Sptl Gizi 2012
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Transcript of Sptl Gizi 2012
8/12/2019 Sptl Gizi 2012
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DEPARTEMEN IKARSMH PALEMBANG
Gizi Buruk Kode ICD :E 40,E 41,E 44.0, E
44.1,E 4,E 4!, E
4",E 4#
No Doku$e%&&&&.
No.Re'i(i!)!011
H*+*$*% :1)1"
P*%du*% Pr*kekK+i%i(
T*%--*+ Re'i(i1 ko/er !011
Die*k*% +e,Keu* Di'i(i Nuri(i d*% Pe%2*ki Me*/o+ik
Dr. 3u+iu( A%z*r, S.A
Dei%i(i Ter+i* (*%-* kuru( d*% **u ede$* d*% **u BB)TB **u BB)PB
5 6 "SD /erd*(*rk*% -r*ik eru$/u*% 7H *u% !00 u%uk
*%*k 8 # *u% d*% -r*ik CDC !000 u%uk *%*k 9 # *u%
Eio+o-i Sekru$ e%2e/*/ : I%*ke kur*%- ke$i(ki%*%, keid*k*u*%,
e%2*ki;, e%2*ki (i(e$ik
P*o-e%e(i(Sik+u( i%ek(i, di*re d*% kur*%- -izi 2*%- dier/er* o+e
i$u%odei(ie%(i, *roi)di(u%-(i or-*%, $*+*/(or/(i)$*+di-e(i,
kei+*%-*%)dei(ie%(i $e%i%-k*, k**/o+i($e $e%i%-k*
dei(ie%(i $*kro)$ikro%urie% -*%--u*% eru$/u*%
$*+%uri(i
Be%uk K+i%i(K+*(iik*(i;
K+*(iik*(i /erd*(*rk*% k+i%i(:
• M*r*($u(
• M*r*($ik k<*(iorkor
• K<*(iorkor
A%*$%e(i(• Se=*k k**% u/u $*ki% kuru( d*%)**u i$/u+%2* ede$*
• Se=*k k**% er=*di e%uru%*%)i+*%-%2* %*(u $*k*% d*%
$e%>*ri *kor redi(o(i(i
• Ri<*2* $*k*% (e/e+u$ (*ki, ri<*2* e$/eri*% ASI d*%
MP ASI
• Ge=*+* d*% *%d* e%2*ki e%2er*)2*%- $e%d*(*ri
$i(*+%2* di*re, u/erku+o(i(, /*uk kro%ik, >*>i%-*%, d*%
>*$*k, (er* *%d*6*%d* dei(ie%(i $*kro)$ikro%urie%
• K**% diure(i( er*kir
• Ri<*2* u$/u ke$/*%-
• Ri<*2* i$u%i(*(i
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Pe$erik(**% i(ik K+*(iik*(i /erd*(*rk*% k+i%i(:
• Gizi /uruk de%-*% ede$*
• Gizi /uruk *%* ede$*
Gizi Buruk dengan Edema
• Peru/**% (*u( $e%*+: **i( ? re<e+
• R*$/u ii(, ke$er**% ( <*r%* r*$/u =*-u%-, $ud*
di>*/u *%* (*ki, $ud* ro%ok
• 7*=* $e$/u+* d*% (e$/*/
• P*%d*%-*% $** (*2u
• Pe$/e(*r*% *i
• Mi%i$*+ *d* kedu* u%--u%- k*ki, /er(i* ii%- ede$*
• Der*=* ede$*:
@ Kedu* u%--u%- k*ki
@@ Tu%-k*i ? +e%-*% /*<*
@@@ Se+uru u/u <*=* ? eru;
• Der*=* ede$* u%uk $e%e%uk*% =u$+* >*ir*% 2*%-
di/erik*%
• o $e%-e>i+ ioroi;
• Ke+*i%*% ku+i /eru* /er>*k $er* $ud* 2- $e+u*( ?
