patofisiologi itu mudah (info kesehatan)

Senin, 23 November 2020

FAST pepeling keur jelema nu setruk

Rabu, 11 November 2020

carita abah nursi (munggaran) : pirus kopid

Rabu, 06 Februari 2013

STATUS NUTRISI

STATUS NUTRISI

Nutrisi memegang peranan penting dalam memelihara kesehatan dan menambah daya tahan tubuh terhadap penyakit serta membantu proses penyembuhan penyakit. pasien yang kebutuhan nutrisinya terpenuhi akan dapat mempertahankan status kesehatannya dan cenderung memiliki proses penyembuhan penyakit yang lebih baik.

Penilaian status nutrisi melibatkan beberapa indikator yang berhubungan dengan nutrisi, asupan nutrisi, penggunaan energi, dan indikator biokimia. Pengukuran antropometrik akan membantu dalam penilaian status nutrisi.

Penilaian status nutrisi secara langsung terdiri dari: antropometrik, pemeriksaan klinis, iokimia, dan biofisik.

A. Antropometrik

Antropometrik merupakan ukuran tubuh manusia dan berhubungan dengan berbagai macam pengukuran dimensi tubuh dan komposisi tubuh dari berbagai tingkst umur dan tingkat nutrisi. Antropometrik digunakan untuk menilai keseimbangan asupan protein dan energi.

1. Berat Badan

Berat badan (BB) merupakan salah satu indikator dari status nutrisi. namun pada kondisi tertentu, pengukuran BB yang aktual tidak dapat dilakukan karena keterbatasan dari pasien misalnya pasien tirah baring atau tidak sadar. untuk mengatasi masalah tersebut, BB ideal dapat diperkirakan berdasarkan panjang badan pasien.

cara memperkirakan BB berdasarkan tinggi badan

BB laki-laki wanita

sedang 48 kg untuk 152 cm yg pertama, selanjutnya 45,5 kg untuk 152 cm pertama, selanjutnya

tambahkan 2,7 kg untuk setiap 2,5 cm tambahkan 2,3 kg untuk setiap 2,5 cm

tambahan tambahan

kecil Kurangi 10% Kurangi 10%

Besar Tambahkan 10% Tambahkan 10%

catatan: perkiraan BB dapat juga menggunakan persamaan Hamwi

pria: 48 + (TB - 152) x1,06
wanita : 45,4 + (TB - 152) x 0,89

2. Tinggi Badan

pengukuran tinggi badan pada pasien yang tirah baring dapat dilakukan dengan beberapa cara pengukuran, yaitu ;

berdasarkan tinggi lutut. persamaan yang digunakan adalah TB laki-laki = 64,19 - (0,04 x usia) + (2,02 x tinggi lutut), sedangkan untuk wanita = 84,88 - (0,24 x usia) + (1,83 x tinggi lutut)
berdasarkan armspan (kedua tangan direntangkan, lalu diukur panjang dari ujung jari kanan ke ujung jari kiri).persamaan yang digunakan adalah, laki-laki = 53,4 + (0,67 x armspan), dan untuk wanita = 81,0 + (0,48x armspan)
berdasarkan demispan
perdasarkan panjang tulang ulna

3. Indeks Massa Tubuh (IMT/BMI)

IMT dihitung berdasarkan BB dan TB. IMT digunakan untuk menilai status nutrisi dari seseorang atau pasien dan merupakan perkiraan ukuran lemak tubuh.

persamaan yang digunakan adalah IMT/BMI = BB (kg) / TB (m)2, tinggi badan dikuadratkan dalam meter.

penghitungan IMT berdasarkan lingkar lengan atas (LLA):

Laki-laki = 1,01 x LLA - 4,7 dan untuk wanita = 1.10 x LLA - 6,7

nilai standar IMT (yang diusulkan untuk orang asia, 2000)

