DISCHARGED PLANNING

Nama

: Sarkawi

Umur

: 72 tahun

Jenis kelamin : laki-laki

Berat Badan

: 38 Kg

Tinggi Badan
BMI

: 150 cm

: 16,8 Kg (underweight)

Diagnosis
: Limfoma Malignum Non
Hodgkin
Extra nodul et regio
Orbita Dextra

Geriatri Comphrehensif Assesment

Penapisan Depresi : 3 (normal )
MMSE

: 25 (Ringan)

ADL Barthel

: 16 ( ketergantungan ringan)

Uji Mental Singkat : 9 (Normal)

MNA

: 12 (malnutrisi)

Post
Kemoterapi
Hari 1

Jam
07.00
WIB

Jenis
Formula
Bubur
palito

komposisi kalori
Tepung
beras ( 50
g)
Gula aren
(30 g)
Santan

180,5 kcal

110,7 kcal

28,4 kcal

(40 g)
10.00
WIB

Susu

Tepung
susu (25 g)

116 kcal

Gula pasir
(20g)

77,4 kcal

13.00
WIB

Bubur
Palito

Tepung
beras (50
g)
Gula aren
(30 g)
Santan

180,5 kcal

110,7 kcal

28,4 kcal

(40g)
16.00
WIB

Susu

Tepung
susu (25 g)

116 kcal

Gula pasir

77,4 kcal

(20 g)
19.00
WIB

Bubur
Palito

Tepung
beras (50

180,5 kcal

g)
Gula aren
(30g)

110,7 kcal

Santan

28,4 kcal

(40g)
22.00
WIB

Total

Susu

Tepung
susu (25g)

116 kcal

Gula pasir
(20g)

77,4 kcal
1539 kcal

Post
Kemoterapi

Jam

Jenis
Formula

komposisi

kalori

Hari ke 2

07.00 WIB

Bubur
palito

Tepung
beras (50g)

180,5 kcal

Gula aren
(30g)

110,7 kcal

Santan
(40g)
10.00 WIB

Susu

Tepung
susu (25g)
Gula pasir

28,4 kcal
116 kcal

13.00 WIB

Bubur
Palito

(20g)

77,4 kcal

Tepung
beras (50g)

180,5 kcal

Gula aren
(30g)

110,7 kcal

Santan
(40g)
16.00 WIB

19.00 WIB

Susu

Bubur
Palito

28,4 kcal

Tepung
susu (25 g)

116 kcal

Gula pasir
(20g)

77,4 kcal

Tepung
beras (50g)

180,5 kcal

Gula aren
(30g)

110,7 kcal

Santan

28,4 kcal

(40g)
22.00 WIB

Total

Susu

Tepung
susu (25g)

116 kcal

Gula pasir
(20g)

77,4 kcal
1539 kcal

Post
Kemoterapi

Jam

Jenis
Formula

komposisi

kalori

Hari Ke 3

07.00 WIB

Bubur
palito

Tepung
beras (50g)

180,5 kcal

Gula aren
(30g)

110,7 kcal

Santan
(40g)
10.00 WIB

Susu

28,4 kcal

Tepung
susu (25g)

116 kcal

Gula pasir

77,4 kcal

(20g)
13.00 WIB

Bubur

Tepung

180,5 kcal

Palito

beras (50
g)
Gula aren
(30g)
Santan

110,7 kcal

28,4 kcal

(40g)
16.00 WIB

19.00 WIB

Susu

Bubur
Palito

Tepung
susu (25g)

116 kcal

Gula pasir
(20g)

77,4 kcal

Tepung
beras (50g)

180,5 kcal

Gula aren

110,7 kcal

(30g)
Santan

28,4 kcal

(40g)
22.00 WIB

Susu

Tepung
susu (25g)

116 kcal

Gula pasir
(20g)

77,4 kcal

Total

Post
Kemoterapi

1539 kcal

Jam

Jenis
Formu

komposisi

kalori

la
Hari ke 4

07.00
WIB

Nasi
Tim
Saring

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam
wortel (50g)
Minyak kelapa
sawit

