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HASIL RE-CALL SEBELUM INTERVENSI

Keterangan Nama : Iffah Suarsi


Bentuk Makanan : Makanan biasa NIM : K211 14005
Jenis Penyakit : Neoplasma Ovarium kistik + Mioma Uteri Multiple Kelas :I

Nama : Ny. Hanawiya Sex : perempuan Umur : 48 Tahun Berat : 50,33 Kg Tinggi : 152 cm Tanggal : 8 Oktober 2017
Waktu Menu Bahan Berat ENERGI Protein (gr) LMK HA (gr) Serat F Fe Vit. A Vit. B1 Vit. C Na (mg)
(gr) Kal Hwn Nbt (gr) (gr) (mg) (mg) (SI) (mg) (mg)

Nasi Putih Beras giling 100 130.0 2.4 0.2 28.6 0.3 37.0 0.4 0.0 0.0 0.0 0.0
pagi Ikan goreng Ikan layang 50 49.2 10.7 0.4 0.0 0.0 64.8 0.3 6.6 0.0 0.6 36.6
Minyak 5 8.6 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Sayur Paria Pare 50 10.0 0.4 0.2 2.2 0.7 19.5 0.2 14.5 0.0 3.0 0.5

Sub Total 197.8 13.5 1.8 30.8 1.0 121.3 0.9 21.1 0.0 3.6 37.1
Snack Kue Donat 60 240 3.1 13.1 27.8 0.6 40.8 0.2 14.4 0 0.0 12.0
Teh Teh 100 50.0 0.0 0.0 10.0 0.0 50.0 0.0 0.0 0.0 0.0 150.0
Gula pasir 20.0 77.4 0.0 0.0 20.0 0.0 0.4 0.0 0.0 0.0 0.0 0.2
Sub Total 367.4 3.1 13.1 57.8 0.6 91.2 0.2 14.4 0.0 0.0 162.2
siang Nasi Putih Beras giling 100 130.0 2.4 0.2 28.6 0.3 37.0 0.4 0.0 0.0 0.0 0.0
Ikan goreng Ikan layang 50 49.2 10.7 0.4 0.0 0.0 64.8 0.3 6.6 0.0 0.6 36.6
Minyak 5 8.6 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Sayur Paria Pare 50 10.0 0.4 0.2 2.2 0.7 19.5 0.2 14.5 0.0 3.0 0.5
Pisang pisang susu 100 92.0 1.0 0.5 23.4 2.4 20.0 0.2 8.0 0.1 9.0 1.0

Sub Total 289.8 14.5 2.3 54.2 3.4 141.3 1.1 29.1 0.1 12.6 38.1
Nasi Putih Beras giling 100 130.0 2.4 0.2 28.6 0.3 37.0 0.4 0.0 0.0 0.0 0.0
Ikan goreng Ikan layang 50 49.2 10.7 0.4 0.0 0.0 64.8 0.3 6.6 0.0 0.6 36.6
malam Minyak 5 8.6 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Sayur Paria Pare 50 10.0 0.4 0.2 2.2 0.7 19.5 0.2 14.5 0.0 3.0 0.5

Sub Total 197.8 13.5 1.8 30.8 1.0 121.3 0.9 21.1 0.0 3.6 37.1

Total 1052.8 44.6 19.0 173.6 6.0 475.1 3.1 85.7 0.1 19.8 274.5
Standar Kebutuhan 1759.3 66.0 39.0 286.0
% Asupan 60% 68% 49% 61%
L SEBELUM INTERVENSI

K (mg) Ca
(mg)

0.0 3.0
25.8 6.6
0.0 0.0
0.0 13.5

25.8 23.1
21.6 16.8
0.0 100.0
0.0 0.2
21.6 117.0
0.0 3.0
25.8 6.6
0.0 0.0
0.0 13.5
0.0 6.0