< 18,5 berat kurang

18,5 - 22,9 BB normal

> 23 preobese

23 -24,9 obese ringan

25 - 29,9 obese sedang

> 30 obese berat

4. Lipatan Trisep. LLA, LOLA (lingkat otot lengan atas)

Lipatan trisep menyatakan status lemak, sedangkan LLA dan LOLA menentukan status protein

LOLA/mid-arm muscle circumference (MAMC) = LLA - (3,14 x TSF)

LLA dalam cm, TSF = triceps skinfold (dalam cm)

sampai saat ini nilai normal LOLA untuk orang indonesia belum ada, namun untuk orang kaukasia, nilai normalnya adalah : 90% standar = 22,5 cm untuk laki-laki, 20,9 cm untuk wanita (Dudek, 2001 dalam Hartono, 2007).

B. Klinis

pemeriksaan klinis merupakan metode penting dalam penilaian status nutrisi. metoda ini didasarkan pada perubahan jaringan tubuh akibat defisiensi zat gizi tertentu. dapat dilihat pada jaringan epitel (supervicial apithelial tissues)

kemungkinan kelainan fisik pada pasien yang kekurangan zat gizi tertentu

No Bagian tubuh   Tanda klinis Kemungkinan kekurangan
1 Tanda umum   a. Penurunan berat badan, lesu a. kalori
   b. Dehidrasi, haus b. air
c. Pertumbuhan terhambat c. Vitamin A
2 Rambut Kekuningan, kekurangan pigmen, kusut Protein
3 Kulit   a. Dermatitis a. niasin, riboflavin, biotin
b. Dermatosis pada bayi b. lemak
c. Ptechial hemorrhages c. asam ascorbat
d. Eksema d. piridoksin

4 Mata a. Photopobia a. riboflavin
b. rabun senja b. vitamin A
5 Mulut   a. stomatitis a. riboflavin, asam ascorbat
b. glossitis b. niasin, asam folat, B12, zat besi
6 Gigi   Gigi karies Fluor
7 Neuromuskular a. kejang otot a. Vitamin D
b. lemah otot b. potasium
8 Tulang Riketsia   Vitamin D
9 Gastrointestinal a. anoreksia a. thiamin
b. mual dan atau muntah   b. garam dapur (NaCl)
10 Endokrin Gondok   Iodium
11 Kardiovaskuler a. perdarahan a. Vitamin K
b. penyakit jantung b. thiamin
c. anemia c. pyridoxine dan besi
12 Sistem saraf Kelainan mental dan kelainan saraf perifer   Vitamin B12
Sumber; Nurachmah, 2001.

C. Biokimia

penilaian status nutrisi dengan menggunakan pemeriksaan spesimen secara labolatoris yang dilakukan pada jaringan tubuh. jaringan yang diperiksa tersebut antara lain darah, urein, tinja, jaringan hati dan otot.

pemeriksaan biokimia digunakan sebagai data tambahan dalam asuhan keperawatan. data yang digunakan adalah total limfosit, albumin, Fe, Hb, transferin, kreatinin, hematokrit, keseimbangan nitrogen, dan tes antigen kulit.

pemeriksaan biokimia yang dikombinasi dengan antropometrik dapat membentu memberikan gambaran status nutrisi dan respon imunologi pasien.

Protein Viseral yang Bisa Dipakai dalam Penilaian Nutrisi
Usia Paruh   Batas Normal
Albumin 18 hari   3,5 – 5,5 mg/dl
Transferin 8 hari 200 – 400 mg/dl
Prealbumin pengikat tiroksin 2 hari   15,7 – 29,6 mg/dl
Protein pengikat-retinol 12 jam   2,6 – 7,6 mg/dl
Sumber: Hartono, 2006

Protein viseral dan malnutrisi
Albumin Serum (gr/dl) Transferin serum (gr/dl)
Malnutrisi ringan 3,0 – 3,5   1,5 – 2
Malnutrisi sedang 2,1 – 3,0 1 – 1,5
Malnutrisi berat < 2,0   < 1
Sumber: Hartono, 2006

4. Biofisik

merupakan metode penentuan status gizi dengan melihat kemampuan fungsi (khususnys jaringan) dan melihat perubahan struktur jaringan. umumnya dapat digunakan untuk situasi tertentu seperti kejadian buta senja epidemik (epidemic of night blindness). cara yang digunakan adalah tes adaptasi gelap.