/eru/* <*r%* $e%=*di >ok+* kei*$*% d*% erke+u*(crazy pavement dermatosis;
• Seri%- di(er*i e%2*ki i%ek(i u$u$%2* *ku; *%e$i*
d*% di*re
Gizi buruk tanpa edema
• T*$*k (*%-* kuru(, i%--* (eeri u+*%- er/u%-ku(
ku+i
• 7*=* (eeri or*%- u*
• Ce%-e%-, re<e+
• Ku+i keriu, =*ri%-*% +e$*k (u/kui( (*%-* (ediki (*$*i
id*k *d* >e+*%* +o%--*r baggy pants;
• Peru u$u$%2* >eku%-
• Tu+*%- ru(uk $e%o%=o+ I-* -*$/*%-, piano sign” ;
• Seri%- di(er*i e%2*ki i%ek(i u$u$%2* kro%i( /eru+*%-;
di*re er(i(e%
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Krieri* Di*-%o(i( Dasar Diagnosis:
• (i* 8 # *u% de%-*% -ro< >*r 7H !00, (>ore 5
6" SD
• (i* 9 # *u% $e$*k*i CDC !000, BB)TB : 5 0
• K+*(iik*(ik*% /erd*(*rk*% $*%ie(*(i k+i%i(
Langkah Diagnosis:
• Te*k*% Gizi Buruk
• Te*k*% k+*(iik*(i ) /e%uk k+i%ik Gizi Buruk
• Te*k*% ko%di(i
• Te*k*% di*-%o(i( e%2*ki 2*%- $e%2er*i $e%d*(*ri d*%
e%2er*;, (e>*r* rui%:
TBC (*%d*rd roe(i TBC
ISK (*%d*rd roe(i ISK
I%ek(i e+i%-* kro%i( ) $*(oidii( (*%d*r roe(i THT
• C*ri e%2e/*/ +*i% $e*/o+ik) e%dokri%, e%2*ki =*%u%-
/*<**%;
Indikasi Rawat: Se$u* e%deri* Gizi Buruk /er* dir*<*.
Tatalaksana
1. enatalaksanaan
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!. 1" Langkah dalam # $ase
%o. Tindakan&tabilisasi
Transisi
' ()1*
Rehabilitasi
+g #),
Tindak
Lan-ut
+g )/,' 1)/ ' #)
1 A*(i)>e-*
io-+ike$i*
! A*(i)>e-*
ioer$i*
" A*(i)>e-*
deidr*(i
4Per/*iki --%
e+ekro+i
# /*i i%ek(i
Per/*iki de.
%urie% $ikroT*%* Fe @Fe
M*k*%*% (*/.
Tr*%(
M*k*%*% u$/u
ke=*r
Si$u+*(i
10Si*k*% i%d*k
+*%=u
B. 0rutan elaksanaan
B.1. +enetapkan 2ondisi berdasarkan:
Tanda Baha3a 4
Tanda enting
2ondisi
I II III I5 5
Re%=**% So>k; @ 6 6 6 6
Le*r-i( Tid*k S*d*r; @ @ 6 @ 6
Mu%*)Di*re)Deidr*(i @ @ @ 6 6
B./. &tabilisasi
B./.1. &tabilisasi !wal
P*(ik*% **k* *d* -*%--u*% u%-(i 'i*+ e%uru%*% ke(*d*r*%,
re(2ok, -*%--u*% k*rdio'*(ku+er d*% er%**(*%; ) *%d* /**2*
2*%- $e%-*%>*$ keidu*% e%deri* (eeri io-+ike$i*, ioer$i*,
i%ek(i /er* (e(i(; d*% deidr*(i)-*%--u*% ke(ei$/*%-*% >*ir*%,
e+ekro+i, d*% *(*$ /*(*.