25.8 29.1
0.0 3.0
25.8 6.6
0.0 0.0
0.0 13.5

25.8 23.1

99.0 192.3
HASIL RE-CALL SEETELAH INTERVENSI HARI I
Keterangan Nama : Iffah Suarsi
Bentuk Makanan : Makanan biasa NIM : K211 14005
Jenis Penyakit : Neoplasma Ovarium kistik + Mioma Uteri Multiple Kelas : I

Nama : Ny. Hanawiya Sex : perempuan Umur : 48 Tahun Berat : 50,33 Kg Tinggi : 152 cm Tanggal : 9 Oktober 2017
Waktu Menu Bahan Berat ENERGI Protein (gr) LMK HA (gr) Serat F Fe Vit. A Vit. B1 Vit. C Na (mg)
(gr) Kal Hwn Nbt (gr) (gr) (mg) (mg) (SI) (mg) (mg)

Pagi Nasi Putih Beras giling 100 130.0 2.4 0.2 28.6 0.3 37.0 0.4 0.0 0.0 0.0 0.0
Ikan goreng Ikan layang 50 49.2 10.7 0.4 0.0 0.0 64.8 0.3 6.6 0.0 0.6 36.6
Minyak 5 8.6 0.0 0.0 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Sayur Paria Pare 50 10.0 0.4 0.2 2.2 0.7 19.5 0.2 14.5 0.0 3.0 0.5

Sub Total 197.8 10.7 2.8 1.8 30.8 1.0 121.3 0.9 21.1 0.0 3.6 37.1

Siang Bubur Beras giling 25 90.3 1.7 0.2 19.9 0.2 25.8 0.3 0.0 0.0 0.0 0.0
Kecap 20 12.0 2.1 0.0 1.1 0.2 26.0 0.1 0.0 0.0 0.0 1117.2

Sub Total 102.3 0.0 3.8 0.2 21.0 0.4 51.8 0.4 0.0 0.0 0.0 1117.2
Malam Bubur Beras giling 25 90.3 1.7 0.2 19.9 0.2 25.8 0.3 0.0 0.0 0.0 0.0
Kecap 20 12.0 2.1 0.0 1.1 0.2 26.0 0.1 0.0 0.0 0.0 1117.2

Sub Total 102.3 0.0 3.8 0.2 21.0 0.4 51.8 0.4 0.0 0.0 0.0 1117.2

Total 402.4 21.1 2.2 72.8 1.8 224.9 1.7 21.1 0.0 3.6 2271.5
Standar Kebutuhan 1759.3 66.0 39.0 286.0
% Asupan 23% 32% 6% 25%
ETELAH INTERVENSI HARI I

K (mg) Ca
(mg)

0.0 3.0
25.8 6.6
0.0 0.0
0.0 13.5

25.8 23.1

0.0 2.0
0.0 4.0

0.0 6.0
0.0 2.0
0.0 4.0

0.0 6.0

25.8 35.1
HASIL RE-CALL SEETELAH INTERVENSI HARI II
Keterangan Nama : Iffah Suarsi
Bentuk Makanan : Makanan biasa NIM : K211 14005
Jenis Penyakit : Neoplasma Ovarium kistik + Mioma Uteri Multiple Kelas :I

Nama : Ny. Hanawiya Sex : perempuan Umur : 48 Tahun Berat : 50,33 Kg Tinggi : 152 cm Tanggal : 8 Oktober 2017
Waktu Menu Bahan Berat ENERGI Protein (gr) LMK HA (gr) Serat F (mg) Fe Vit. A Vit. B1 Vit. C Na K (mg)
(gr) Kal Hwn Nbt (gr) (gr) (mg) (SI) (mg) (mg) (mg)

Pagi Bubur Beras giling 25 90.3 1.7 0.2 19.9 0.2 25.8 0.3 0.0 0.0 0.0 0.0 0.0
Kecap 20 12.0 2.1 0.0 1.1 0.2 26.0 0.1 0.0 0.0 0.0 1117.2 0.0