Daftar Pustaka

Ballmer, P. 2001. Causes and Mechanisms of Hypoalbuminemia. Clinical Nutrition , 20, 271-273.

Bonggard, F. S., & Sue, D. Y. 2002. Current Critical Care Diagnosis & Treatment. USA: McGraw-Hill Companies.

Cairella, G., Scalfi, L., Canani, R. B., Garbagnati, F., & Gentile, M. G. 2004. Nutritional Management of Stroke Patients. Rivista Italiana di Nutrizione Parenterale ed Enterale ,22, 205-226.

Delaune, S. C., & Ladner, F. C. 2002. Fundamentals of Nursing Standards & Practice. Australia: Delmar.

Hartono, A. 2006. Terapi Gizi dan Diet Rumah Sakit. Jakarta: EGC.

Shahar, S., & Pooy, N. S. 2003. Predictive Equation for Estimation of Stature in Malaysian Elderly People. Asia Pasific Journal Clician Nutrition , 80-84.

NUTRITIONAL STATUS

Nutritional status is a multidimensional phenomenon that requires a variety of methods of assessment. It is the assessment of indicators related to nutrition, nutrient intake, energy use (body mass index, BMI), and biochemical markers. Anthropometric measurements such as the thickness of the layers of the skin (skin folds), the surface area of the triceps (triceps skin fold, TSF), and upper arm muscle circumference measurements (mid-arm muscle circumference, MAMC) will assist in the assessment of nutritional status in patients with acute stroke (Wiryana, 2007).

Assessment of nutritional status is an early stage in the delivery of nutritional care for patients. Assessment of nutritional status is the foundation that provides the data for implementation of the nutrition care or nutrition therapy and the optimal diet for patients. Assessment of nutritional status includes four components, namely nutrition and diet history, anthropometric measurements, laboratory tests and physical examination (Hartono, 2006).

Direct assessment of nutritional status consists of four forms, namely anthropometric, clinical, biochemical, and biophisical.

A. Anthropometric

Anthropometric interpreted generally is a measure of the human body. Nutritional Anthropometric means dealing with a wide range of measuring body dimensions and body composition of various age levels and nutrient levels. Anthropometric used to see an imbalance of protein and energy intake.

Anthropometric measurement is a measurement of weight and size proportions of the human body. These measurements include height, weight, skin fold thickness (TSF) and arm circumference (MAC). Head, chest, and arms are areas anthropometric measurements (Hartono, 2006).

1. Body Weight

Body weight (BW) is one indicator of the patient's nutritional status. However in certain circumstances measurements of actual BWcould not be done because of the patient's disability or helplessness. To overcome these problems, BW can be estimated based on the ideal length of the patient's body (Hartono, 2006).

2. Height

Height measurement on patients who are bed rest can be done with several measurement techniques. Estimating height based on knee height (Cairella et al, 2004). The equation used is:

Male, height = 64.19 - (0.04 x age) + (2.02 x knee height)

Women, height = 84.88 - (0.24 x age) + (1.83 x knee height)

The other techniques of estimate the height is to use the arm-span (the length measured from the tip of your finger left to right hand fingertips stretched position (Shahar & Pooy, 2003). For Asia, the equation used is: men, high body = 53.4 + (0.67 x armspan)

Women, height = 81.0 + (0.48 x armspan).

3. Body mass index (BMI)

BMI is calculated based on BB (in kg) and TB (in cm). BMI is used to measure the patient's nutritional status and estimate the size of body fat. IMT measurement results, although still limited, but more accurate estimates compared to just using the BB alone.