B././. &tabilisasi Lan-utan
B.#. Tatalaksana $ase &tabilisasi !wal dan Lan-utan &etiap 2ondisi
B.#.1. 2ondisi I
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Stabilisasi awal
/ -am I :
- ! 16! +)$e%i, *(*%- NGT
- P*(*%- IFD RLG # RL @ D10 1:1;
- D10 I /o+u( do(i( # $+)k-BB
-
ReSoM*+ # $+)k-BB)NGT
• 3*$ I: IFD RLG # 1# $+)k-BB (e+*$* 1 =*$ #
()$e%i)k-BB $*kro;
• 3*$ II:
6 N*di ku*, rek %**( J IFD (*$*i 1 =*$ /eriku%2*,
ReSoM*+ (e(u*i ke$*$u*%;
6 N*di d*% rekue%(i %**( e* i%--i IFD RLG # 4 $+)
k-BB)=*$ 1 ()k-BB)$e%i;
1" 6am II
6 IFD dieru(k*% (e$e%*r*;
6 ReSoM*+ (e+*%-6(e+i%- i* =*$ de%-*% F6#
6 ASI @; dieru(k*% (ee+* F6#
6 C** %*di, rekue%(i %**( i* 1 =*$
Stabilisasi lanjutan bila telah:
- Reidr*(i F6# ) ! =*$
- Di*re 6; re(o$*+ (o
- Di*re @; re(o$*+ e* di/erik*% (ei* di*re
A%*k 5 ! *u% : #06100 >>)di*re
A%*k ! *u% : 1006!00 >>) di*re
Di*re ) $u%* /erkur*%- d** $e%-*/i(k*% (e/*-i*% /e(*r F6#
F6#)" =*$ (i(*%2* +e<* NGT;
Bi(* $e%-*/i(k*% (e/*-i*% /e(*r F6#
F6#)4 =*$
B.#./. 2ondisi II
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Stabilisasi awal : 6 Bo+u( D10 I # $+)k-BB
- NGT D10 +*r. Gu+* 10 #0 $+
2 Jam I : ReSoM*+ or*+)NGT i* "0, # $+)k-BB)k*+i, C**
%*di, %**( i* "0
10 Jam II :
Me$/*ik Me$/uruk
ReSoM*+6 F6# ) 1 =*$
C** %*di, %**( i* 1 =*$ IFD **+*k(*%* ko%di(i I;
Reidr*(i Re(o$*+ d*% F # (e+*%-6(e+i%- i* =*$
Di*re 6; re(o$*+ (o
Di*re @; re(o$*+ : 6 A%*k 5 ! *u% : #06100 >>)di*re
- A%*k ! *u% : 1006!00 >>) di*re
B.#.#. 2ondisi III
Stabilisasi awal : #0 $+ D10 **u +*r. Gu+* P*(ir 10 r*+)NGT;
2 Jam I : ReSoM*+ or*+)NGT i* "0, # $+)k-BB)k*+i
C** %*di, %**( i* "0 T*/e+ 4, Buku I H*+. 10;
10 Jam II :
Me$/*ik Me$/uruk
ReSoM*+6 F6# ) 1 =*$
C** %*di, %**( i* 1 =*$ IFD **+*k(*%* ko%di(i I;
Reidr*(i Re(o$*+ d*% F # (e+*%-6(e+i%- i* =*$
Di*re 6; re(o$*+ (o
Di*re @; re(o$*+ : 6 A%*k 5 ! *u% : #06100 >>)di*re
- A%*k ! *u% : 1006!00 >>) di*re
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B.#.*. 2ondisi I5
Stabilisasi awal : 6 Bo+u( D10 I # $+)k-BB
- #0 $+ D10 **u +*r. Gu+* P*(ir 10 r*+)NGT;
2 Jam I :
F6# i* "0 $e%i, =u$+* 2*%- *ru( di/erik*% i* ! =*$ NGT;
C** %*di, %**( i* "0 T*/e+ #;
Le*r-i( @; Le*r-i( 6;
F6# ) "0, =u$+*)! =*$ NGT; 10 =*$ /eriku%2*:
C** %*di, rekue%(i %**( d*% F6# 6 F6#)! =*$ or*+)NGT;
i* "0 6 N*di, %**(, ke(*d*r*% i*
Pe%2e/*/ +*i%O 1 =*$
6 ASI
Le*r-i( 6;
Stabilisasi lanjutan: F6#)! =*$
Bi+* d** $e%-*/i(k*% (e/*-i*% /e(*r F6#
F6#)" =*$ (i(*%2* +e<* NGT;
Bi(* $e%-*/i(k*% (e/*-i*% /e(*r F6#
F6#)4 =*$
B.#.. 2ondisi 5
Stabilisasi awal : 6 # $+ D10 **u +*r. Gu+* P*(ir 10 or*+
6 C** %*di, %**(, ke(*d*r*%
2 Jam I : F6#)"0, (e+*$* ! =*$ (e(u*i BB
T*/. F6# de%-*%)*%* ede$*;
C** %*di, rek. N**(, ke(*d*r*% d*% *(u*% F6#)"0
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10 Jam II:
6 F6#)! =*$ T*/e+ F6# de%-*%)*%* ede$*;
6 C** %*di, rek. N**(, *(u*% F6#)"0
6 ASI *%*r* F6#
Stabilisasi lanjutan: F #)! =*$
Bi+* d** $e%-*/i(k*% (e/*-i*% /e(*r F6#
F6#)" =*$ (i(*%2* +e<* NGT;
Bi(* $e%-*/i(k*% (e/*-i*% /e(*r F6# F6#)4 =*$
B.*. $ase Transisi
• P*(ik*% id*k *d* -e=*+* *d* (*diu$ (*/i+i(*(i, $u+*i e$/eri*%
$*k*%*% eror*+ de%-*% $e%i+*i ke*d**% di*re d*% $e$er*ik*%ke$*$u*% $*k*%, di-e(i, d*% */(or(i (*+ur*% >er%*.
