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Hasil FFQ 1). Kualitattif Genis, jumah, frekuensi dan cara pengolahan) we elke S Wa cts Yess We (bts © eh. ee ates Ve feet eakans Arles © \ bas Save boos r(We (td . ” {we es Ber fone Ve [lee Uh! Sersters ME (mo Utk. Wr Le (MKeO Lee, It be (wee (hee wm be (We Ly Dern sevctors (he © edn Moe Peles . (eho mn’ We (oy @ Dew Ce Repr Decles © Lian. 2) Kuantitatif Swen Serbin Ar (us Oleds Bes tees le (hoe Segre SeQ Ae [WO ery Sesme Charnes Ue (osolsee Energi (kcal) Protein (g) Lemak (9) KH (9), Na (mg) Cairan (ml) ‘Asupan oral Woo be any N43 enteral - - 2 - Parenteral ~ . 2 z Kebutuhan | (gow 40 ce Uys Capaian (%) 90.007, SA.bo GOL AA OTR Nutrition Care Process (NCP) Instalasi Gizi RSDM\ Rate PEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI ‘. Hasil Recall 24 Jam 41) Kualitatitf (ons, jumiah, fekvensi dan cara pengolahan) Lat es — os Tee Weel, Go 9065 Oy Meer ewer Meter eeu Nets 7 Cami quer © %e Rem beter (ay, (enw aon (ty a a noe See lentes 8s, be See me sot Lay Saye Seve Ges | 2) Kuantitatif Energi | Protein(@) | Lemakig) | KHI@) Na (mg) Cairan (ml) (kcal) ‘Asupan oral oo Ey Aon Ze, enteral ~ ~ = s Parenteral ~ : = + Kebutuhan (woe oe so Wr ‘Capaian (%) 64.aor | Sek 206% BONN KesimpulAN: Wegener Vor decay Wines, Ctr carcten evens’, BUEN, onste He Rh | aot (Rei) i fedical History Pemeriksaan penunjang: nce ase TTerapi medis Tenis obat Fangsi Tnterakel dengan zat gli ~ Keworenp = Une erie’ tertann wow o. Theremin eh Gey Lenteor | Pad (excet wns Weeydrin’ eter Wack ade Nutrition Care Process (NCP) Instalasi Gizi SDM aaPEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI aX eS Ror.) Remves tein Lecce aot gen’ Conn’ dr Reuter) Weorlercben deme \wigecleteeacne 9 eraen dee Rulern ACHES Bersun Rewer YersatonLerie Qeredetes’ «ar aoe Tujuan Diet: AMrewbate Were ie diupic Genes’ Seste thos (erin Rowen 7 Weenbcrhe MemRerenanier Gert Pater ager Weep RERLTIA Gas do Terehs — Veet enngne Velannar cress Bae Yuin UW RU LER ate METRE Ge meters Aner We Syarat dan Prinsip Diet [ree Ion: vem’ Ae be lige 7 RET hen! Tor fesBe PSEMH Cat ACL gar bubs ercay Hinde ag Bucs UY Welarine arereveisearersi” qalesn Kent [Rese weet woes ts, Preskripsi Jenis Diet D Accom ene Torsa! QUE Weoolind Bentuk Makanan—: Gre, Ceew) CaraPemberian —? gay FrekuensiMakanan 4 Weve tere Lp Sebi er Perhitungan Kebutuhan zat Eres Ae Hed (hota . ere : 7 Ao Kar 2S Fo evens ~ (poetic) 2 + XS yp woo Reo teens a4 rose ° 7 tkas ASO 2 S05em FS0nte 4 a ao kan €-Cenr) > Hoe te 2 = \200-(Abe tare) = \d0- ow 2990 tance _ * hution oe Poces neP sais sow EAINSTALASI GIZI PEMERINTAH PROVINSI JAWA, TENGAH oe RSUD Dr. MOEWARDI Rerdeter Leg rhen erae due] - henter esa’ oorcap sn lees] “Ws HEP Gpert Serkrent as Rader he Merten guage Biden] OE rte anemic a cpeahccnaae = eer Geman a 2 een en Avereier es Weems yon Wa ay — eo ten Me Nees ae aa —_| Parameter Tolok Ukui rarge _ | fs ww Fas Gre ge vores | Deen” wh WALe Gus Geet _| were Gury ron l. wars [= Qe ee ee Netra or P Sseerients +L Cer Saerccerens Yee Va : atin lene Ou eH Pao, Surakarta, ..2 