A.

Form Asuhan Gizi Terstandar

NAMA : ALFIS DYAN TREESMA
NIM : P17111173033
Patient Profile and Health History
The patient, Edna Meyer, is a 62 year old African American female who is 5’1”tall and
weighs 155 pounds. Her BMI is 29.3, meaning she is in the overweight category. She
hassuffered from intermittent constipation for most of her adult life. She recently began to
haveepisodes of diarrhea and cramping in the lower left quadrant of the abdomen.Patient is a
homemaker and works out of her home as a seamstress. She lives with her husband, who is
66, and has two granddaughters ages 13 and 15. Her highest level of educationis
high school. She reports having a good appetite and enjoys cooking and baking. She
hastrouble maintaining regular bowel movements and believes that her consumption of prune
juiceand prunes has improved her regularity to some extent. Normal intake includes coffee,
whitetoast with butter and jam, and a fried egg for breakfast, soup or sandwich with coffee
for lunch,and meat with vegetables, rice or potatoes, bread or biscuits, and iced tea or coffee
for dinner.She has had no previous medical nutrition therapy. She purchases her own food
and does nottake any vitamins or supplements. She has no food allergies or intolerances. She
does not smokeor consume alcohol or recreational drugs. Note that her diet is particularly low
in fiber, fruits and vegetables, and she consumes large amounts of coffee and tea daily. Her
low fiber consumption could be a contributing factor to the development of diverticulosis
and increasing fiber intake would be beneficial.

In the past 24 hours patient has had 3 episodes of rectal bleeding. She complained of bright
red blood in her stool and cramping in the lower left quadrant of the abdomen. She was
diagnosedwith hypertension 3 years ago and takes 5 mg of lisinopril daily. Family history
includes hermother’s death from ovarian cancer and her father ’s death from
colon cancer. She appearedsomewhat anxious upon her visit to the physician, but otherwise
not in any apparent distress.The physical exam revealed a body temperature of 98.8 degrees
F, heart rate of 72 BPM, and blood pressure of 120/82. Heart sounds are normal with clear S1
and S2, and no rub, murmur, or Case Study on Diverticulosis 4 of 12 gallop. Eyes and nose were
clear, and throat was supple with no adenopathy, thyromegaly, or bruits. Her neurological
function is normal, and she does not have edema. Chest and lungs areclear. Abdomen is
not tender or distended and bowel sounds are present throughout. Peripheral pulses are
palpable. All biochemical labs are within normal ranges.EER: 1722 kcal/day, EPR: 70-85
grams protein/day
ADIME note
A: Patient is a 62 year old African American female.
Height: 5’1”
Weight: 155 lbs
BMI: 29.3 (overweight)
EER:1722 Kcal/day
EPR: 70-85 grams protein/ day
Medications: 5mg lisinopril daily

Nama : Ny. EM
No. Register : -
Ruang/Bed : -
Usia : 62 th
Diagnosis Penyakit : Diverticulitis
ASSESSMENT/REASSESSMENT KESIMPULAN
ANTROPOMETRI BB = 70 kg AD-1.1.5
TB = 156 cm overweight
LILA = -
IMT = 29

BIOKIMIA Hemoglobin (Hb) = N

N
Eritrosit (RBC) =
N
Leukosit (WBC) =
N
Hematokrit =
N
Trombosit (PLT) =
N
MCHC =
N
RDW = N
Na = N
K=N
Cl = N

FISIK-KLINIS KU = Baik N
Nadi = 72 x/menit (N)
Suhu = 98.8oF -> 37oC
Tekanan Darah : 120/82 (N)
RIWAYAT GIZI Riwayat Gizi Dahulu : FH-1.2.2.2
Normal intake FH-1.2.2.5
kopi, whitetoast with butter
Pola konsumsi kurang
and jam, dan telur untuk
bervariasi
sarapan, soup atau
sandwich dengan kopi untuk
makan siang,dan daging,
sayur, rice or potatoes, bread
or biscuits, dan iced tea or
coffee for dinner. (Low fiber
dan lebih banyak
mengonsumsi kopi dan teh)
Riwayat Gizi Sekarang :
-24 hour recall:
2 slices white toast with 3
teaspoons margarine,
2 teaspoons jelly1/2 cup
sliced prunes black coffee2
slices white bread with 1 oz
ham, 1 T mayonnaise2 oz
potato chips black coffee2-3
oz pork chop (trimmed &
fried in corn oil)1 cup
macaroni and cheese1
biscuitwater2 (1”) slices of
pound cake1/2 cup vanilla ice
cream