Sub Total 102.3 0.0 3.8 0.2 21.0 0.4 51.8 0.4 0.0 0.0 0.0 1117.2 0.0

Siang Bubur Beras giling 25 90.3 1.7 0.2 19.9 0.2 25.8 0.3 0.0 0.0 0.0 0.0 0.0
Kecap 20 12.0 2.1 0.0 1.1 0.2 26.0 0.1 0.0 0.0 0.0 1117.2 0.0

Sub Total 102.3 0.0 3.8 0.2 21.0 0.4 51.8 0.4 0.0 0.0 0.0 1117.2 0.0
Malam Bubur Beras giling 25 90.3 1.7 0.2 19.9 0.2 25.8 0.3 0.0 0.0 0.0 0.0 0.0
Kecap 20 12.0 2.1 0.0 1.1 0.2 26.0 0.1 0.0 0.0 0.0 1117.2 0.0

Sub Total 102.3 0.0 3.8 0.2 21.0 0.4 51.8 0.4 0.0 0.0 0.0 1117.2 0.0

Total 306.9 11.4 0.6 63.0 1.2 155.4 1.2 0.0 0.0 0.0 3351.6 0.0
Standar Kebutuhan 1759.3 66.0 39.0 286.0
% Asupan 17% 17% 2% 22%
TELAH INTERVENSI HARI II

Ca
(mg)

2.0
4.0

6.0

2.0
4.0

6.0
2.0
4.0

6.0

18.0
HASIL RE-CALL SEETELAH INTERVENSI HARI III
Keterangan Nama : Nurhaswi
Bentuk Makanan : Makanan biasa NIM : K211 14 012
Jenis Penyakit : Sirosis hari + TB Paru, Anemia mikrositik hipokran, AKI on CKD Kelas : III

Nama : Tn. Baso Aksan Sex : Laki-laki Umur : 44 Tahun Berat : 53 Kg Tinggi : 166 cm Tanggal : 28 September 2017
Waktu Menu Bahan Berat ENERGI Protein (gr) LMK HA (gr) Serat F Fe Vit. A Vit. B1 Vit. C Na
(gr) Kal Hwn Nbt (gr) (gr) (mg) (mg) (SI) (mg) (mg) (mg)

27/9 Roti Isi cokelat Roti 70 198.8 0.0 6.0 3.0 36.8 1.9 74.2 0.4 0.0 0.1 0.0 405.3
Snack
Sub Total 198.8 0.0 6.0 3.0 36.8 1.9 74.2 0.4 0.0 0.1 0.0 405.3
Malam Nasi putih Beras giling 100 360.0 0.0 6.8 0.7 78.9 0.4 140.0 0.8 0.0 0.1 0.0 2.5
Tumis sawi hijau Sawi hijau 80 12.0 0.0 1.8 0.1 1.7 1.6 32.8 0.9 242.2 0.0 20.0 12.8
Minyak 10 86.2 0.0 0.0 10.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Oseng tempe Tempe 30 59.8 0.0 5.6 2.4 5.0 0.4 61.8 0.6 0.4 0.0 0.0 1.8
Kecap 3 1.8 0.0 0.3 0.0 0.2 0.0 3.9 0.1 0.0 0.0 0.0 167.6

Sub Total 519.8 0.0 14.5 13.2 85.8 2.4 238.5 2.4 242.6 0.1 20.0 184.7
28/9 Bubur Beras giling 35 126.3 0.0 2.3 0.2 27.8 0.3 26.0 0.2 0.0 0.0 0.0 0.0
Pagi Jalangkote Jalangkote 50 175.5 0.0 5.9 13.3 7.8 0.3 56.0 0.5 19.0 0.0 0.0 20.5

Sub Total 301.8 0.0 8.2 13.5 35.6 0.6 82.0 0.7 19.0 0.0 0.0 20.5
Snack Buah Pepaya 500 194.9 0.0 3.0 0.5 49.0 9.0 25.0 0.5 675.0 0.1 310.0 15.0

