E-POSTER VERSION

MANAGEMENT OF NON AMBULATORY, TUBE-FED ADULT
PATIENTS WITH CEREBRAL PALSY AND
HYPONATRAEMIA

PREPARED BY : SHAHIRAH AYUNI ANWAR,
SUPERVISED BY : DR DIVYA VANOH, EN.AHMAD SYUKRI, EN.AHMAD KARAMI,

UNDERGRADUATES STUDENTS OF UNIVERSITI SAINS MALAYSIA,

INTRODUCTION NUTRITION DIAGNOSIS

Mr S, a 40 years-old male present with feverish, seizure, shortness No initial diagnosis on the 1st visit.
of breath and coffee ground aspiration was admitted to Medical However, due to low sodium level on the
Ward for Septic Shock Secondary To Orthostatic Pneumonia, next follow up, the nutrition diagnosis was
Breakthrough Seizure Secondary To Electrolyte Imbalance and Altered nutrition related laboratory value
Gred 4 Sacral Sore. He was cerebral palsy with epilepsy since (Na) related to metabolic disorders as
childhood evidenced by hyponatremia

BACKGROUND NUTRITION INTERVENTION

Cerebral palsy (CP) : A group of disorders that affect a person’s The nutrition goal was to provide
ability to move and maintain balance and posture. adequate energy and protein
requirements.
CP is caused by abnormal brain development or damage to the It was also aim to promote recovery while
developing brain that affects a person’s ability to control his or increasing sodium level.
her muscles. With the minimum energy requirement of
Hyponatremia: Occurs when the concentration of sodium in your 1100 kcal, he was given, RTF, Nasogastric,
blood is abnormally low. with 5 scoop of Glucerna, Bolus Feeding,
Symptoms : Seizure, nausea, vomiting, confusion 4 hourly, 5 times per day on 2nd visit.
Causes : Certain medications, heart & kidney problem, hormonal Moreover, the enteral formula was
changes change from Glucerna during the next
Risk factors: Age, certain drugs, conditions that decrease your follow up (4th visit) to Ensure Gold with the
body's water excretion. same feeding regime since there was no
Septic shock: Persistent hypotension requiring vasopressors to changes in sodium level and to maintain
maintain mean a arterial pressure of 65 mm Hg or higher and a normal blood glucose level
serum lactate level greater than 2 mmol/L (18 mg/dL) despite
adequate volume resuscitation. MONITORING AND EVALUATION

NUTRITION ASSESSMENT CBS level, sodium level and other
biochemical data, clinical data, dietary
ANTHROPOMETRY data and toleration towards feeding
regime without gastric aspiration was
Mr S was categorised as underweight based on BMI monitored.
15.3kg/m2.
CONCLUSION & DISCUSSION
BIOCHEMICAL DATA
There should have been no need for a
1st visit : his serum Creatine, Uric acid, Albumin and change in the EN sodium content in
Sodium were low while liver function such AST, ALP, this case.
ALT were high. It is critical to identify all factors
Next follow up, the biochemical data does not that predispose EN patients to
shows good improvement. hyponatremia and hypernatremia.
Although the sodium content of the EN
CLINICAL DATA solution is frequently highlighted,
sodium and fluid can also be
On Nasal Prong, hemodynamically supported administered through other means,
with IV Noradrenaline and poor GCS E2V2M4. such as medication admixtures and
Patient was comfortable at room air on the next maintenance intravenous fluids.
follow up with a moderate GCS E2V2M5

DIETARY DATA

Given RTF, Nasogastric, Bolus Feeding with
Ensure Gold during the 1st & 2nd visit. On the next
follow up, the formula for enteral nutrition was
change from Ensure Gold to Glucerna.

