PA
PANDUAN PRAKTIK KLINIS
NDUAN PRAKTIK KLINIS (PPK)
(PPK)
TATA LAKSANA KASUS
TATA LAKSANA KASUS
RSUD BALARAJA
RSUD BALARAJA
MALNUTRISI ENERGI PROTEIN (ICD 10: ………..)
MALNUTRISI ENERGI PROTEIN (ICD 10: ………..)
1.
1. PPenenggerertt!!n n (D(De"e"nn##)) PPenen$$!!%%t t !t!t!!& & %%ee!'!'!!!!n n %%nn# # $$!n!ng g ''!%!%!!tt%%!n !n tt''!% !% teter*r*eenn&+&+n$n$!! %e&t&+!n *r,ten '!n energ$ %!ren! !#&*!n $!ng %&r!ng !t!& %e&t&+!n *r,ten '!n energ$ %!ren! !#&*!n $!ng %&r!ng !t!& %e&t&+!n-%e&!r!n $!ng enng%!t !t!& %e'&!n$! #e/!r! %e&t&+!n-%e&!r!n $!ng enng%!t !t!& %e'&!n$! #e/!r! er#!!.
er#!!. .. AAnn!!nnee####
Pert&&+!n %&r!ngPert&&+!n %&r!ng
An!% %&r&# An!% %&r&#
An!% t'!% An!% t'!% !& !%!n!& !%!n
Serng en'ert! #!%t er&!ngSerng en'ert! #!%t er&!ng
T& eng%!% *!'! %e'&! %!% #!*! #e&r&+ t&&+T& eng%!% *!'! %e'&! %!% #!*! #e&r&+ t&&+
3.
3. Peer%#!!n #%Peer%#!!n #% Tent&%!n &%&r!n !ntr,*,etr !n!% &nt&% en! #t!t&#Tent&%!n &%&r!n !ntr,*,etr !n!% &nt&% en! #t!t&#
g2 g2
A*!%!+ !n! A*!%!+ !n!% t!*!% #!ng% t!*!% #!ng!t %&r !'!t %&r !'! e'e! *!'! e'e! *!'!!
%e'&! *&ngg&ng %!% %e'&! *&ngg&ng %!%
T!n'! 'e+'r!# : t!*!% +! !t! /e%&ng3 t&rg,r &r&%T!n'! 'e+'r!# : t!*!% +! !t! /e%&ng3 t&rg,r &r&%
( +!t4+!t enent&%!n #t!t&# 'e+'r!# *!'! !n!% g2 ( +!t4+!t enent&%!n #t!t&# 'e+'r!# *!'! !n!% g2 &r&% )
&r&% )
A'!%!+ t!n' A'!%!+ t!n'! #$,% : t!! #$,% : t!ng!n 'ngnng!n 'ngn3 CRT !3 CRT !!t3 n!'!t3 n!'
e!+ '!n /e*!t3 %e#!'!r!n en&r&n ) e!+ '!n /e*!t3 %e#!'!r!n en&r&n )
De! #&+& 5 6738 'er!9!t /e/&# !t!& +*,ter #&+& De! #&+& 5 6738 'er!9!t /e/&# !t!& +*,ter #&+&
6838 'er!9!t /e/&# 6838 'er!9!t /e/&#
re%&en# '!n t*e *ern!"!#!n : !'!n$! *ne&,n! !t!&re%&en# '!n t*e *ern!"!#!n : !'!n$! *ne&,n! !t!&
g!g! 9!nt&ng g!g! 9!nt&ng
P&/!tP&/!t
Pee#!r!n +!t '!n %ter&#Pee#!r!n +!t '!n %ter&#
A'!%!+ *er& A'!%!+ *er&t %e&ng3 #t %e&ng3 #ng &#&# eeng &#&# ee!+-enngg3!+-enngg3
t!n'! !#/te# t!n'! !#/te#
T!n'! 'e"#en# ;t!n A *!'! !t! : %,n9≯! !t!&T!n'! 'e"#en# ;t!n A *!'! !t! : %,n9≯! !t!&
%,rne! $!ng %erng3 er/!% t,t3 &%&# %,rne! '!n %,rne! $!ng %erng3 er/!% t,t3 &%&# %,rne! '!n %er!t,!!#!
%er!t,!!#!