The general formula, BMI = (weight (kg)) / [TB (m)] ^ 2

Relations BMI with MAC

Men; BMI = 1.01 x (MAC - 4.7)

Women; BMI = 1.10 x (MAC - 6.7)

Default Values BMI (proposed for asia, 2000)

<18.5 Weight less

18.5 to 22.9 weight nrmal

> 23 Preobese

23 to 24.9 Obese light

25 to 29.9 Obese being

> 30 Obese heavy

4. Triceps Skinfolds, MAC, Mid-Arm Muscle Circumference (MAMC)

Measurement of ticeps skinfold thickness (TSF) aims to determine the status of body fat while upper arm circumference / mid-arm circumference (MAC) and upper arm muscle circumference / mid-arm muscle circumference (MAMC) to determine the status of the muscle protein.

MAMC = MAC (cm) - {3.14 x TSF (cm)}

Until now, the normal value for Indonesian adults MAMC is do not exist, but for the Caucasian, normal values: 90% standard = 22.5 cm for males, 20.9 cm for women (Dudek, 2001 in Hartono, 2007).

B. Clinical

Clinical examination is a very important method to assess nutritional status. This method is based on changes in tissue due to lack of nutrients. This can be seen in the epithelial tissue (supervicial epithelial tissues) such as skin, eyes, hair and oral mucosa or in organs close to the surface of the body such as the thyroid gland.

Physical examination of a patient associated with the early signs of malnutrition or nutritional deficiencies. The principle of physical examination is cephalo caudal, from head to toe. Physical examination is composed of swallowing function, the absorption function, anthropometric measurements, and physical abnormalities or complaints related to nutritional deficiencies (Delaune & Ladner, 2002).

C. biochemical

Assessment of nutritional status using the labolatoris specimen examination conducted in various body tissues. Network among others; blood, urine, feces, and also some body tissues such as the liver and muscle. This method is used as the information of the possibility of malnutrition state is more severe. However, the information can not show the state of malnutrition or nutritional status.

Biochemical examination which is used as the data on nursing care is total lymphocyte levels, albumin, iron, hemoglobin, transferrin, creatinine, hematocrit, nitrogen balance, and skin test antigen. The value of these biochemical tests and anthropometric together will help give you an idea of nutritional status and immunological responses of patients (Nurachmah, 2001).

Laboratory tests can provide information about the nutritional status especially on the somatic and visceral compartment of the body (creatinine-height index and urinary 3-methylhistidine). Somatic compartment composed of skeletal muscle and adipose tissue. Visceral compartment includes examining albumin, transferrin and prealbumin, retinol binding.

Visceral Proteins that Can Used in Assessing Nutrition

half time Limit Normal Part

Albumin 18 days 3.5 - 5.5 mg / dl

Transferrin 8 days 200-400 mg / dl

Thyroxine-binding prealbumin 2 days 15.7 - 29.6 mg / dl

Retinol-binding protein 12 hours 2.6 - 7.6 mg / dl

Sources: Hartono, 2006

Visceral Protein and Malnutrition

albumin (g / dl) Transferrin (g / dl)

Mild Malnutrition 3.0 - 3.5 1.5 - 2

moderate Malnutrition 2.1 - 3.0 1 - 1.5

Severe malnutrition < 2.0 < 1

Sources: Hartono, 2006

D. Biophysical

It is a method of determining the nutritional status by looking at the ability to function (particularly networking) and see the changes in the structure of the network. Generally it can be used for specific situations such as the incidence of blindness twilight epidemic (epidemic of night blindness). Method used was dark adaptation tests.

Senin, 10 September 2012

acute myocard infarc

AMI is the process of myocardial ischemia caused by the blockage of a coronary artery by the thrombus which has having atherosclerosis

clinical manifestation :

precordial chest pain with or without spread to the left arm, left shoulder and neck, back
identifay pain, constant or intermittent
ST segmen elevation > 1mm in 2 or more leads with or without changes in Q wave
changes in cardiac enzimeCK-MB, troponin-T, troponin-I
peripheral cold, clammy skin, diaphoresis
blood glucose ↑
tightness, rapid breathing, cyanosis
tachicardia, blood tension ↑
oliguri or anuri
nausea and vomiting