ENVIROMENT DATA

Patient was ADL Dependent

References:
Bagshaw, S. M., Townsend, D. R., & McDermid, R. C. (2008). Disorders of sodium and water balance
in hospitalized patients. Canadian Journal of Anesthesia/Journal Canadien D’anesthésie, 56(2), 151–
167. doi:10.1007/s12630-008-9017-2
Mageswary, L., Chong, M. K., Majid, H., Khor, B. H. & Lee, Z. Y. & Hafizatul, A., et al. (2017). Medical
Nutrition Therapy (MNT) Guidelines for Critically Ill Adults 2017. Malaysian Dietitians' Association and
Ministry of Health, Putrajaya
The Royal Children's Hospital Melbourne. (2018). Hyponatraemia. Retrieved July 29 2022. from
https://www.rch.org.au/clinicalguide/guideline_index/Hyponatraemia/

SAFETY OF EARLY NUTRITION ADMINISTRATION: A CASE
STUDY IN UPPER GASTROINTESTINAL BLEEDING PATIENT

COMPLICATED WITH PEPTIC ULCER





Syammimi SH 1, Nur Hidayah G 1
1. Center of Nutrition and Dietetics, Faculty of Health Science,

Universiti Teknologi MARA



INTRODUCTION

Early nutrition provision in patients with upper gastrointestinal bleeding (UGIB) is always a controversial issue and has always
been debated among healthcare professionals. Previous data showed several results in mortality, days of hospitalization, and
risk of rebleeding when early nutrition administer 1.

NUTRITION ASSESSMENT

CLIENT HISTORY BIOCHEMICAL DATA, MEDICAL TEST, AND PROCEDURES
The patient was 86 years old Biochemical data showed high readings of urea and creatinine,
Malay was referred to the dietitian on day 2 of but low in albumin and hemoglobin. Hence, two pints of the
admission packed cell were transfused
Reason of admission because of the development
of fast atrial fibrillation and the presence of pre-

rectum bleeding, lethargy, abdominal pain, and

constipation

The medical diagnosis of UGIB secondary to

peptic ulcer disease and underlying hypertension,

IHD, and atrial fibrillation.



ANTHROPOMETRIC

The estimated height was 153cm calculated from

a knee height measurement of 45cm with IBW of

56kg with a BMI of 24kgm-2.



NUTRITION-FOCUSED PHYSICAL FINDING

Nutritionally, this patient looks lethargic, had
abdominal pain and constipation for about three FOOD NUTRITION-RELATED HISTORY
months before admission, and had per-rectum As to determine the location of the bleeding, the patient was
bleeding nil-by-mouth, intravenous with two-pint normal saline, and
esophagogastroduodenoscopy (OGDS) procedure was
planned.
IV pantoprazole and double hematinic were prescribed to
inhibit gastric acid secretion and to increase the hemoglobin

NUTRITION DIAGNOSIS NUTRITION MONITORING

& EVALUATION
Inadequate protein-energy intake related to
feeding interrupted (planned for OGDS Nutritional adequacy of protein-energy and their toleration of ONS
procedure) as evidenced by intake at hospital been monitored and evaluated as well as other clinical parameters of
0kcal (intake of clear fluid) and NBM for the renal profile and hemoglobin.
procedure.



NUTRITION INTERVENTION






With the aim to achieve adequate protein-

energy intake, 25kcal/ kg of energy and 1.5g/kg

of protein were prescribed respectively.

Clear fluid was replaced with clear nourishing

fluid, then gradually transition to complete and

balanced oral nutrition supplement (ONS)

before a combination of both ONS with a soft

diet.















DISCUSSION



The patient was successfully well tolerated with early nutrition

provision with no gastrointestinal complications. Even though the

appetite was still not satisfied but it is improving. Hence there is no

need to delay refeeding in patients with gastritis or peptic ulcer, and

they can be fed to prevent malnutrition 2.

1.
REFERENCES

2.