Pembimbing kasus harian , Nitin re Poces wer esa Ganson |PEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI TAPORAN KASUS HARIAN (NUTRITION CARE PROCESS) BIDANG ASUHAN GIZI KLINIK NAMA MAHASISWA ; CAalete Meer Deweelens’ IAI 2OW, NIM INSTITUSI 1. Identitas Pasien Nama (inisial) = (\y. ¢ | Pendidikan 3 7 Tanggal Lahir/usia: (oa ise (4 tus \ | Pekerjaan Ver | NomorRM Tg by gaa Aone ~ Tenis Kelamin = Recortvem Saka Ty 5 Ruang/kamar = Awe ‘Alamat 1 Barpoae angel ais = es /.4 oor Tanggal Masuk: 24 /oi [tery 2. Riwayat Penyakit eluhan Utama: Gt page Riwayat Penyakit Sekarang: wer Ades eed dorm (ether sesex Heres, sesen PMS vn NOMMEe SOR heen! Sumy, fore Rees eetins Seek letbanes for ewe tbat Riwayat Penyakit Dahuluy Way ode jr Ror Aen wren! Rea Welse ’Riwayat Penyakit Keluarga: (Wim Ge ‘Diagnose Meds Wad var en. Nutrition Care Process (NCP) instalasi Gizi RSDMPEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI 1. Antropometri (AD) Berat badan aktual 38 ‘9 IMT: A688 (ese) kg/m? Berat badan ideal: ac ig WAU: 6G Chendey Tinggi badan eeeeen2c cm Rentanglengan cm Tinggi lutut a cm Estimasi tinggi badan : cm LA deer we 3am Bhan roan las ers 2. Biokimia (BD) Kesimpulah! Gaceyaken aude eeteponetn sets quae Rewen nerant 1, We COAG2% femne “Parameter Hasil Nilai Normal & satuan Keterangan [ Rewestabe _ Var 120-18, (at Teel Memetsko Aa ye Auh weent ; caer st GA | Ace Wo ewofut Theor! _| \aa \O-AW abel Remi Sar | Ajo glows] Tee 20 Zro0ea/Al Mas io Zieo a(sk | rese Ae ‘Nutrition Care Process (NCP) Instalasi Gizi RSOMPEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI T Referee Ker Base Lacan, PASEO Wernetann’ cose deme 3. Klinis dan Fisik (PD) Parameter Hasil Nilai Normal & satuan ~~ Keterangan Tekanan Darah WS [oa waits Zoojes Fert Respirasi 20¥ (pent la terbenst, remel Nadi S04 (worst be Neon fvaned pron ‘Suhu yee 4b -3%VC rant, asi Pemeritsaan FRC aE Rowe Se emain .Comtosnenht um Geile rege Kesimputan: Vasven Meet ems Ae Serer weess 4, Dietary History (FH) a & HasilFFQ o> We see — 2) Kualitatitf (ens, jumlah,frekuensi dan cara pengolahsan) PRS (hee [Renters elts © Aub Coser 509 Ar (my Olghs a Pe vere bles oer Gasne Woerrs xx [ms@ eos Neen Axles © Loner Covaerers\ hom CH [ns Lets (arouers den ertene ) wrehee eerege Ge antes be (eo Lae FT Wen, Xe Dam Sees Le[MOlan Svestorn, SO Arlms @ \nwweCarqurers 2-0 trebur d. ee 7 om RPI Fl O Gan Borers more ar [ora 6 \ us — ee [Ke Veluee Cag eS Melke OS oan [Mere Se (ne ess Race Urace Ge. Rermae (x (nee (ols 2) Kuantitatif ir (nee to Energi (kcal) | Protein (g) | Lemak(g) | KHig) | Na(mg) Cairan (ml) Asupanoral | taxes “ae | cor | a a | enteral y Parenteral ~ Kebutuhan | (avo [ Capaian (%) | 5y, Wh, - ‘Nutrition Care Process (NCP) instalasi Gizi RSOMj PEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI ’b. Hasil Recall 24 Jam coe Bulac 3 cde Few be bw aide fryer gocens acer merry 260% 1) Kualitatitif Genis, jumlah, frekuensi dan cara pengolahan) — se Ge bre oem! fame Ve Wace Veh sade Sore, eal Beet (ear Arent \eon ae Crary een earns Woenel Dahm ase anes Pree Goners 2) Kuantitatif Energi | Protein (g) | Lemak (g) KHig) | Na(mg) Cairan (ml) (keal) ‘Asupan oral ceo hs om ges | enteral ~ Parenteral _ Kebutuhan we | Os avr Wee Copan Ae p ee perk | Aatet ‘| Kesimpulan: Qo gnrerer dere Sven beers, 1, Capea Gwar Ietern Rerren, eres (Ao r6te VRomre COATPY, one C2497, ore ecoamreert (48 ba ) earns Pan eovenen Lowe ary 5. Medical History Pemeriksaan penunjang: A Wore GR ® Pork Felony. Beer vey She Greasy, ven Dacor) coembeetet|pereenen Terapi medis Jenis obat Fungsi Interaksi dengan zat gizi | Brgitek (eons © Ree wagon’ ore porate Se a Oa Pomme beacns, me Berta ees fede ke. Br: Nutrition Care Process (NCP) instatasi Giai RSOM [APEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI rao OORT] Pera lato Bier de’ Seren, we A Nene en ers BLN Bree ot Wreselnr bentatnn ote on Be Comewiem aren eroen Brae ny (one Ban es ares TWA emanmin eelrtepen Te SH) (tested Gaterten Seren fara! Ronen Stereos Bbc! Berge Laawend ed (igen 38) LOL C10 a) hersint OMe KOLC A004) fee PSSA Revie en lecbuidps ereadinn eran Serax rps ev eeree! dtrn f Cater aren bea bas t Coons) Trasaerat 1. Rencana Asuhan Gizi cee Oe ynvenn “Jens adele! ae So E ee aeacrten etree WR Ree FER oe Cee pent Getin Ferem bereatne hc ere » rote ameeeven (eane Yolttel Fee behing bene o~ a Menbente Queene Seve ee ' syarat dan Prinsip Diet: Kaen atteentiin sow’ & ~ Baiere conve es [les bo b Nenew come 157, Gert FN Gets IK lecchancanh SVs gan! Sr ergs reese HUES leek Fo fess Heed Wet terns . a pene eerendurs 25 phctan delete (e988 1 Preskripsi Diet: Jenis Diet 2 Qex Tenens FLeeve Cabo Cara Pemberian gy Bentuk Makanan FrekuensiMakanan iy.Q iwi. Ub Dy eters Perhitungan Kebutuhan zat gizi: Ererar's 0 bred (lst) De RE EWN crores Lefer (rer WAS ~ to vac aw A TT : son bee s/h 9661 Wie &- Cord) «hear 2 Vso- te wave) + bp ea + We bore eee + FFE (Or bea A a Nutrition Care Process (NCP) Instalasi Gizi RSDMPEMERINTAH PROVINSI JAWA TENGAH. RSUD Dr. MOEWARDI INSTALASI GIZI Z, Rencana Konsultasi Gizi Tujuan konsultasi gizi Masalah gizi \ rede Fee bente emiente ation Syn meer Ronen Cer ne 3807. Yeerneee Vena Lene a eee eee Vecke sid Macrae Be bee Newbee Luceotr tes barter te: Wetrgerers bere, Sons Ween wena AroteReme Gate Reon Weterer gery oe een here erence | Ov bees sey (ee eS 3. Rencana Monitoring, Evaluasi dan Tindak Lanjut Parameter. Tolok Ukur Target LT AckaQutate Be) Se Prac. Vaesers bed, LL, ae WON FR Lave fee one NL 5 Rey ARS Drevens Ltivery, Tans oune: (bert ees fen tenn been tea Deve bores Hommes, Det bes ey Cages eee Cree) ease, an Bo EM auenie Dre unre’ ome 20H, Surakarta, A Fee Wd Pembimbing kasus harian ,f oS dv (002) fe Babee vac Nemes shea Memon bose oe e Yohor lease cose Ya sh Bees cee @ ] np Cee) @ @ Ses eae A Cran © wee cog Ure) € boo Nee 5c \Reegnee C \wreees cone \euar (Tete com ear Ne | fa seo¢ Yosh (Mees wo oe CE Smee org Cees) aan aa aaa cp Beene ee, | \reen Quien Cuore) Gae« Wee AD Utece bse Temte omen Cog, Co hemes acer es Keds Se Mos, iy ——PEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI . TAPORAN KASUS HARIAN (NUTRITION CARE PROCESS) BIDANG ASUHAN GIZI KLINIK NAMA maHASISWA = SASHA Cher Rewnctenn NIM _ Dusserecgus Vtere Yolleebes. Semacers INSTITUS! 