Sub Total 194.9 0.0 3.0 0.5 49.0 9.0 25.0 0.5 675.0 0.1 310.0 15.0
Siang Nasi putih Beras giling 75 270.7 0.0 5.0 0.5 59.6 0.6 77.3 0.5 0.0 0.0 0.0 0.0
Ikan pindang goreng Ikan layang 60 49.2 10.7 0.0 0.4 0.0 0.0 64.8 0.2 6.6 0.0 0.6 36.6
Minyak 5.0 86.2 0.0 0.0 10.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Tempe balado Tempe 30.0 59.7 0.0 5.7 2.3 5.1 0.4 61.8 0.7 0.3 0.0 0.0 1.8
Cabe merah 2.0 6.4 0.0 0.2 0.3 1.1 0.5 5.9 0.2 83.2 0.0 1.5 0.6

Sub Total 472.2 10.7 10.9 13.5 65.8 1.5 209.8 1.6 90.1 0.0 2.1 39.0

Total 1687.5 53.3 43.7 273.0 15.4 629.5 5.6 1026.7 0.3 332.1 644.0
Standar Kebutuhan 2559.8 39.7 56.8 472.2 4000.0
% Asupan 66% 134% 77% 58% 16%
ETELAH INTERVENSI HARI III

K (mg) Ca
(mg)

88.2 7.7

88.2 7.7
100.0 3.0
161.6 59.2
0.0 0.0
110.0 27.8
6.4 0.6

378.0 90.6
28.4 2.8
71.5 7.0

99.9 9.8
1285.0 120.0

1285.0 120.0
60.8 6.0
114.0 6.6
0.0 0.0
110.1 27.9
40.3 3.0

325.2 43.5

2076.4 261.8
1277.0
163%
PERENCANAAN MENU SEHARI
Keterangan Nama : Nurhaswi
Bentuk Makanan : Makanan biasa NIM : K211 14 012
Jenis Penyakit : Sirosis hari + TB Paru, Anemia mikrositik hipokran, AKI on CKD Kelas : III

Nama : Tn. Baso Aksan Sex : Laki-laki Umur : 44 Tahun Berat : 53 Kg Tinggi : 166 cm Tanggal : 28 September 2017
Waktu Menu Bahan Berat ENERGI Protein (gr) LMK HA Serat F Fe Vit. A Vit. B1 Vit. C Na (mg)
(gr) Kal Hwn Nbt (gr) (gr) (gr) (mg) (mg) (SI) (mg) (mg)
Pagi Nasi putih Beras giling 50 180.0 0.0 3.4 0.4 39.5 0.4 51.5 0.3 0.0 0.0 0.0 0.0
Telur dadar Telur ayam 55 85.3 6.9 0.0 5.8 0.6 0.0 94.6 0.7 104.5 0.0 0.0 68.2
Margarin 10 63.6 0.0 0.0 7.2 0.0 0.0 0.0 0.0 25.0 0.0 0.0 0.0
Sup Labu siam 35 7.0 0.0 0.3 0.1 1.5 0.5 13.6 0.1 10.1 0.0 2.1 0.3
Kentang 30 27.9 0.0 0.6 0.0 6.5 0.4 15.0 0.1 0.0 0.0 3.9 1.5
Wortel 20 8.4 0.0 0.2 0.1 1.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Margarin 10 63.6 0.0 0.0 7.2 0.0 0.0 0.0 0.0 25.0 0.0 0.0 0.0

Sub Total 435.8 6.9 4.5 20.8 50.0 1.3 174.7 1.2 164.6 0.0 6.0 70.0
Snack Kelepon Tepung beras ketan 50 180.4 0.0 3.3 0.3 39.8 0.4 51.5 0.3 0.0 0.0 0.0 0.0
Kelapa parut 5 8.9 0.0 0.1 0.8 0.4 0.2 2.8 0.1 0.0 0.0 0.1 0.5
Gula aren 15 55.4 0.0 0.1 0.0 14.1 0.0 16.5 0.3 0.0 0.0 0.0 5.7