1.Antunes, C., & Copelin II, E. L. (2021). Upper gastrointestinal bleeding. In: StatPearls [Internet]. Treasure Island (FL): StatPearls
Publishing. https://www.ncbi.nlm.nih.gov/books/NBK470300/

2.Hébuterne, X., & Vanbiervliet, G. (2011). Feeding the patients with upper gastrointestinal bleeding. Current Opinion in Clinical Nutrition
and Metabolic Care, 14(2), 197-201. https://doi.org/10.1097/mco.0b013e3283436dc5

Nutrition Management on Wound Healing in Dementia Patient with Sacral Sore

Low Aileen1, Siti Nurhana Abd Wahid1, Dr. Nik Nur Izzati Binti Nik Mohd Fakhruddin2, Norazizah Binti Mahidin2
1Division of Nutrition & Dietetics, School of Health Sciences, International Medical University, Kuala Lumpur, Malaysia

2Department of Dietetics and Food Service, Hospital Tuanku Jaafar, Negeri Sembilan, Malaysia

BACKGROUND NUTRITION INTERVENTION (CON’T)

• Dementia- a chronic, progressive neurological disorder due to Nutrition Plan:
abnormal brain changes • Prescribed minced diet
• Idented ONS;
• Symptoms- deterioration in cognitive function and behavioral • Nutren Diabetik Plus, 2 bottles → 10am and 8pm
changes • Low-fat mik, 1 pack.day → breakfast
• Ceprolac+50mL water, 1 sachet/day → 3pm
• Malnutrition is a common issue in dementia patients (29%).
• Nutritional problems- taste and smell changes, inability to focus, - Providing 1829kcal (113% ER) and 88.8g (128% PR) with 41%
total energy intake and 55% total protein intake from ONS
dyspraxia, disturbed eating behavior, dysphagia
NUTRITION MONITORING & EVALUATION
NUTRITIONAL CONCERN

Grade IV Pressure Ulcer Dementia

↑ energy & protein ↓ oral intake
requirements

Malnutrition

NUTRITION ASSESSMENT

Client history Outcomes & Follow-up (4 days later)
• Madam P, 85 years old, Indian female • Inadequate oral intake → 1070kcal (66% ER), 39g protein (56%
• Reason for referral: high protein diet for wound healing
• Underlying disease: diabetes, hypertension, dementia PR)
Anthropometry measurements • Uncertain eating pattern → 50% hospital meals + all ONS or 100%
• Weight: 45kg; Height: 1.52m→BMI: 19.5 / 2 (underweight)
Biochemical data, medical tests, and procedures hospital meals only
• High fasting blood glucose (5.8→9.4): U/L diabetes + stress- • Poor oral intake + insulin (stopped) → hypoglycemic episode

induced hyperglycaemia Nutrition Plan:
• Reducing trend in total protein (73→66.8), albumin (25 →24.2), 1. Prescribed high protein, minced diet
2. Changed ONS: 7 scoops Nutren Optimum + 200mL water, 2x/day
haemoglobin (10.6 →8.4): inadequate protein intake
Food and Nutrition-related history → 10am and 8pm
• Tolerate minimally, feeding assistance required - Providing 2087kcal (129% ER) and 91.4g (110% PR) with 41%
• Poor appetite (<50% hospital meal + 100% ONS) → 1100kcal
total energy intake and 55% total protein intake from ONS
(68% energy requirement), 53.5g protein (77% protein - Able to provide >80% energy and protein requirement based on
requirement)
• Medication: Actrapid, 6units, s/c; S. lactulose, 15mL, orally patient’s eating pattern records
Nutrition focused physical findings
• Conscious and edentulous DISCUSSION
• MNA scoring of 6 (malnourished)
• Madam P was discharged to new nursing home before 2nd
NUTRITION DIAGNOSIS follow-up

Inadequate protein energy intake related to physiological cause • Short length of hospital stay → limited nutrition care provided
increasing nutrient needs to promote wound healing as evidenced by Continuation of long-term care in the community (e.g nursery
intake at ward providing 1100kcal (68% energy requirement) and home) to improve nutritional status
53.5g protein (77% protein requirement) as compared to the
requirement of 1617kcal and 69.3g protein. i. Caregiver education & training
✓ importance of healthy balanced diet
NUTRITION INTERVENTION ✓ dietary challenges in dementia → provide nutritious “finger