3s Pasien top 7 Pendidikan Tanggal Labir/Usia= % /\ fav Ge tun) | Pekedaan t= NomorkM | otboasy ay ‘Agama nes Tenis Keema = Roceuspeen Suku een UangMKME ! Aes | Alamat (oe worse 7 - FFanggal Macuk? 36 wana | Tanagal Kass © 2.0 gwen’ 2ots 2. Riwayat Penyakit Keluhan Ulama igen ao acca celeen Kawah, ote bergen so tednens bees Riayat Penyait SearanG? Avaya Tinayat Panyaki Dahir sow Gos qv Pergdh So Riwayat Penyakit Keluarga:\ gan ove OSs crane pompalett oles Diagnosis Meds A waigaveown ‘Nutrition Care Process (NCP) instalasi Giai RDMPEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZt Posi korl 1. Antropometri (AD) LA qe, Kesimpula cores. 2. Biokimia (BD) Berat badan aktual AY kg IMT: So 5 Caer gym? Berat badan ideal AQ kg uAU : A192 eae yg Tinggi badan \se cm Rentang lengan em Tinggi tutut etc Estimasi tinggi badan cm Beccfarnren Aa eet eiemein’, Es DO PEED Metals ute tegen Glees tier em Parameter Hasil Nilai Normal & satuan Keterangan’ | Mereotann Basle Weresma) Mw em esuuatt AN Beach Perl [\eetoest | Was Age usm] Ter [Cre woot aes Leu aru, Tem! enn Aue A tons pak Tee OTe _ 82,6 6-54%e fue rerreny weet ads Ade Hoe Teel MWrede _ he) MLo = The ala re Wee Roe 26 | Cima Iscton car Process Ge om EAPEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI s INSTALASI GIZI . Weer Werden’ lente Why | 3. Kiinis dan Fisik (PD) Parameter Has Tilai Normal & satuan Keterangan Tekanan Darah Wre/go mets, ensige wus ec a “ eto (nen Soacw Respirasi rey (wen \et-7 i he ow! Nac suyleant lemee( eee © \ Suh WC ae nice beet Hasil Pemeriksaan Fisk dll: Rasicer em tee Lar, Comtemerhy, Chgen’ th! ace totes Geet One Keer cten EDEN Kesimpulan: qayien Monee Ga Jen Gr SERS 4. Dietary History (FH) ‘a. Hasil FFQ 1) Kualitatitif jenis, jumtah, frekuensi dan cara pengolahan) Tree a(he © Vets Sean sor te (be Lets Nerkes coms (y(esoibe SOF Sennen ales OLS leerscbors k2x fhy Save bey Q\aa5 S (br ovsy ter les © Uns ws & [or Ory We Gun 2a soe ks Ronen Gers Bee eve epee ee We Gwe aber Been cee) Efotby Adm blue ers, Bene eee (ef Ol bu, (ee Ares © lever A Deon Manm ke Fen med bela Oley, 7 (bie Dyers CEEREAS Ls OL Watbeeeth 2) Kuantitatit \enters Sorta tr (os @ (okt Energi (kcal) | Protein (g) | Lemak (g) KH (@) Na(mg) | Cairanim) | | Asupan oral | (55 © & Be Kr AL enteral “| - - _ Parenteral a ns ~ - an - Kebutuhn [ters go| 99 stab ‘| 2190, 70 a Capaian (%) | 4a >, BaCK eat | 826 : _ ‘Nutrition Care Process (NCP) InstalasiGizi RSDMPEMERINTAH PROVINSI JAWA TENGAH. RSUD Dr. MOEWARDI INSTALASI GIZI ’b. Hasil Recall 24 Jam 1) Kualitatitif (lenis, jumlah, frekuensi dan cara pengolahan) Sucde Ge felanre Or ce 2) Kuantitatif Energi | Protein (g) | Lemak (g) KH(g) Na (mg) | (kcal) ‘Asupan oral ~ enteral [tena | AD 3H. \sa,t - Parenteral [ | - Kebutuhan [aang ab 95 che AO4ae Capaian (%) vot] A Qegn] lqe | atl Kesimpulan: tg ebsee Kem Avtany Wettig ¢ TeCagertn GLE erers RUD, em okt Zour, 5. Medical History Pemeriksaan penunjang: Wan as eerenvira Rerurnce Terapi medis Jenis obat Fungsi Interaksi dengan