MODULE 2. DIETARY AND CLINICAL ASSESSMENT 1. What is the function of nutritiona assess!

ent in c inica settin"# Tujuan penilaian status nutrisi adalah untuk mencari kemungkinan malnutrisi yang sudah ada sebelumnya untuk mencegah penurunan berat badan lebih lanjut terutama massa sel, komposisi dan fungsinya. Di klinik, penilaian status nutrisi lebih ditujukan pada penderita-penderita dengan kecurigaan malnutrisi saat masuk ICU, namun secara tehnik penilaian status nutrisi pada penderitapenderita gawat sulit dan tidak banyak membantu. 2. $o% to assess the &ietar' inta(e# There are many ways to document dietary intake. The accuracy of the data is fre uently challenged, howe!er, since both uestioning and obser!ing can impact the actual intake. During a nutrition inter!iew the practitioner may ask what the indi!idual ate during the pre!ious twenty-four hours, beginning with the last item eaten prior to the inter!iew. "ractitioners can train indi!iduals on completing a food diary, and they can re uest that the record be kept for either three days or one week. Documentation should include portion si#es and how the food was prepared. $rand names or the restaurant where the food was eaten can assist in assessing the details of the intake. %stimating portion si#es is difficult, and re uesting that e!ery food be measured or weighed is timeconsuming and can be impractical. &ood models and photographs of foods are therefore used to assist in recalling the portion si#e of the food. In a metabolic study, where accuracy in the uantity of what was eaten is imperati!e, the researcher may ask the indi!idual to prepare double portions of e!erything that is eaten'one portion to be eaten, one portion to be sa!ed (under refrigeration, if needed) so the researcher can weigh or measure the uantity and document the method of preparation. &ood fre uency uestionnaires are used to gather information on how often a specific food, or category of food is eaten. The &ood *uide "yramid suggests portion si#es and the number of ser!ings from each food group to be consumed on a daily basis, and can also be used as a reference to e!aluate dietary intake. During the nutrition inter!iew, data collection will include uestions about the indi!idual+s lifestyle' including the number of meals eaten daily, where they are eaten, and who prepared the meals. Information about allergies, food intolerances, and food a!oidances, as well as caffeine and alcohol use, should be collected. %,ercise fre uency and occupation help to identify the need for increased calories. -sking about the economics of the indi!idual or family, and about the use and type of kitchen e uipment, can assist in the de!elopment of a plan of care. Dental and oral health also impact the nutritional assessment, as well as information about gastrointestinal health, such as problems with constipation, gas or diarrhea, !omiting, or fre uent heartburn. ). $o% to assess nutritiona status in infant* chi &ren an& a&u t +eo+ e# - $egins with a thorough history - Collect and e!aluate clinical conditions, diet, body composition and biochemical data, among others - Classify patients by nutritional state . well-nourished or malnourished - /ubjecti!e *lobal -ssessment (/*-) . 0eight changes, changes in dietary intake, *I symptoms, functional capacity, link between disease and nutritional re uirements, physical e,am focused on nutritional aspects ,. What (in& of -ioche!ica nutritiona +ara!eter# -t 1isk 2e!el /erum albumin 3 4.5 g6d2 Total lymphocyte count 3 7588 cell6mm4 /erum transferring 3 798 mg6d2 /erum pre-albumin 3 7: mg6d2 Total iron-binding capacity 3 ;58 mcg6d2 /erum cholesterol 3 758 mg6d2 .. E/+ ain in a -rief nutritiona + annin" in acute care settin" an& a!-u ator' settin" 0$arrison1 2. What is the criteria of !a nourishe& +atient in c inica settin" 0$arrison1

MODULE ).,. NUTRITION IN T$E OLDER 3O3ULATION

7. What is the &e!o"ra+hic of a"in"# (gak nemu .") 2. $o% the ris(s factor affectin" +oor nutritiona status in o &er a"es#
&aktor resiko rendahnya nutrisi pada lansia . $erkurangnya kemampuan mencerna makanan akibat kerusakan gigi atau ompong. $erkurangnya indera pengecapan mengakibatkan penurunan terhadap cita rasa manis, asin, asam, dan pahit. %sophagus6kerongkongan mengalami pelebaran. 1asa lapar menurun, asam lambung menurun. *erakan usus atau gerak peristaltic lemah dan biasanya menimbulkan konstipasi. "enyerapan makanan di usus menurun. "rotracted nutrient losses. malabsorption syndromes, short gut syndrome, draining abscesses, wounds, fistulae, effusions, renal dialysis Intake of catabolic drugs. corticosteroids, immunosuppressants, antineoplastics "rotracted emesis. anore,ia ner!osa, bulimia, hyperemesis gra!idarum, radiation, cancer chemotherapy Chronic disease (especially -ID/, diabetes, cystic fibrosis, stroke, cancer) &aktor yang mempengaruhi kebutuhan cairan pada lansia . 7. $erat badan (lemak tubuh) cenderung meningkat dengan bertambahnya usia, sedangkan sel-sel lemak mengandung sedikit air, sehingga komposisi air dalam tubuh lansia kurang dari manusia dewasa yang lebih muda atau anak-anak dan bayi. ;. &ungsi ginjal menurun dengan bertambahnya usia. Terjadi penurunan kemampuan untuk memekatkan urin, mengakibatkan kehilangan air yang lebih tinggi. 4. Terdapat penurunan asam lambung, yang dapat mempengaruhi indi!idu untuk mentoleransi makanan-makanan tertentu. 2ansia terutama rentan terhadap konstipasi karena penurunan pergerakan usus. <asukan cairan yang terbatas, pantangan diit, dan penurunan akti!itas fisik dapat menunjang perkembangan konstipasi. "enggunaan laksatif yang berlebihan atau tidak tepat dapat mengarah pada masalah diare. 9. 2ansia mempunyai pusat haus yang kurang sensitif dan mungkin mempunyai masalah dalam mendapatkan cairan ( misalnya gangguan dalam berjalan ) atau mengungkapkan keinginan untuk minum (misalnya pasien stroke).