Sub Total 244.7 0.0 3.5 1.1 54.3 0.6 70.8 0.7 0.0 0.0 0.1 6.2
Siang Nasi putih Beras giling 100 360.0 0.0 6.7 0.6 79.5 0.8 103.0 0.6 0.0 0.1 0.0 0.0
Tahu goreng Tahu 50 38.0 0.0 4.1 2.4 0.9 0.6 48.5 2.7 0.0 0.0 0.0 3.5
Margarin 10 63.6 0.0 0.0 7.2 0.0 0.0 0.0 0.0 25.0 0.0 0.3 0.0
Perkedel kentang Kentang 40 37.2 0.0 0.8 0.0 8.6 0.6 20.0 0.2 0.0 0.0 0.0 2.0
Margarin 10 63.6 0.0 0.0 7.2 0.0 0.0 0.0 0.0 25.0 0.0 0.0 0.0
Kangkung tumis Kangkung 40 6.0 0.0 0.9 0.1 0.8 0.8 16.4 0.4 121.5 0.0 0.0 6.4
margarin 5 31.8 0.0 0.0 3.6 0.0 0.0 0.0 0.0 12.5 0.0 0.0 0.0

Sub Total 600.2 0.0 12.5 21.1 89.8 2.8 187.9 3.9 184.0 0.1 0.3 11.9
Snack Jus jambu Jambu biji 100 50.9 0.0 0.8 0.6 11.9 5.4 25.0 0.3 0.0 0.1 0.0 3.0
gula pasir 15 58 0.0 0.0 0.0 15.0 0.0 0.3 0.0 89.9 0.0 0.0 0.2

Sub Total 108.9 0.0 0.8 0.6 26.9 5.4 25.3 0.3 89.9 0.1 0.0 3.2
Malam Nasi beras giling 100 360.0 0.0 6.7 0.6 79.5 0.8 103.0 0.6 0.0 0.1 0.0 0.0
Sup Jagung 35 37.8 0.0 1.2 0.5 8.8 1.0 36.0 0.2 4.6 0.1 2.1 5.9
Wortel 30 12.6 0.0 0.4 0.1 2.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Tempe bacem Tempe 25 49.8 0.0 4.8 1.9 4.3 0.3 51.5 0.6 0.3 0.0 0.0 1.5
Gula aren 5 18.5 0.0 0.0 0.0 4.7 0.0 5.5 0.1 0.0 0.0 0.0 1.9
Margarin 10 63.6 0.0 0.0 7.2 0.0 0.0 0.0 0.0 25.0 0.0 0.3 0.0

Sub Total 542.3 0.0 13.1 10.3 100.1 2.1 196.0 1.5 29.9 0.2 2.4 9.3
Snack Jus mangga Mangga harum manis 100 65.0 0.0 0.5 0.3 17.0 1.8 11.0 0.1 10.0 0.1 43.0 2.0
Gula pasir 15 58.0 0.0 0.0 0.0 15.0 0.0 0.3 0.0 0.0 0.0 0.0 0.2

Sub Total 123.0 0.0 0.5 0.3 32.0 1.8 11.3 0.1 10.0 0.1 43.0 2.2

Total 2054.9 43.0 54.2 353.1 12.2 654.7 7.6 468.4 0.4 8.8 100.6
Standar Kebutuhan 2559.8 39.7 56.8 472.2 4000.0
% Asupan 80% 108% 95% 75% 3%
NAAN MENU SEHARI

K (mg) Ca (mg)

40.5 4.0
69.3 27.5
0.0 0.0
67.2 9.4
117.3 1.5
0.0 0.0
0.0 0.0

294.3 42.4
40.5 4.0
8.9 0.3
50.3 56.5

99.7 60.8
81.0 8.0
60.5 52.5
0.0 0.0
156.4 2.0
0.0 0.0
80.8 29.6
0.0 0.0

378.7 92.1
284.0 20.0
0.3 0.2

284.3 20.2
81.0 8.0
87.2 0.7
0.0 0.0
91.8 23.3
16.8 18.9
0.0 0.0

276.8 50.9
156.0 10.0
0.3 0.2

156.3 10.2

1333.8 266.4
1277.0
104%