

    Frequent causes of failure to respond :

    a. Problems with the treatment facility :- poor environment for malnourished children- insufficient or inadequately trained staff- inaccurate weighing machine- food prepared or given incorrectly

  • PEM. C. Failure to respond to treatment :

    Frequent causes of failure to respond :

    b. Problems of individual children :- insufficient food given- vitamin-mineral deficiency- malabsorption of nutrients- rumination- infections- serious underlying disease

  • PEM. C. Failure to respond to treatment :

    CriteriaTime of admissionPrimary failure to respond:failure to regain appetiteDay 4Failure to start to lose oedemaDay 4Oedema still presentDay 10Failure to gain at least 5 g/kg/dDay 10

    Secondary failure to respond :failure to gain at least 5 g/kg/d During rehabilitation for 3 consecutive days

  • PEM. C. Failure to respond to treatment :

    1. Death = within first 24 hrs :- hypoglycemia- hypothermia- dehydration- sepsis

    = within 24 72 hrs :- volume of formula >>- caloric density >>

  • PEM. C. Failure to respond to treatment :

    2. Inadequate gaining weight :- infection- diet- psychologic

    Weight gain := satisfactory: > 10 g/kg/d good == sufficient : 5-10 g/kg/d > 50 g/kg/wk= poor : < 5 g/kg/d or < 50 g/kg/wk

  • PEM. D. Discharge before fully recover:

    = Dietary advice :- high protein and calorie- frequent feeding ( 5x/d )- finish all meals given- vit-min supplementation & electrolytes- continue BF= frequent controle ( 1x/wk )= Immunization

  • Emergency :Shock : N2 or RLG5%15 ml/kg, 1 hrRepeat 1 hr moreResomal 10 ml/kg, 10 hrsSpecial formula sepsisMaintenance, 4 ml/kg/hrFresh blood, 10 ml/kgImprovement+ _

  • Emergency :Severe anaemia.Hb ?Hb < 4 g/dlHb 4-6 g/dlResp.distress/heart failure?Fresh blood 10 ml/kg*PRC 10 ml/kg*Observation* : give furosemid 1 mg/kg, iv, before transfusion + _

  • PEM. Pasien dipulangkan dari RS Perawatan:W/H : - 1 SD or severe PEM moderate/mild- Education for mother :- hygiene & sanitation- healthy foods- immunization- stimulation- regular controle

    - to continue the th/ of chronic diseases

    - to completing immunization

  • On admission :Sh, girl, 2 yrs,W : 3.875 gH : 67 cmW/H : < -4SD 2 weeks later : W : 4.750 g H : 67.4 cm W/H : < -3 SD 4 weeks later : W : 5.310 g H : 67.7 cm W/H : + -3 SD 5 weeks later :W : 6.280 g H : 67.8 cmW/H : - 2 SD

  • 7 yrs,10 kgRecovery : 16 kg

  • 6. Prognosis :6.1. Perbaikan / kemunduran :- perbaikan --> penyembuhan :- nafsu makan >- BB >- kemunduran --> perburukan :- nafsu makan