GIZI BURUK-INED.ppt

8/14/2019 GIZI BURUK-INED.ppt

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Gizi Buruk

Bag.I.kesehatan AnakFakultas Kedokteran Universitas YARSI

Dr.Wan Nedra K. Sp.A


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PENANGANAN PASIEN GIZI ANAK: 1. mengerjakan ANAMNESIS2. mengerjakan PEM.FISIK3. menentukan PEM.PENUNJANG4. menegakkan DIAGNOSIS5. memberikan TERAPI

6. mempertimbangkan PROGNOSIS7. mengusahakan PREVENSI


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1. Anamnesis : 8 Riwayat makanan : - jangka pendek : sblm sakit

- jangka panjang: sejak bayi8 Nafsu makan : baik / kurang / buruk ?8 Masukan makanan : jumlah dan jenis mak. yang

dikonsumsi --> dapat utk menilai / kesan ttg :X kwalitas : baik / kurang, berdasarkan :

- jenis mak.

- komposisi nutrien- distribusi kalori

X kwantitas : cukup / kurang / lebih --.> thd. RDA- energi / protein / vitamin / mineral dll.


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2. Pemeriksaan fisik 2.1. Tanda / gejala penyakit gizi :

- MEP : wajah, rambut, otot, jar.lemak subkutis,edema, dsb.

- KVA ( Xerophthalmia ) : bercak Bitot, xerosis

konyungtiva, ulkus kornea, dst.- Anemia defisiensi : pucat ( organomegali - )- GAKI : kel.tiroid >, kretin, dll.- def.vit B

1: beri-beri / edema, polineuritis,refleks fisiol. obesitas )- gizi baik ( wellnourished )- gizi kurang ( undernourished )

- gizi buruk ( severe malnutrition)Kesan klinis dibuat berdasarkan tanda / gejalaklinis.

2.3 . Menentukan status gizi secara ANTROPOMETRIS :- BB/U - BB/TB- TB/U - LILA, dsb.


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Status Gizi anak laki2, 2 thn

BB: 7 kg TB: 60 cm Status Gizi: BB/U: 7/ 12,8: x 100%: 54 % (G.Buruk)

BB/TB: 7/ 6 x 100%: 116% TB/U: 60/ 87 x 100: 69%


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Defisiensi vit A (Xerophthalmia)Bitotspot Ulcus

cornea

Xerosis conyunctiva & cornea Keratomalacea


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2. Pemeriksaan fisik 2.2. Membuat KESAN KLINIS tentang status gizi :

- gizi lebih ( overweight --> obesitas )- gizi baik ( wellnourished )- gizi kurang ( undernourished )

- gizi buruk ( severe malnutrition)Kesan klinis dibuat berdasarkan tanda / gejalaklinis.

2.3 . Menentukan status gizi secara ANTROPOMETRIS :- BB/U - BB/TB- TB/U - LILA, dsb.


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Kwashiorkor & Marasmus

Iga gambang

Rambut

Hepar >>

Edema

Atrofi otot

Lemak SC


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Marasmic-Kwashiorkor

Baggy pants

Edema

Iga gambang

Atrofi ototJar.lemak SC


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3. Pem. Penunjang :

3.1. Pem. Laboratoris :- Hb- protein serum, albumin, globulin

- profil lipid ( lipid total, triglserida,kolesterol, LDL, HDL)- BUN, dll

3.2. Pem.radiologis : - usia tulang- osteoporosis/osteomalasia

3.3. Pem.antropometris : - BB, TB/PB, LILA, LK, TLK.


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4. Diagnosis :

4.1. Sehat : - status gizi baik- T-K normal / optimal- + kriteria sehat lain

4.2. Penyakit gizi :- defisiensi : MEP, Vit - Min.

- kelebihan : Obesitas, intoksikasi vit-min.


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5. Terapi :

5.1. Terapi nutrisi : - oral / enteral / parenteral

- dukungan thd. penyakit utama : ginjal,sal.cerna, DM, IEM, dsb.

5.2. Menentukan dosis obat

5.3. Pemantauan respons th/ keseluruhan


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6. Prognosis : 6.1. Perbaikan / kemunduran :

- perbaikan --> penyembuhan :- nafsu makan >- BB >

- kemunduran --> perburukan :- nafsu makan 60% + oedema)

+ clinical signs & symptoms : - oedema (M-K)- severe dehydration- persistent diarrhoea and / or vomiting- severe pallor, hypothermia, shock- signs of systemic/local infection, URI- severe anaemia ( Hb < 5 g/dl)- jaundice- anorexia

- < 1 yr of age

PEM


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PEM.

