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Dampak Biofilm (Makalah)
Dampak Biofilm (Makalah)
Dampak Biofilm (Makalah)
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Klinik yang unggul di Indonesia dan di kawasan Asia
VISI
Pasifik pada tahun 2019
dr. Murni
dr. Benedicta Afianti Indrastuti
dr. Lista Andriyati *
dr,. Fatmawati Nur Husain
dr. Iman Prawira Saputra
dr. Dina Noerlaila Hadju
dr. Indrawaty Alimuddin
dr. Ni Luh Eka Suprapti
dr. Urfa
PATIENT IDENTITY
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No. MR : 841780
Room : The front top of 2nd Lontara, 10th Room Bed 4
Name : Mrs. H
Age : 60 years old
Gender : Woman
Date of Admission : March 23rd , 2019
Date of Consul : March 28th , 2019
Medical Diagnosis :
AN INTRA-ABDOMINAL MASS DUE TO PANCREATIC TAIL TUMOR
PATIENT’S PHOTO
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SUBJECTIVE
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Medical History
No history of Hypertension and diabetic
A lump in the stomach has appeared since a year ago
Therapy’s Histories
2 weeks ago, got diagnosed intraabdominal tumor in the surgery polyvclinic
at Awal Bross Hospital
5 days ago, the patient hospitalized in RSWS until today waiting for operation
schedule.
SUBJECTIVE
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Psychosocial History
• Patient is a housewife
• Passive smoking from her husband for > 20 years, 5 stick – a pack /day
• Non alcoholism
SUBJECTIVE
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Food History
Healthy, She ate 1 – 1 ½ portion of rice, veggies and fruits 3 times a day. Fish
cooked with coconut milk dominantly. She also liked fries 3 – 4 times a week.
2 months ago, there was descreasing in ½ portion of rice.
2 weeks ago, she only ate 2 – 3 spoons rice, a few side dish and veggies.
2 days ago, only 1 -2 spoons porridge with fruit and veggies in a day.
There are no restriction and no allergic for food and milk.
OBJECTIVE
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General Condition: Moderate pain, GCS 15
(E4V5M6)
• Energy : 70 kcal
24 hours • Carbohydrate : 1.6 gr
• Protein : 16 gr
Food Recall • Fat : 0 gr
E Abdomen
X
A • Distended
M • Normal peristaltic
I • The hepar palpates 3 fingers under the arcus costae.
N • Tumor mass in the right hypochondrium
A
T Extremities
I
O • There is wasting, no edema
N
LABORATORY
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Type of Test Februari 25th 2019 Normal
Hb 11.2 12.0 – 16.0 g/dl
WBC 11.890 4.0 – 10.0 x 10³/µL
TLC 735.9 2 – 4 x 10³/µL
PLT 498,000 150 – 400 x10³/µL
MCV 82 80 – 100 µM³
PT 10,5 10 – 14 seconds
INR 1.01 --
PNI 41.67 50
SUPPORTING EXAMINATION
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MRI Chorangiopancreatography (without contras), February 25th,
2019
No result at all.
Thorax X-ray, February 25th, 2019
There are no signs of metastasis in the thorax photo
Cardiomegaly
MSCT Whole Abdomen, May 3rd 2018
Massa Cauda pancreas
Hepatomegaly accompanied Hypodens multiple lesions on hepar
Cholelithiasis
THERAPY OF COLLEAGUES
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Metabolic Status
(February 25th , 2019)
- Normocytic Normochrome Anemia (11.2)
- Leukocytosis (11,890)
- Thrombocytosis (498,000)
- Hypoalbuminemia (3.3)
- PNI 41.67
Medical Diagnosis :
AN INTRA – ABDOMINAL MASS DUE TO PANCREATIC TAIL TUMOR
PLANNING
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Basal Energy Expenditure : 1,023.3 kcal
Total Energy Expenditure : 1,600 kcal (Af : 1.2/Sf : 1.3)
Macronutrient composition :
• Protein 1.5 g/kg IBW/day = 68.85 g = 17.2 %
• Carbohydrate 50 % = 200 g
• Fat 32.8 % = 58.3 g
Diet is given 40 % TEE (640 kcal ) :
A. Oral
• Peptisol 5 x 100 kcal
B. Parenteral
• Lipofundin 100 ml /24 hours/intravena
PLANNING
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Hypoalbuminemia Correction with protein intake 1.5 kg/KgIBW/day
Fluid maintenance 1,300 – 1,600 ml/day
Oral Supplementation :
- Zinc 20 mg/24 hours
- B-Complex 2 tablet/8 hours
Evaluation and Monitoring :
- Vital signs
- Daily intake
- Gastrointestinal tolerance
Nutritional education
Laboratory : Total Protein, Lipid’s profile, UUN
Subjective Objective Assesment Planning
Oral intake. There are General Condition : Moderate pain , Nutrition status : Basal Energy Expenditure : 1.023.3 kcal
no nausea and GCS E4M5V6 Subjective Global Assessment score B Total Energy Expenditure : 1.600 kcal
vomiting. There no Blood Pressure : 110/70 mmHg
abdominal pain. RR : 24 x/ minute Metabolic status: Macronutrient composition :
Pulse : 90 x/ minute Protein 1.5 g/kgIBW/day = 68.86 g = 17.2 %
Defecate : 1 x T : 37.6° C (25/02/2019) Carbohydrate 50 % = 68.85 g
yellowish SpO2 : 97 % Normocytic Normochrome Anemia (11.2) Fat 32.8 % = 58.9 g
Urinate: via toilet 24 hours Food Recall via oral and Leukocytosis (11,890)
parenteral : Thrombocytosis (498,000) 1. Diet is given 60 % TEE (960 kcal) :
- Energy : 483 kcal ( 44.03 %) Hypoalbuminemia (3.3) A. oral :
- Protein : 12.4 g ( 15.04 %) PNI (41.67) • Porridge with side dish and vegetable (ad
- Carbohydrate : 151 g (53.95 % %) libitum)
- Fat: 22.71 g (29.02 %) Gastrointestinal status : Fungsional • Fruit juice 100 kcal
Anthropometry • Peptisol 300 kcal
Body Length : 151 cm B. Parenteral
Ideal Body Weight : 41 kg Nutritional Diagnosis : Moderate Protein • Smoflipid 100 ml/24 hours
MUAC : 21.3 cm Energy Malnutrition
MUAC Body Weight : 38.0 kg 2. Fluid maintenance 1300 - 1600 ml/24 hours
Medical Diagnosis :
Physical Examination: 3. Hypoalbuminemia correction with protein
Pancreatic Cauda Tumor
Head and neck : Conjunctiva anemic, intake 1.5 g/KgIBW/day and Cork fish capsule
sclera isn’t icteric. Non O2 supporting .
Thorax : symmetric. There is Lost of 4. Oral Supplementation :
Subcutaneous Fat. Vesicular, There - Zinc 20 mg/24 hours
FOLLOW UP aren’t rhonchi and wheezing . - B. Complex 2 tablet/8 hours
Abdomen: Flat, normal peristaltic , The 5. Monitoring and evaluation
1st day hepar palpates 3 fingers under the - Daily intake
(March 1st , 2019) arcus costae.Tumor mass in the right
hypochondrium - Gastrointestinal tolerance:
Extremities: There is wasting, non 6. Nutritional education
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