RIWAYAT Riwayat penyakit dahulu = CH-2.1.5

PERSONAL Sembelit intermiten, diare
dan kram di kuadran kiri Gastrointestinal
bawah perut

DIAGNOSA GIZI - Inadequate fiber intake (NI-5.8.5) as related to low intake of

fruits, vegetables, legumes, andwhole grains as evidenced by 24
hour recall and numerous diverticula found in colon
--NB-1.1 Pengetahuan yang kurang tentang makanan dan zat gizi
berkaitan dengan kurangnya informasi yang ditandai dengan
asupan makanan yang tidak mencukupi kebutuhan px.
 INTERVENSI GIZI RENCANA MONITORING & EVALUASI

ND-1.2 Modifikasi diet AD-1.1.5 overweight

serat FH-1.2.2.2 Tipe makanan
E-1.4 Edukasi FH-1.2.2.5 Variasi makanan
CH-2.1.5 gastrointestinal

PERUBAHAN DIET
-

B. RENCANA INTERVENSI

1. INTERVENSI DIET (ND)

a. Tujuan Intervensi:
-Mengistirahatkan usus untuk mencegah perforasi.
-Mencegah akibat laksatif dari makanan berserat tinggi.

b. Prinsip Diet
Makanan cair, rendah sisa

c. Syarat Diet
d. M e n g u s a h a k a n a s u p a n e n e r g i d a n z a t - z a t g i z i
c u k u p s e s u a i dengan batasandiet yang ditetapkan.
e. Bila ada pendarahan, dimulai dengan makanan Cair Jernih.
 f. M a k a n a n d i b e r i k a n s e c a r a b e r t a h a p , m u l a i
d a r i D i e t S i s a Rendah I ke DietSisa Rendah II dengan konsistensi
yang sesuai.
g. hindari makanan yang banyak mengandung biji-biji kecil, seperti tomat, jambu biji,
dan stroberi, yang dapat menumpuk dalam divertikular.
h. Bila perlu diberikan makanan Enteral Rendah atau Bebas Laktosa.
i. Untuk mencegah konstipasi, minum minimal 8 gelas sehari.

j. Jenis diet
Diet Divertikulitis / diet rendah sisa I

k. Perhitungan Kebutuhan Energi dan Zat Gizi

o EER: 1722 kcal/day, EPR: 70-85 grams protein/day

2. INTERVENSI EDUKASI/KONSELING

a. Tujuan :
- Memberikan konseling mengenai pola makan yang seimbang, menganjurkan
untuk mengatur tentang jenis bahan makanan agar lebih bervariasi,
frekuensi/jumlah yang dikonsumsi, dan jadwal makan yang teratur.
- Memberikan konseling mengenai makanan yang boleh dikonsumsi, tidak
boleh dikonsumsi, serta bahan makanan yang dibatasi konsumsinya.
- Memberikan konseling mengenai asupan makanan yang tinggi vitamin dan
mineral dari sayur dan buah-buahan.
- Membimbing klien dan keluarga dalam merawat diri sesuai kondisi yang ada.

b. Metode : konseling, diskusi, dan tanya jawab

c. Waktu : 30 menit / menyesuaikan kesepakatan di awal

d. Tempat : ruang rawat inap pasien

e. Alat dan Bahan : leaflet dan food model

f. Sasaran : pasien dan keluarga pasien

g. Materi :
- Pola makan yang benar dan seimbang sesuai dengan diet yang dianjurkan
- Penjelasan tentang penyakit
- Bahan makanan yang boleh dikonsumsi, dibatasi, dan dihindari.
- Bahan makanan yang harus lebih dikonsumsi (sayur dan buah-buahan)
- Motivasi
C. PERENCANAAN MENU

Makan Pagi
Roti Bakar
Orak-arik telur
Susu
Snack jam 10.00
Puding maizena+saos susu
Makan Siang
Nasi tim
Semur tahu+daging giling
Tumis labu siam
Pepaya
Snack jam 16.00
Teh encer
Makan Malam
Nasi tim
Sup bola-bola ayam
Tim tahu
Setup wortel
Semangka