Signs & symptoms of dehydration :

- history of diarrhoea or no/diminished intake- weak, apathetic unconscious

- weak to absent radial pulse- thirst, dry mouth and absent of tears- sunken eyes and fontanel

- hypothermia- cold hands and feet- Urine flow


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Dehydration

Sunken eyes


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Dehydration

Turgor :

PEM


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PEM.

Therapy:

Mild-moderate PEM (Gizi kurang) : - no specific clinical signs : thin, hypotrophic

- not necessary to hospitalize- looking for the probable causes- nutr. education & supplementation

Severe PEM : should be hospitalized

PEM


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PEM.

5 ASPECTS in the MANAGEMENT of Severe PEM :

A. 10 main steps

B. Treatment of underlying diseases

C. Failure to respond to treatment

D. Discharge before recoverE. Emergency

PEM


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PEM.

A : 10 main stepsNo Interven- Stabilization Transition Rehabilitation Follow-up

tion d.1-2 d.3-7 wk-2 wk 3-6 wk 7-261. Treat/preventhypoglycaemia

2. Treat/preventhypothermia

3. Treat/preventdehydration4. Correct electr.

imbalance5. Treat infection6. Correct micro- without Fe + Fe

nutrients defic.7. Begin feeding8. Increase feeding9. Stimulation

10. Prepare fordischarge

PEM


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PEM.

B. Treatment of underlying diseases / infection :

Bacterial infection : - no apparent signs of infection/no complication:

cotrimoxazole ( 5 mg TMP/kg, 2x/d, 5 days )

- signs of infection / complications / sepsis :- ampicilline 50 mg/kg/6 hrs, IM/IV,

for 2 days oral (ampi / amoxy)

- gentamycin 7.5 mg/kg, IM/IV, 7 days- KP + anti-TB drugs

Viral infection : no specific th/- all PEM should receive measles vaccine

PEM


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PEM.

C. Failure to respond to treatment :

Frequent causes of failure to respond :

a. Problems with the treatment facility :

- poor environment for malnourished children- insufficient or inadequately trained staff

- inaccurate weighing machine- food prepared or given incorrectly

PEM


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PEM.


Frequent causes of failure to respond :

b. Problems of individual children :

- insufficient food given- vitamin-mineral deficiency- malabsorption of nutrients

- rumination- infections- serious underlying disease

PEM


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PEM.


Criteria Time of admissionPrimary failure to respond:- failure to regain appetite Day 4

- Failure to start to lose oedema Day 4- Oedema still present Day 10- Failure to gain at least 5 g/kg/d Day 10

Secondary failure to respond :- failure to gain at least 5 g/kg/d During rehabilitation

for 3 consecutive days

PEM


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PEM.


1. Death= within first 24 hrs :

- hypoglycemia- hypothermia- dehydration- sepsis

= within 24 72 hrs :- volume of formula >>- caloric density >>

PEM


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PEM.


2. Inadequate gaining weight :- infection- diet- psychologic

Weight gain :

= satisfactory: > 10 g/kg/d good == sufficient : 5-10 g/kg/d > 50 g/kg/wk= poor : < 5 g/kg/d or < 50 g/kg/wk

PEM


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PEM.

D. Discharge before fully recover:

= Dietary advice :- high protein and calorie

- frequent feeding ( 5x/d )- finish all meals given- vit-min supplementation & electrolytes- continue BF

= frequent controle ( 1x/wk )

= Immunization

E


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Emergency :

Shock :

N2 or RLG5%15 ml/kg, 1 hr

Repeat 1 hr more

Resomal 10 ml/kg, 10 hrs

Special formula

sepsis

Maintenance, 4 ml/kg/hrFresh blood, 10 ml/kg

Improvement+

_


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Emergency :

Severe anaemia.

Hb ?

Hb < 4 g/dl Hb 4-6 g/dl

Resp.distress/heart failure?

Fresh blood 10 ml/kg*PRC 10 ml/kg* Observation

* : give furosemid 1 mg/kg, iv, before transfusion

+ _

PEM.


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PEM.

Prepare for discharge :

- W/H : - 1 SD or severe PEM moderate/mild - Education for mother :

- hygiene & sanitation- healthy foods- immunization- stimulation- regular controle

- to continue the th/ of chronic diseases

- to completing immunization


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On admission :Sh, girl, 2 yrs,W : 3.875 gH : 67 cmW/H : < -4SD

2 weeks later :W : 4.750 gH : 67.4 cmW/H : < -3 SD

4 weeks later :W : 5.310 gH : 67.7 cmW/H : + -3 SD

5 weeks later :W : 6.280 gH : 67.8 cm

W/H : - 2 SD


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7 yrs,10 kg

Recovery : 16 kg

GIZI BURUK-INED.ppt

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