U%&# *!'! &&tU%&# *!'! &&t
,%&# n"e%# *!'! teng!3 tengg,r,%!n3 *!r& '!n %&t,%&# n"e%# *!'! teng!3 tengg,r,%!n3 *!r& '!n %&t
Le# %&t *!'! %<!#+,r%,r : +*, Le# %&t *!'! %<!#+,r%,r : +*, !t!& +*er*gent!#!t!& +*er*gent!#33
'e#%&!!#3 &#er!# *!'! %!%3 *!+!3 gent!3 *!t!n *!+! 'e#%&!!#3 &#er!# *!'! %!%3 *!+!3 gent!3 *!t!n *!+! '!n e!%!ng teng!3 e# e%#&'!t" #erng%! 'eng!n '!n e!%!ng teng!3 e# e%#&'!t" #erng%! 'eng!n n"e%# #e%&n'er
n"e%# #e%&n'er
T!n'! '!n ge9!! =I>
?. Krter! D!gn,## MEP er!t t*e %<!#+,r%,r
E'e! &&n$! #e&r&+ t&&+ '!n ter&t!! *!'! %!%
( ',r#& *e'# )
R!&t t*#3 %eer!+!n #e*ert <!rn! r!&t 9!g&ng3
&'!+ '/!&t t!n*! r!#! #!%t3 r,nt,%
Per&!+!n #t!t&# ent! #!*! !*!t# Ane!
Pee#!r!n +!t Atr," ,t,t
Ke!n!n %&t er&*! er/!% er!+ &'! $!ng e&!# '!n
er&!+ <!rn! en9!' /,%!t %e+t!!n '!n ter%e&*!# ( /r!2$ *!;e.ent 'er.!t,## )
Serng '#ert! n"e%#3 !ne! '!n '!re
MEP er!t t*e !r!#&# :
T!*!% #!ng!t %&r&# +ngg! t&!ng ter&ng%&# %&t @!9!+ #e*ert ,r!ng t&!
Cengeng3 re<e
K&t %er*&t3 9!rng!n e!% #&%&t# #!ng!t #e'%t #!*!
t'!% !'!
Per&t /e%&ng
Serng '#ert! *en$!%t %r,n%3 '!re %r,n% Atr," ,t,t
MEP !r!#%4%<!#+,r%,r :
Ter'!*!t t!n'! '!n ge9!! %n# !r!#&# '!n
%<!#+,r%,r #e/!r! er#!!!n K!#"%!# @=O &nt&% !n&tr#:
!). M!n&tr# #e'!ng 4 T'!% !'! e'e! 4 BB-TB 46SD #!*! SD (7040) 4 TB-U SD (84) ). M!n&tr# er!t 4 Ter'!*!t e'e! 4 BB-TB 46SD #e;ere <!#tng (70) 4 TB-U 46SD #e;ere #t&ntng (8)
5. D!gn,##
M!n&tr# energ *r,ten . D!gn,## B!n'ng
7. Peer%#!!n Pen&n9!ng Peer%#!!n '!r!+ *er"er eng%!*3 !9& en'!* '!r!+
Ee%tr,t: N!3 K3 CL G&! '!r!+ #e<!%t& &ng# +!t
Urn eng%!* e#e# eng%!*
Peer%#!!n !n #e#&! n'%!#
8. T!t!!%#!n! Ter'r '!r 6 "!#e:
1. !#e n#! (re#&#t!#)
At!# +*,ter!3 +*,g%e!3 '!n 'e+'r!# . !#e tr!n##
6. !#e re+!t!# T!t!!%#!n! e'# :
1) At!# '!n /eg!+ +*,g%e!
Per%#! %!'!r g&! '!r!+
Ber%!n !%!n!n $!ng e+ #erng
B! GDS 80 g-'L ,&# 80 g&%,#! 10 !t!&
!r&t!n #&%r,#! 10 ( 1 #'t g&! '!! 8 #' !r ) er%!n #e/!r! ,r! !t!& NGT
Ber%!n #et!* 60 ent #e!! 9! ( er%!n
!g!n )
) At!# '!n /eg!+ +*,ter!
