Nama :

NIM :

Kelas :
KASUS : PASIEN LUKA BAKAR

Mn, laki-laki umur 16 tahun,pelajar SMP. 7 hari sebelum masuk RS, os memperbaiki antena TV, tangan
memegang pipa antena lalu tersengat listrik, pakaian terbakar, sempat dirawat di RSUD dan sekarang di
rujuk ke RS pusat. Diagnosis dokter combustio grade III 38%. Pasien merasa susah BAB dan sulit menelan,
dan merasakan nyeri pada luka bakar. TB 160 cm, BB 55 kg, Hb 11,2 gr/dl, albumin 2,06 gr/dl, K = 3,7
mmol/L (N=3,6-5), Cl : 86,7 mmol/L (N=98-100), GDS 156 mg/dl (N=75-115), SGOT= 64, SGPT=140, TD =
106/48, RR = 25x/mnt, Nadi = 80x/mnt, Suhu tubuh = 38oC. Hasil recall : E = 30,4%, P=67,5%, L=24,83%,
KH=64,7%. Tidak makanan pantangan dan alergi.

Perhitungan Kebutuhan :
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Diagnosa Gizi :
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 DAFTAR MAKANAN SEHARI
NAMA : ........................................................ BB : ...................................................
JK : ........................................................ TB : ...................................................
UMUR : ........................................................ TANGGAL :.....................................................
VIT VIT VIT
Berat Protein Lemak Ha CA FE
A B-1 C
Waktu Hidangan Bahan BM Kal Srt
H N
(Gr) Gr SI Ml Mg Mg Mg Mg
Gr Gr
 DAFTAR BELANJA

BERAT HARGA
NO NAMA BAHAN JUMLAH (Rp) KET.
(gr) SATUAN (Rp)