Nutrition goal: food” for patient having problems with coordination
Short-term: To optimize patient’s nutritional intake to promote wound ✓ advice on enriching dietary protein and energy content →
healing
Long-term: To prevent malnutrition by meeting nutrients requirement small, frequent meals, regular snacks based on their food
Nutrition prescription: preference
1617kcal @ 35kcal/kg; 69.3g protein @1.5g/kg [CPG for PrU 2019]; ✓ strategies to manage aversive eating behaviors → provide
Minimum 1.6L fluid/ day [ESPEN Geriatrics 2019] gentle encouragement and persistence

ii. Modification of mealtime environment
✓ calm and relaxing environment
✓ minimize sensory distraction → avoid loud music

✓ good lighting quality → to allow food recognition

CONCLUSION

• Dementia: negative impact on ability and desire to consume food
→ less likely to meet nutritional requirements

• Early intervention and long-term care → decreasing negative health
outcomes and increasing quality of life in dementia

References:
1. Eating and drinking difficulties in dementia [Internet]. Bda.uk.com. 2022 [cited 29 July 2022]. Available from: https://www.bda.uk.com/resource/eating-and-drinking-difficulties-in-dementia.html
2. Prevention and Treatment of Pressure Ulcers: Clinical Practice Guidelines (2019)
3. ESPEN Guidelines on Nutrition in Dementia (2015)
4. Borda MG, Ayala Copete AM, Tovar-Rios DA, Jaramillo-Jimenez A, Giil LM, Soennesyn H, Gómez-Arteaga C, Venegas-Sanabria LC, Kristiansen I, Chavarro-Carvajal DA, Caicedo S. Association of malnutrition with functional and cognitive trajectories in people living with dementia: a five-year follow-up

study. Journal of Alzheimer's Disease. 2021 Jan 1;79(4):1713-22.

NUTRITIONAL MANAGEMENT FOR PATIENT WITH INFECTIVE
ACUTE GASTROENTERITIS (AGE) WITH RESOLVED COMPENSATED

SHOCK, NOSOCOMIAL PNEUMONIA, AND EARLY ABSCESS OF
LEFT KNEE WITH UNDERLYING GLOBAL DEVELOPMENTAL DELAY

Anis Syazwina Salman1, Noor Zarirah Jusoh2, Chin Yi Ying1

1School of Nutrition and Dietetics, Faculty of Health Sciences, Universiti Sultan Zainal Abidin, Gong Badak Campus, 21300 Kuala Nerus, Terengganu
2Department of Dietetics, Hospital Tuanku Ja’afar, Jalan Rasah, 70300 Seremban, Negeri Sembilan

INTRODUCTION

Severely ill children frequently suffer from malnutrition, which worsens their prognosis by raising their risk of complications and

mortality. Children who are critically ill have a higher protein turnover due to an increase in whole-body protein synthesis and

degradation. Protein degradation causes a loss of lean body mass (LBM), which in turn causes growth failure, malnutrition, and other

detrimental effects [1].

BACKGROUND NUTRITIONAL DIAGNOSIS

PERSONAL INFORMATION Inadequate protein-energy intake (NI-1.1) related to reduce ability

• 9y 4m / Male / Orang Asli Water source: to consume sufficient energy intake due to medical conditions as
• Birth history: Born ELLSCS drinks from a evidenced by estimated energy intake at 932 kcal @ 65 % of
nearby water dam. energy requirement and protein intake at 34.3 g/day @ 71% of
for 1 previous scar protein requirement.
• Birth weight: 2.5 kg

• Father, 42 year old: work as Socioeconomic: NUTRITIONAL INTERVENTION
Low
contractor Encourage orally as tolerated with high protein diet
• Mother, 39 year old: work as
•Finish at least half from hospital meal
housekeeper •Educate on importance of adequate protein
• Taken care mostly by her sister (17
for recovery process and malnutrition.
year old); main caretaker at home
Provide ONS (60 %) through RTF (1st visit)

DIETETICS NEW CASE •To supplement with Pediasure milk
Regime: 3 scoops of Pediasure + 180 ml 4 hourly, 6x/d
Referred for Inpatient Case on 12th April 2022 (1st visit) Providing:
• For high protein diet and Pediasure milk. 814 kcal @ 65 % from energy requirement
24 g @ 50 % from protein requirement
NUTRITIONAL ASSESSEMENTS Strength: 0.8 kcal/mL | Fluid: 1800ml/day