Ber !%!n!n /!r-",r&! %+&#&# ( &! 'eng!n
re+'r!# ! *er& )
=!ng!t%!n !n!% 'eng!n *!%!!n !t!& #e&t #!*!
en&t&* %e*!!3 et!%%!n 'e%!t !*& !t!& *e!n!# ( 9!ng!n g&n!%!n ,t, !r *!n!# ) !t!& *e&% !n!%
''!'! & '!n '#e&t 6) At!# '!n /eg!+ 'e+'r!#
J!ng!n engg&n!%!n 9!&r I> &nt&% re+'r!# %e/&!
%e!'!!n #$,% %!ren! !+!$! e!n #r%&!# '!*!t ert!!+ er!t
G&n!%!n !r&t!n g!r! %+&#&# ( re#,! : re+$'r!t,n
#,&t,n ",r !n&trt,n ) 'eng!n /!r! :
) C!r!n re#,!-*engg!nt #e!n$!% 8 -%gBB #et!* 60 ent #e!! 9! #e/!r! ,r! !t!& NGT
) Se!n9&tn$! er 8410 -%gBB-9! #e!! ?410 9! er%&tn$!
) G!nt re#,!-*engg!nt *!'! 9! %e4 '!n %e410 'eng!n ",r&! %+&#&# #e9&!+ $!ng #!!3 ! %e!'!!n #t!
;) Se!n9&tn$! &! er ",r&! %+&#&# ?) K,re%# g!ngg&!n %e#e!ng!n ee%tr,t
P!'! #e&! MEP er!t ter9!' %ee+!n n!tr&
<!!&*&n %!'!r N! *!#! ren'!+
De"#en# %!& 'er%!n K 4? EF-%gBB-+!r De"#en# Mg 'er%!n 036403 EF-%gBB-+!r S!*%!n !%!n!n t!n*! 'er g!r!
T!!+!n K '!n Mg '!*!t '#!*%!n '!! ent&%
/!r!n '!n 't!!+%!n !ng#&ng *!'! !%!n!n 8) O!t '!n /eg!+ n"e%#
Der%!n *!'! #e&! !n!% 'eng!n g2 &r&% :
>!%#n /!*!% 9%! !n!% 5 &!n '!n e&
&n#!# !t!& 9%! 5 &!n '!n #&'!+ *ern!+ &n#!# #ee& &!n3 t&n'! 9%! !n!% #$,%
Ant,t% #*e%tr& &!#
) J%! t'!% !'! %,*%!# !t!& t'!% !'! n"e%# n$!t! er %,tr,%#!2,e ,r! 8 g SMH 8 g TMP-%gBB #et!* 1 9! #e!! 8 +!r
) J%! !'! %,*%!# !t!& 9e!# !'! n"e%# er%!n (1) A*#n 80g-%gBB IM-I> #et!* 9! #e!!
+!r3 '!n9&t%!n 'eng!n !,%##n ,r!
18g-%gBB #et!* 9! #e!! 8 +!r. J%! t'!% ter#e'! er !*##n ,r! 80 g-%gBB #et!* 9! #e!! t,t! 7 +!r
() Dt!!+ 'eng!n gent!#n 738 g-%gBB-+!r IM-I> #e!! 7 +!r3 ! !n&r!-,g&r! 't&n'! &nt&% en/eg!+ e"e% t,%## gent!#n
(6) J%! !n!% t'!% e!% '!! ? 9! t!!+%!n %,r!"en%, 8g-%gBB IM-I> #et!* 9!
#e!! 8 +!r3 !t!& ! ''&g! enngt# ',## %,r!"en%, 8g-%gBB IM-I> #et!* 9! #e!! 10 +!r
(?) J%! ter'!*!t /!/ng er een'!2, 100g-%gBB #e!! 6 +!r !t!& !en'!2, 0g-%gBB ',## t&ngg!. Ber een'!2, #ete!+ 7 +!r *er!<!t!n <!!&*&n e& tern'%!# !'!n$! n"e%# /!/ng ) K,re%# 'e"#en# n&tren %r,
T!!+%!n &t;t!n
A#! ",!t 1 g-+!r ( 8 g +!r *ert!! ) Seng ( n ) g-%gBB-+!r
Te!g! ( C& ) 03 g-%gBB-+!r
B! BB &! n!% : e 6 g-%gBB-+!r !t!& #&"!#
"er,#&# 10 g-%gBB-+!r
>t!n A ,r! *!'! +!r 13 '!n 1?