6 F6# F6100)4 =*$, de%-*% 'o+u$e F # 2*%- er*kir T*/. F6#;
dier**%k*% ! *ri, >** %*di, rek. %**(, d*% *(u*% F6100)4 =*$
T*/e+ ;
6 H*ri ke6" F6100 T*/e+ F6100; i* 4 3*$ di%*ikk*% 10 $+ (*$*i
id*k $*$u $e%-*/i(kk*% id*k $e+e/ii =u$+* $*k(i$*+ !!0
>>)k-BB *d* */e+ F6100;
6 H*ri ke64 F6100)4 =*$ T*/e+ F6100;
Per**%k*% (*$*i *ri ke 614 **u (e(u*i de%-*% ko%di(i *%*k.
B.. $ase Rehabilitasi
• P*(ik*% id*k *d* -e=*+* *d* (*diu$ (*/i+i(*(i)r*%(i(i, ke$*$u*%
$*k*% /*ik.
BB 5 K- BB K-
6 F6100 6 F6100
6 M*k*%*% Lu%*k)Le$/ik 6 M*k. Lu%*k)Le$/ik d*% M*k. Bi*(*
6 S*ri /u* 6 Bu*
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6adwal dan dosis emberian 5itamin !
Ge-ala 'ari 2e)1 'ari 2e)/ 'ari 2e)#
Tid*k *d* -e=*+* $** **u
id*k er%* (*ki >*$*k
d*+*$ " /u+*% er*kir
Di/eri
k*(u+
de%-*% do(i(
(e(u*i u$ur
Tid*k di/eri
k*(u+
Tid*k di/eri
k*(u+
Ad* (*+* (*u -e=*+*:
- Ber>*k ) Bio- N*%*)r*d*%-- +ku( keru- +ku( kor%e*- Per%* (*ki >*$*k d*+*$
" /u+*% er*kir
Di/erik*(u+
de%-*% do(i(
(e(u*i u$ur
Di/erik*(u+
de%-*% do(i(
(e(u*i u$ur
Di/erik*(u+
de%-*% do(i(
(e(u*i u$ur
D./. $e
Do(i( T*/+e Be(i d*% Siru Be(i u%uk A%*k $ur Bu+*% (*$*i # T*u%
Bentuk $ormula $e Dosis
T*/+e Be(i)Fo+* 0 $-
Be(i e+e$e%*+ d*% 0,!#
$- A(*$ Fo+*;
B*2i u(i* 61! /u+*% 1 Q (e*ri */+e 1#
$-;
A%*k u(i* 16# *u% 1 Q (e*ri */+e "0
$-;
&irup Besi
Sei* # $+ $e%-*%du%-
"0 $- Be(i e+e$e%*+
B*2i u(i* 61! /u+*% 1 Q (e*ri (e%dok e
1# $-;
A%*k u(i* 16# *u% 1 Q (e*ri 1 (e%dok e"0 $-;
C***%:
- Perik(* k*d*r H/ u%uk $e$*(ik*% **k* *d* *%e$i* /er*.- Fe di/erik*% (ee+* $e$*(uki *(e (*/i+i(*(i **u *ri ke614.- Fe di/erik*% (ei* *ri (e+*$* 4 $i%--u **u +e/i (*$*i k*d*r H/ %or$*+
(e+*$* ! /u+*% /eruru6uru.- Do(i( Fe: 16" $- Fe e+e$e%*+)k-BB)*ri.- Bi+* *d* +*kuk*% e$erik(**% H/ u+*%- i* 1 /u+*%.