94,13 kcal

43,1 kcal

(5 g)
10.00
WIB

Susu

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal

13.00
WIB

Nasi
Tim
Saring

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam
wortel (50g)
Minyak kelapa
sawit

94,13 kcal

43,1 kcal

(5g)
16.00
WIB

Susu

19.00
WIB

Nasi
Tim

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal

Beras putih giling

(50g)

180,5 kcal

Saring

Daging sapi (35g)

94,13 kcal

Tahu (55g)

41,8 kcal

Sayur bayam
wortel (50g)

9,5 kcal

Minyak kelapa
sawit

43,1 kcal

(5g)
22.00
WIB
Total

Susu

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal
1687,3
kcal

Post
kemoter
api

Jam

Jenis
Formula

komposisi

kalori

Hari ke 5

07.00
WIB

Nasi Tim
Saring

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam
wortel (50g)
Minyak kelapa
sawit

94,13 kcal

43,1 kcal

(5g)
10.00

Susu

Tepung susu (25g)

116 kcal

WIB
13.00
WIB

Nasi Tim
Saring

Gula pasir (20g)

77,4 kcal

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam
wortel (50g)
Minyak kelapa
sawit (5g)
16.00
WIB

Susu

19.00
WIB

Nasi Tim
Saring

94,13 kcal

43,1 kcal

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal

Beras putih giling

(50g)

180,5 kcal

22.00
WIB
Total

Susu

Daging sapi (35g)

94,13 kcal

Tahu (55g)

41,8 kcal

Sayur bayam
wortel (50g)

9,5 kcal

Minyak kelapa
sawit (5g)

43,1 kcal

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal
1687,3
kcal

Post
Kemoter
api

Jam

Jenis
Formula

komposisi

kalori

Hari ke 6

07.00
WIB

Nasi Tim
Saring

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam

94,13 kcal

wortel (50g)

43,1 kcal

Minyak kelapa
sawit (5g)
10.00
WIB

Susu

13.00
WIB

Nasi Tim
Saring

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam
wortel (50g)
Minyak kelapa
sawit (5g)

94,13 kcal

43,1 kcal

16.00
WIB

Susu

19.00
WIB

Nasi Tim
Saring

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal

Beras putih giling

(50g)

180,5 kcal

Daging sapi (35g)

41,8 kcal

Tahu (55g)

9,5 kcal

Sayur bayam
wortel (50g)
Minyak kelapa
sawit (5g)
22.00
WIB

Susu

94,13 kcal

43,1 kcal

Tepung susu (25g)

116 kcal

Gula pasir (20g)

77,4 kcal

HASIL PERHITUNGAN
========================================================
=============

Total
hasil analisis

Zat Gizi

nilai

nilai/hari

rekomendasi

persentase

pemenuhan

______________________________________________________________________________
energy

1687.3 kcal

water

0.0 g

protein
fat

1900.0 kcal

2700.0 g

67.3 g(16%)

57.1 g(30%)

carbohydr.

48.0 g(12 %)
77.0 g(< 30 %)

5.4 g

alcohol

0.0 g -

PUFA

6.3 g

cholesterol

0%

227.2 g(54%)

dietary fiber

89 %

30.0 g

10.0 g
-

74 %

351.0 g(> 55 %)

97.5 mg

140 %

63 %
-

18 %

65 %

1687,3
kcal

HASIL PERHITUNGAN
=====================================================================
Zat Gizi

hasil analisis

nilai

nilai/hari

rekomendasi

persentase

pemenuhan

______________________________________________________________________________
energy

1539.0 kcal

water

0.0 g

protein
fat

1900.0 kcal

2700.0 g

27.6 g(7%)

3.4 g

alcohol

0.0 g -

PUFA

0.9 g

Vit. A
carotene

58 %

77.0 g(< 30 %)

306.3 g(80%)

dietary fiber

cholesterol

0%

48.0 g(12 %)

23.2 g(13%)

carbohydr.

81 %

351.0 g(> 55 %)
30.0 g

11 %

10.0 g

18.8 mg

315.0 g
0.0 mg -

9%
-

800.0 g
-

30 %

39 %

87 %