Marasmus + Bronkopneumonia .Nurmega
Marasmus + Bronkopneumonia .Nurmega
•Nama : By. RS
•Jenis Kelamin: laki laki
•Tanggal Lahir : 15 September 2017
•Alamat : Palembang
NUTRISI
Keluhan Utama
3
•Sesak Napas
NUTRISI
Keluhan utama
Kepala: NCH (-), normosefali, mata cekung (-), wajah seperti orang tua (-), conjungtiva palpebra
anemis (+), sklera ikterik (-), pupil bulat isokor 0 3mm, refleks cahaya normal, sugar baby (+),
rambut kemerahan, tipis dan tidak mudah dicabut
Leher : pembesaran KGB (-)
Dada : simetris, retraksi (-), iga gambang (-)
cor/pulmo :Bunyi jantung normal, murmur (-) gallop (-)
Abdomen : cembung, lemas, hepar dan lien sulit dinilai, BU (+) N, cubitan kulit perut
kembali cepat
Extremitas : edema pretibial (+), edema dorsum pedis (+)/(+), akral hangat, CRT <2’, baggy
pant (-)
Kulit : crazy pavement dermatosis (-)
PEMERIKSAAN FISIK
Keadaan spesifik
Pemeriksaan neurologis:
Refleks patologis - - - -
Assessment
Assessment
– Berat Badan lahir 2200 gram – Sejak lahir s.d 3 bulan diberi ASI
– Cukup bulan, langsung menangis, – Usia 3 bulan s.d sekarang diberi susu formula
Riwayat
A/S score ??, ditolong Penyakit
bidan Riwayat Nutrisi
– Jenis susu formula : SGM 1
– Pajang badan lahir 48 cm – Cara ibu membuat susu : 1 centong = 30 cc air
– Berat Badan tertinggi 2800 gram – Tidak pernah memberikan makanan lain selain
– Panjang badan saat ini : 50 cm susu kepada anak
– Anak dapat minum via oral – Bayi dapat menegakkan leher usia
4 bulan
– Bayi dapat miring kanan dan kiri
usia 5 bulan
Assessment
Assessment
Pemeriksaan Fisik
– Keadaan umum tampak sakit sedang, – Kepala : NCH (+) konjungtiva anemis (-), rambut
compos mentis, napas tampak cepat
pirang mudah dicabut, wajah seperti orang tua
– Sens : Compos Mentis (-)
– Nadi : 118 x/m
– Thoraks simetris, retraksi (+) IC, SC. Iga gambang
– RR : 48 x/m
(-)
– Temp : 36.8 C
– Pulmo Ves (+) N, ronchi basah halus nyaring +/+,
wheezing -/-
Berat Badan (BB): 2,6kg
– Cor BJ I-II N, murmur (-) gallop (-)
Panjang Badan (PB): 50 cm
LILA: 7,2 cm
– Abdomen datar,lemas, BU(+)N
BB/U : <-3SD (severely underweight) – Ekstremitas akral hangat, CRT <3, baggy pants (-
PB/U : <-3SD (severely stunted)
), Crazy pavement dermatosis (-)
BB/PB : < -3 SD (severely wasting)
Assessment
Assessment
Status Antropometri
– BB/U TB / U
– Median : 7.5 Kg – Median 65.9 cm
- -1 SD : 6.7 Kg – -1 SD 63.8 cm
- -2 SD : 6 Kg – -2 SD 61.7 cm
- -3 SD : 5.3 Kg – -3 SD 59.6 cm
– BB/ TB
– Median : 3.5 Kg
- -1 SD : 3.2 Kg
- -2 SD : 3 Kg
- -3 SD : 2.7 Kg
Assessment
Assessment
Laboratorium
Hb 14,8
Diagnosis dan Komorbiditas
RBC 5,620,000
WBC 12,700
HT 44
PLT 299,000 Marasmus kondisi V
MCV 77,4
MCH 26
MCHC 34
Komorbiditas :
LED 3 Bronkopneumonia
DC 0/3/25/62/10
Reti 1,2
CRP<5
Assessment
Assessment
Terapi
– O2 Nasal 2 lpm
– Inj Ampicillin 3 x 250 mg iv
– Inj Gentamycin 2 x 10 mg iv
Asuhan Nutrisi Pediatrik
Assessment
Status Antropometri Food Recall
monitoring
Waktu awal
Pernafasan 32 x/menit
Denyut jantung 98 x /menit
Asupan glukosa Habis, muntah (-)
2 jam pertama :
– F75 setiap 30 menit 11.2 c = 15 cc
monitoring waktu
monitoring
Waktu 21.30 22.30 23.00 23.30 24.00 24.30 01.00 01.30 02.00 03.00
Pernafasan + + + + + + + + + +
Nadi + + + + + + + + + +
Asupan f75 + + + + +
Asuhan Nutrisi Pediatrik
Assessment
Kebutuhan Nutrisi Formula
– Sesuai penatalaksanaan marasmus • F 75 (12 x 45 cc) : 405 kkal
kondisi V
• Vitamin c 1x1 tablet
– Target kalori : BB berdasarkan usia
• Vitamin B complex 1x 1
tinggi x RDA = 3.5 kg x 120 Kkal =
tablet
420 kkal
• Asam folat 1x 1 mg
Asuhan Nutrisi Pediatrik
Assessment
Rute Pemberian Monitoring
Monitoring Acceptabilitas dan komplikasi
Acceptabilitas baik
• Enteral via NGT Habis,
Residu (-)
Komplikasi : tidak ada
mekanis : malposisi NGT, aspirasi,
chocking
Gastrointestinal : muntah, kembung, diare
Metabolik : hipo/ hipernatremia, hipo/
hiperkalemia, tanda tanda
refeeding sindrom
Toleransi baik
Efikasi berat badan turun dan edema berkurang
Clasification
27
Penyakit
NUTRISI Jantung
Bawaan
28
2. Energy requirement
Age RDA (kcal/kg
Indirect calorimetry (year) Wt)
the most accurate
method 0-1 100-120
Harris-Benedict 1-3 100
equation (REE) 4-6 90
WHO (REE) 7-9 80
Schofield equation 10-12 M : 60-70
(REE) F : 50-60
M : 50-60
RDA simplest 12-18
method F : 40-50
Penyakit
NUTRISI Jantung
Bawaan
2. Calculation of Catch-Up Growth
requirement
29 in the Pediatrics
Indication
Children who are below normal growth parameters due to chronic
undernutrition or illness affecting their nutritional intake and status
Penyakit
NUTRISI Jantung
Bawaan
Percent of Ideal Body Weight (IBW)
30
Penyakit
NUTRISI Jantung
Bawaan
33 4. Type of Infant Feeding
What are the options?
Breast feeding
The WHO recommends exclusive breast feeding at least for 6
months
(Protecting, promoting and supporting breastfeeding: the special
role of maternity services. A joint WHO/UNICEF statement. Geneva,
WHO, 1989)
Formula feeding
Complementary Feeding
Penyakit
NUTRISI Jantung
Bawaan
5. Monitoring results of
nutrition care
34
Parameter:
Acceptability
like or dislike
Tolerance
look for adverse food reactions
Efficacy
growth monitoring
Penyakit
NUTRISI Jantung
Bawaan