D.#. !sam $olat
# $-)*ri *d* *ri er*$*, (e+*%=u%2* 1 $-)*ri
D.*. Elekmin dan Re&o+al +i* +*$ir*%;
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E. Trans8usi
6ika 'asil emeriksaan 'b atau 't Tatalaksanan3a
6 H/ 5 4,0 -)d+ Berik*% r*%(u(i d*r* (e-*r (e/*%2*k
10 $+)k-BB d*+*$ <*ku " =*$. Bi+* *d*
*%d* -*-*+ =*%u%- -u%*k*% Packet Red
Cell u%uk r*%(u(i d*+*$ =u$+* 2*%-
(*$*
A*u
6 H/ 4,06,0 -)d+ di(er*i di(re(
er%**(*% **u *%d* -*-*+
=*%u%-
Berik*% Furo(e$id 1 $-)k-BB (e>*r* I
*d* (** r*%(u(i di$u+*i.
He%ik*% (e$u* e$/eri*% >*ir*% +e<*
or*+)NGT (e+*$* *%*k dir*%(u(i.
Ko$+ik*(i d*%
Pro-%o(i(
• 3*%-k* e%dek :
G*%-u*% u%-(i 'i*+ 2*%- d** $e%-*%>*$ keidu*%
k*re%* io-+ike$i*, ioer$i*, deidr*(i d*% -*%--u*%
ke(ei$/*%-*% e+ekro+i6*(*$ /*(* (er* i%ek(i /er*
(eike$i*;, *$/**% e%2e$/u*% e%2*ki e%2er*.
• 3*%-k* *%=*%- : stunting , /erkur*%-%2* oe%(i u$/u
ke$/*%-
M*+%uri(i 2*%- dir*<*: ke$*i*% !06"0, *k*% $e%i%-k*
/i+* k*d*r *+/u$i% 5 1,# -, -+uko(* d*r* 5 " $$o+)L **u
5 #0 $-)d+, (uu rek*+ 5 "#,#oC d*% *d*%2* i%ek(i /er*.
Ge=*+* (i(*: e%>**i*% u$/u ke$/*%- er*$/*
er$*(uk e%uru%*% i%e+e-e%(i, eru*$* =ik* $*+%uri(i er=*di
*d* u(i* kur*%- ! *u%.
D**r keu(*k**% 7H, Se'ere M*+%uriio%. D*+*$ :Po>ke Book o Ho(i*+ >*re or>i+dre%, !00: 1"617H, Guide+i%e( or e i%*ie% re*$e% o (e'ere+2
$*+%ouri(ed >i+dre%, !00"De*re$e% Ke(e**% RI, Peu%=uk Tek%i( T**+*k(*%* A%*k GiziBuruk, !00
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L*i%6+*i% A+-*ri$*,Prooko+, Pro(edur,
S*%di%- rder; Lampiran
$ormula &usu untuk 2E
Bahan $ $ 1"" $ 1#
Su(u Ski$ -; !# "0 0Gu+* -; 100 #0 #
Mi%2*k -; "0 0 #
E+ek$i% $+; !0 !0 !
Air 1000 1000 1000
Larutan Re&o+al
r*+i 7H 1 L 1
Gu+* -; #0
E+ek$i% $+; 40
Air $+; !000
Larutan Elekmin
KC+ -; !!4
Trio*(iu$ Cir* -; 1
M*-%e(iu$ C+orid* -;
i%> A>e*e -; ,!
Coer Su+*e -; 1,4
Sodiu$ (e+e%*e 0,0!
Air $+; !#00