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PROSES ASUHAN GIZI TERSTANDAR (NCP) PADA PENYAKIT OSTEOPOROSIS

ETIKA RATNA NOER, S.Gz, M.Si

OUTLINE
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OVERVIEW OF OSTEOPOROSIS NUTRITION ASSESSMENT NUTRITION DIAGNOSIS NUTRITION INTERVENTION MONITORING & EVALUATION

ILUSTRASI : KEPARAHAN OSTEOPOROSIS

The Importance of Connections in Maintaining Strength

Loss of Connections Results in a Loss of Strength


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Background

Penyebab kesehatan serius kecacatan dini (patah tulang) Dipengaruhi : hormonal, nutritional and lifestyle factors
Osteopenia = BMD (1-2,5 SD) early stages of bone loss Osteoporosis = BMD > 2,5 SD progressive bone loss Penyakit yg ditandai dg massa tulang rendah & kerusakan jar tulang, kerapuhan tulang dan peningkatan resiko fraktur

Uncontrollable Risk Factors for Osteoporosis

Genetic factors

family history ethnicity

Uncontrollable factors thinness and/or small frame advanced age hormone levels post-menopause anorexia certain medications

National Osteoporosis Foundation, 2004

Controllable Risk Factors for Osteoporosis

Controllable factors

low calcium intake physical inactivity smoking excessive alcohol intake excessive caffeine use

National Osteoporosis Foundation, 2004

Antropometri : IMT, riwayat BB, BMD (bone mineral density, bone scan) Riwayat gizi : pola makan, asupan kalsium (porsi), phospor, caffein, garam/Na, makanan pengawet, junkfood, aktivitas fisik a. Riwayat personal : riwayat obes, fraktur tulang, tk pendidikan, sosek, terapi obat jangka pjg (HRT)

PEMERIKSAAN BIOKIMIA

blood calcium levels blood vitamin D levels thyroid function parathyroid hormone levels estradiol levels to measure estrogen (in women) follicle stimulating hormone (FSH) test to establish menopause status testosterone levels (in men) osteocalcin levels to measure bone formation

Domain Klinis :
1. 2. Overweight (NC 3.3) Altered nutrition related laboratory values (NC 2.2)

Domain Intake :
1. Excessive energy intake (NI 1.5) 2. Excessive fat intake (NI 5.6.2) 3. Inadekuat mineral (NI 5.10.1)

Domain Perilaku :
1. Rendahnya pengetahuan gizi (NB 1.1) 2. Kepatuhan diit rendah (NB 1.6)

CONTOH DIAGNOSIS GIZI PADA OSTEOPOROSIS


PES : Inadekuat calcium intake berkaitan dengan pantangan makan hewani dan tidak konsumsi susu jangka panjang yang ditandai asupan kalsium < AKG, dan kadar kalsium rendah (Ni 5.10.1) Data asesmen-nya : recall makanan dan hasil pemeriksaan laboratorium darah Intervensi gizi : pemberian diet tinggi kalsium Mon-ev : Pemeriksaan lab dan asupan makanan.

INTERVENSI
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Tujuan Diit Membantu mencegah terjadinya osteoporosis Membantu mengurangi kerapuhan masa tulang lebih lanjut agar dapat melakukan pekerjaan sehari-hari seperti biasanya

Syarat Diit
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Bahan makanan yang digunakan berkalsium tinggi dan makanan sumber vitamin D Sebagian besar protein yang digunakan golongan nabati Penggunaan bahan makanan yang mengandung natrium dibatasi Mengkonsumsi sayur dan buah dalam jumlah cukup. Menghindari konsumsi alkohol Bila terlalu gemuk, jumlah kalori dibatasi

ANGKA KECUKUPAN CALCIUM

BAHAN MAKANAN YANG DIBATASI / BAHAN MAKANAN YANG DAPAT MENGHAMBAT PENYERAPAN KALS
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Kopi, teh kental, minuman yang mengandung soda dan alcohol. Semua daging yang banyak mengandung lemak. Bahan makanan yang berserat tinggi

INTERAKSI CALCIUM DENGAN ZAT GIZI LAIN

Sodium and protein intakes: high sodium intake increases urinary calcium excretion. High protein intake also increases calcium excretion and was therefore thought to negatively affect calcium status. Caffeine intake: this stimulant in coffee and tea can modestly increase calcium excretion and reduce absorption Alcohol intake: alcohol intake can affect calcium status by reducing its absorption and by inhibiting enzymes in the liver that help convert vitamin D to its active form. Phosphorus intake: the effect of this mineral on calcium excretion is minimal. Several observational studies suggest that consumption of carbonated soft drinks with high levels of phosphate is associated with reduced bone mass and increased fracture risk. Fruit and vegetable intakes: Fruits and vegetables, when metabolized, shift the acid/base balance of the body towards the alkaline by producing bicarbonate, which reduces calcium excretion.