) U&r 5 1 t!+&n 00.000 SI ) U&r 41 &!n 100.000 SI ) U&r 048 &!n 80.000 SI
B! !'! &#er!# *!'! !t!3 er t!!+!n *er!<!t!n !t! &nt&% en/eg!+*r,!*# en#! :
(1) Ber %,r!"en%, !t!& tetr!#%n tete# !t! #et!* 46 9! #e!! 7410 +!r
() Tete#%!n !tr,"n tete# !t! 6 %! 1 tete# #e+!r #e!! 648 +!r
(6) T&t&* !t! 'eng!n %!#! $!ng '!#!+ !r&t!n g!r! "!!
7) M&! *eer!n !%!n!n
Per& *en'e%!t!n $!ng +!t4+!t %!ren! "&ng# "!!
!n!% e!+ '!n +,e,#t!t% er%&r!ng
) P,r# %e/3 #erng3 ren'!+ #er!t '!n !%t,#! ) Or! !t!& NGT ( 9!ng!n &! 'eng!n *!renter! ) ) Energ 04100 %%!-%gBB-+!r
;) Pr,ten 14138 g-%gBB-+!r
;) C!r!n 160 -%gBB-+!r ( 100 -%gBB ! !'! e'e! er!t ) er&*! 78 t!* 9!. B! *er& engg&n!%!n #,n'e.
;) ASI ter&#%!n3 tet!* er ",r&! %+&#&# e+ '&& ;) ,r&! %+&#&# '!*!t 'er%!n 'eng!n /!ng%r-ge!#3
! !#+ e!+ '!*!t 'eng!n #en',%-**et ;) J!'<! $!ng '!n9&r%!n :
(1) =!r %e 14 #et!* 9!3 138 #'3 160 -%gBB-+!r
() =!r %e 648 #et!* 6 9!3 #'3 160 -%gBB-+!r (6) =!r %e 47 #et!* ? 9!3 6 #'3 160 -%gBB-+!r ) P!'! !n!% 'eng!n #eer! !%!n !% '!n t'!% e'e
9!'<! '!*!t '#ee#!%!n '!! 46 +!r #!9! ) B! !#&*!n !%!n!n 0 %%!-%gBB-+!r er%!n ##! ",r&! e!& NGT ) J!ng!n er !%!n e+ '!r 100%%!-%gBB-+!r *!'! "!#e #t!#!# n ) !#t!# t&&+ %e9!r
P!'! *er,'e tr!n## '!n9&r%!n &nt&% er&!+ #e/!r! *er!+!n4!+!n '!r ",r&! %+&#&# !<! %e ",r&! %+&#&# !n9&t!n.
G!nt ",r&! %+&#&# !<! 'eng!n ",r&! %+&#&#
!n9&t!n '!! ? 9!
N!%!n 10 #et!* %!3 #!*! !'! #e'%t ",r&!
$!ng ter##!
B! "re%&en# n!"!# 58-ent '!n 'en$&t n!'
58-ent %&r!ng ;,&e *eer!n ",r&!3 #ete!+ n,r! %e! &!ng en!%!n ;,&e #e*ert '!t!#
Sete!+ *er'e tr!n## tere<!t3 !n!% 'er :
) M!%!n!n-",r&! 'eng!n 9&!+ t'!% ter!t!# '!n #erng
) Energ 18040 %%!-%gBB-+!r ) Pr,ten ?4 g-%gBB-+!r
;) B! !#+ en'!*!t ASI 'ter&#%!n3 tet!* er ",r&! e+ '&& %!ren! t'!% !%!n en/&%&* &nt&% t&&+ %e9!r
;) T!ng !n!% #et!* *!g #ee& !%!n ;) =t&ng %en!%!n BB #et!* ngg&
) Se'!%!n #t&!# #en#,r% '!n '&%&ng!n e,#-ent! P!'! KEP er!t ter9!' %eter!!t!n *er%e!ng!n ent! '!n *er!%&3 !%! er%!n :
K!#+ #!$!ng
Lng%&ng!n $!ng /er!