zat gizi_ b Onan Sentoon ~ MERON Fuersurers Une) Mor han (dee ede ‘Nutrition Care Process (NCP) Instalasi Gizi RSDMPEMERINTAH PROVINSI JAWA TENGAH RSUD Dr. MOEWARDI INSTALASI GIZI : RES oKaral BAN 2 Dhar entered OM ade face Weekes ber Strain Berton Getbetime Ie PBL gerie Th ERNE He enernt S867 Cemors’ se pate) bake ln degen Oefethhnibe ~ begers ares: BS Repent lepine teres Regge) tee ote et oer TAME Been were © pe nea! dorsen ee eee re eee cee ee Tujuan Diet Lincterh Weninte ite etcece retnegetns’ (eben SL yesion > Menesce ken WE Seluran Cecne IF Mererenen O See eerne ace us (no FP ecniacint a ee ben’ Movs Ree DEN ET ReMe Rene teeedBerser Fauclenne tetren Syarat dan Prinsip Diet: RARE ERS Cawenotel Eremy Stans bemuertnn IAT, Ae beton + Werbener mete CACT F Beate se Gea ve feo! b Neue Care act, ater F knebanina sete AY Si er eras Ape areegcrn, GE UES Lac vows teases Sbugen eee eek (nh bad eres Teueurneet gate Soe henrlt. | Preskripsi Diet: Jenis Diet Pras eae) eta’ gelesen Bentuk Makanan —: Cece (sende CaraPemberian = Gxey Frekuensi Makanan : Gy torent Perhitungan Kebutuhan zat gizi: \ Frage beth (o.6eem ) aorta \ - Art eo oon aber & Coonan) be peer \= CATY 207 cn) roerk MO 444s, ~44, cee + (4092 - 94 sey ene weeren : 1 CTe lola ener" a 2 Uf igor 2 (oo LOA. Ae Tees taeren ies + SO64F se hrt SARE wey —e e ~ TOO ackel alas €- Caen) Cage bebe | pear ee — get ae + Od ce Lise goer 2 - 5 Aton Cre roces (Py mata Gil RSDPEMERINTAH PROVINSI JAWA TENGAH. RSUD Dr. MOEWARDI INSTALASI GIZI Rencana Konsultasi Masalah gizi = Asem entent brew asoleat fe Renveslansn Lebrngers } Neca her Were e Tujuan konsultasi gi — Werke Qeenbie Nene QeTe PF Stehnghe Wheres (nercose Mitten Serie Alen HS eae Serge oon Wrerertiere bored bed Hehe tue ee wersenen: Nur eres Materi konsultasi gizi Rew, hese, Fyeeet | Ee Brent ae o Neda elaeen onten! Ter ors beeen TAREE Ren boven Ontent ~ Con Nenoebin tan Mem bento neverce ante 3. Rencana Monitoring, Evaluasi dar nTindak Lanjut Parameter Tolok Ukur Target “ARO Regn. ~ ee Tee Oe [ng . sper pero eaves’ oe n — Sed, aoa Leben Leeluhin derge) | Dee em ayer Recedt\ TH RW fo Coen Shee Her DELI OM Boren! Is deen mace ven Surakarta, . fern to Pembimbing kasus harian , Dt Nutrition Care Process (NCP) Instalasi Gizi RSDMfeo Ge Ute eee ec Rembenie , \ekn ese 3 Sonde / FW Sere inge a \y Rerschet en Mca ¥ Fondo YS Gu 6 Fevers Sun Mere Cos. ) Se tere, Meee Ch ban Kets boas, \sse Ce y gue) 7... yer CY tae O: Fete Ce ay) ee Vee) GA) ‘ee acs ae \ Mayen + coe O BK ue. ¢ CO ore Gerxooce catleewer (Se cic 1 CF De Welew Remberers weer Rar’ 3 corde @ Trev Sere > Sonde. an be Rergctemrin rex 3 sordo fees aeoe (Gen aa\ ya Ce Sterne Agr CAg5ds © Tern, Vers, Ayre Caacin \ Ter ce @ a (gue) Toe. sg xe (CK Ge) Weel: Se se & Va) @ Wers a Lar ce a on) @ Dae Eriy ra asthe.ce Weelouck> A Relows Lele he ecel Gore LG, Coste % Combe Se Pe a Were See le Sala lolenda loserte 6. Bren der somge Oe mn he 5 @ ™ tess Meeacach toe wetery ( sees. © Fe Swen col * neko eee oe Oe ee ee oe Ran ee Reesceren, Fadurrd Renberen @ ed enters C08 o-00 0 \G- 08 © ave q.08 @ @