Food

Portion Milk

Milligrams

Fat free

1 cup

306 300 290 Yogurt

Lactose reduced, fat 1 cup free 1% low fat 1 cup

Plain, fat free Fruit, low fat

8 ounces 8 ounces

452 343 103 Cheese

Frozen yogurt, vanilla, 1/2 cup soft serve

Pasteurized process 2 ounces Swiss Ricotta, part skim Pasteurized process American 1/2 cup 2 ounces

438 335 323 311

Mozzarella, part skim 1.5 ounces

Fortified foods Soy drink with added calcium Orange juice with added calcium Tofu with added calcium 1 cup 1 cup 1/2 cup 368 300 253

Cereal with added calcium

1 ounce

236-1043
200 100 40 Vegetables

Cereal bar with added calcium 1 bar Bread with added calcium 1 slice

Whole-grain tortilla with added 1 tortilla calcium

Collards, cooked from frozen Kale, cooked from frozen Bok choy, cooked from fresh Broccoli, cooked or fresh

1/2 cup 1/2 cup 1/2 cup 1 cup Other foods

178 90 79 61

Soybeans, green, cooked White beans, canned Almonds, dry roasted

1/2 cup 1/2 cup 1 ounce

130 96 75

BAGAIMANA SEBAIKNYA CARA MEMASAK ?


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Cara-cara memasak yang baik ialah merebus, mengukus, mengungkep, menumis, memanggang atau membakar. Hindarkankanlah makanan yang diolah dengan cara menggoreng.

MENU UNTUK OSTEOPOROSIS


Pagi : Nasi goreng keju + tomat Snack (10.00) : Selada bangkok Siang : Nasi Pecel daun papaya Tempe mendoan Ikan Mas bakar Melon Snack (16.00) : Puding yoghurt Malam : Nasi Tauge cah tahu teri Brokoli saus bawang Ayam goreng Jeruk

Pemilihan Bahan Makanan

Bahan makanan sumber Kalsium : 1. Tinggi ( > 200 mg/100 gr BM )


Saridele bubuk, rebon, teri, udang kering, sarden, bayam, keju ) 2. Sedang ( 100 200 mg/100 gr BM ) Brokoli, pecay, kacang ijo, tahu, tempe, susu 3. Rendah ( 10 100 mg / 100 gr BM )

Daging, ayam, hati, telur, ayam BAHAN MAKANAN SUMBER NATRIUM :


Roti, krekers, dendeng, abon, ikan asin, ikan pindang

BAHAN MAKANAN SUMBER VITAMIN D


Susu, produk olahan susu ( keju, yoghurt ), kedelai, produk olahan kedelai ( tahu, tempe ), ikan, hati.

Perbedaan diit OSTEOPOROSIS dengan makanan biasa


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Bahan makanan yang digunakan berkalsium tinggi dan makanan sumber vitamin Sebagian besar protein yang digunakan golongan nabati Penggunaan bahan makanan yang mengandung natrium dibatasi Mengkonsumsi sayur dan buah dalam jumlah cukup Menghindari konsumsi alkohol Bila terlalu gemuk, jumlah kalori dibatasi
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Cek perub IMT Cek perub data biokimia Cek aktivitas fisik Kesiapan klien menuju pola makan seimbang Klien dpt menjelaskan pola makan seimbang

OLAHRAGA YG DIANJURKAN UNTUK PENDERITA OSTEOPOROSIS

Berjalan kaki Jogging Menaiki tangga Senam aerobik low impact Menari Senam Pelenturan Tai chi Yoga
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OLAHRAGA YG TIDAK DIANJURKAN Aerobik high impact Latihan yang memerlukan gerakan tiba-tiba dan bertenaga Sit-up perut Latihan yang memerlukan gerakan memelintir badan, seperti mengayun stik golf Latihan yang memerlukan hentakan, berhenti dan memulai dengan tiba-tiba, seperti tenis dan squash

TIPS SEHAT CEGAH OSTEOPOROSIS

Emphasizes a variety of fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products. Includes lean meats, poultry, fish, beans, eggs, and nuts. Tofu made with calcium salts is a good source of calcium (check the label), as are canned sardines and canned salmon with edible bones. Is low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars. Low-fat and nonfat dairy products provide amounts of calcium that are roughly similar to the amounts in their fullfat versions. Stays within your daily calorie needs

REFERENSI

Almatsier, S (2004) Penuntun Diet , Instalasi Gizi RSCM dan Asosiasi Dietisien Indonesia , Jakarta : PT Gramedia Pustaka Utama
Nelms M, Sucher K, Long S. Nutrition Therapy and Pathophysiology 4th ed. 2009. Thomson Escott-Stump,S (1998), Nutrition and Diagnosis Related Care (Fourth ed.) Baltimore: Williams & Wilkin Mahan, K & Stump, SE (2005) Krauses Food, Nutrition & Diet Therapy, 11th ed, Pennsylvania : Saunders, Elsevier. Nelms, anderson. Medical Nutrition Therapy: a case study approach. 2nd ed. 2004. Wardswoth Billon . Clinical Nutrition: Case studies. 2006. Wardswoth

Thanks for Understanding

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