Ter!* er!n ter#tr&%t&r #e!! 18460 ent-+!r A%t;t!# "#% #eger! #ete!+ #e&+
er!n '# )
10) S!*%!n ",,< &* #ete!+ #e&+
B! BB !n!% #&'!+ en/!*! 0 BB-U3 '!*!t '*!#t%!n !n!% #&'!+ #e&+3 *,! *eer!n !%!n '!n #t&!# +!r&# tet!* '!n9&t%!n 'r&!+.
T&n9&%!n %e*!'! ,r!ng t&! :
Peer!n !%!n!n $!ng #erng '!n %!n'&ng!n
energ '!n n&tren $!ng *!'!t
Ter!* er!n ter#tr&%t&r
S!r!n%!n :
Me!<! !n!%n$! %e! &nt&% %,ntr, ter!t&r Peer!n #&nt%!n-&n#!# ( ,,#ter )
Peer!n ;t!n A #et!* &!n
Tn'!%!n *!'! %eg!<!t!n : 1) S$,%
S&t ee'!%!n 'e+'r!# !t!& #e*##3 #$,% %!ren! 'e+'r!# !%!n e!% 'eng!n /e*!t *!'! *eer!n /!r!n I>.
Pe',!n *eer!n /!r!n :
!) Ber%!n 18 -%gBB '!! 1 9! *ert!! /!r!n 'etr,#e 8:N!C 03 1:1 !t!& !r&t!n rnger 'eng!n 'etr,#e 8 1:13 e;!&!# #ete!+ 1 9!
) U!ng *eer!n /!r!n #e*ert '!t!#3 %e&'!n !n9&t%!n 'eng!n /!r!n *er,r! !t!& n!#,g!#tr% 10 -%gBB-9! #!*! 10 9!
/) Se!n9&tn$! er ",r&! %+&#&#
') A*!! t'!% !'! *er!%!n %n# !ngg!* !n!% en'ert! #e*##. Ber%!n /!r!n ?-%gBB-9!
) Ane! er!t
!) Tr!n#"&# '!r!+ '*er&%!n ! =B ? !t!& ! !'! '#tre## n!"!# 'er%!n tr!n#"&# *!'! =B ?4 ) Ber tr!n#"&# '!r!+ #eg!r 10-%gBB '!! 6 9!
/) B! !'! g!g! 9!nt&ng g&n!%!n PRC 'eng!n ',## $!ng #!! '!n er%!n "&r,#e' 1 -%gBB *!'! #!!t tr!n#"&# '&!
') B! !n!% 'eng!n '#tre# *ern!"!#!n #ete!+ tr!n#"&# =B ? g-'L !t!& !nt!r! ?4 g-'L3 9!ng!n &!ng *eer!n '!r!+ . E'&%!#
(=,#*t! =e!t+ Pr,.,t,n)
Pen$&&+!n tent!ng g2 #e!ng Per!%& +'&* er#+ '!n #e+!t
Pen9e!#!n '!gn,#!3 '!gn,#! !n'ng3 *eer%#!!n
*en&n9!ng
Pen9e!#!n ren/!n! *eng,!t!n3 !! *eng,!t!n3 re#%,
'!n %,*%!#
Pen9e!#!n !tern!t;e *eng,!t!n Pen9e!#!n *er%r!!n !! r!<!t In",r /,n#ent
10. Pr,gn,## A' ;t! : '&! A' #!n!t,n! : '&! A' "&ng#,n! : '&! 11. Tng%!t E;'en#
1. Tng%!t Re%,en'!#
13. Pene!!+ Krt# 1. SM Pen$!%t An!%
. 6.
14. In'%!t,r Me'# Kn# '!n !,r!t,## *!#en e!%
Keg!<!'!r&r!t!n #&'!+ ter!t!#
18. Ke*&#t!%!!n 1. Ne#,n3 Tet B,,% ," Pe'!tr/
. P!n'&!n Pr!%t% Kn# I%!t!n D,%ter An!% In',ne#!3 J' 3 01
6. De*!rteen Ke#e+!t!n Re*&% In',ne#!. Pet&n9&% te%n# t!t! !%#!n! !n!% g2 &r&%: &%& II.
J!%!rt!:De*!rteen Ke#e+!t!n006.
?. @=O. M!n!geent ," #e;ere !n&trt,n: ! !n&! ",r *+$#/!n# !n' ,t+er #en,r +e!t+9 <,r%er#. Gene;!:@,r' =e!t+ Org!n2!t,n 1.