ANTHROPOMETRY 2nd visit:
- To off RTF since patient achieve 60% orally
Value Remarks
3 scoops of pediasure + 180 ml, 2x/d (Time: 8 am, 4 pm)
Height (cm) 95 Measured at PICU. Weight-for-age and stature- - To add on: 1 pack jelly ceprolac, 2x/d (Time: 12 pm, 6 pm)
Weight (kg)
9.6 for-age below the 5th percentile (CDC)
Latest weight @ 15th May 2022: 10.75kg

(within 9 days)

BMI (kg/m²) 10.6 BMI-for-age below 5th percentile (CDC) NUTRITIONAL MONITORING & EVALUATION

BIOCHEMICAL CLINICAL Monitor weight changes, biochemical data (sodium, calcium,
potassium, hemoglobin), and dietary data. The caregiver was
12/3 Normal BP Value Remarks given a menu plan and counselling on high-energy-dense and high
9.6 value (mmhg) 99/52 Normal potassium food before discharge.

Hb (g/L) 12 - 15 DISCUSSION & CONCLUSION

WBC 15.2 5 – 13 SPO2 99% Room air Higher energy demand (medical condition)

Sodium 126 136 – i/o 1810/ Protein needs may be GOAL 1: Provide ADEQUATE
(mmol/L) 145 1749 calculated based on the 50th ENERGY and PROTEIN intake
percentile for the actual
Potassium 2.17 3.4 – Stool • Ascaris weight to recover from • Improved nutritional status
Lumbricordes and malnutrition and correct • Promotes recovery [2]
(mmol/L) 4.5 their growth deficits [1].
GOAL 2: Provide ADEQUATE
Calcium 1.8 2.18 – inspection Trichuris trichiura Whey protein (Ceprolac)  FLUID for maintainence
stimulates the synthesis of
(mmol/L) 2.6 ENVIRONMENTAL muscle protein and enhance  Proper hydration and
• Financial supported by parent healing rate [3]. electrolytes balance [4].
DIETARY
and JAKOA for food and milk.
• Currently on formula milk FUNCTIONAL CONCLUSION: Optimal nutrition was important for the malnourished
patient and to reduce the risk of mortality.
200cc 4H (tube feeding). • ADL-semi independent
• Able to finish half of (ambulate with assistance) REFERENCES

normal diet . KNOWLEDGE, ATTITUDE 1. Kareem, Z. U., Panuganti, S. K., & Bhatia, S. (2021). Case Report: Energy-and Nutrient-Dense
• No further complained of • Poor, contemplation stage Formula for Growth Faltering: A Report of Two Cases From India. Frontiers in Nutrition, 8,
588177.
vomiting and diarrhea.
2. Lezo, A., Baldini, L., & Asteggiano, M. (2020). Failure to thrive in the outpatient clinic: a new
Energy requirement: 1440 kcal/day insight. Nutrients, 12(8), 2202
Protein requirement: 48 g/day (1.4g/kg BW @ 50th percentile)
3. Jamison, D. T., Alwan, A., Mock, C. N., Nugent, R., Watkins, D., Adeyi, O., ... & Zhao, K.
(2018). Universal health coverage and intersectoral action for health: key messages from
Disease Control Priorities. The Lancet, 391(10125), 1108-1120.

4. Vega RM, Avva U. Pediatric Dehydration. Published in 2020

Nutritional For Congestive Heart Failure And End-
Stage Renal Disease With Dialysis Patient At
Sardjito Hospital

Kurnia Desy Ambar Wati , CHF and ESRD, Poltekkes Kemenkes Semarang

INTRODUCTION NUTRITION DIAGNOSIS

End Stage Renal Disease is renal failure with progressive and irreversible renal Inadequat oral intake related to decreased appetite due to
function impairment with the body's ability to fail to maintain metabolism and dyspnea, heartbun, nausea as indicated by the severe
fluid and electrolyte balance, causing uremia, namely retention of urea and other deficiencies of energy and macronutrients intake.
nitrogenous wastes in the blood. ESRD is a persistent disease having a GFR of less
than 60 mL/min/1.73 m2 for three months or more and/or albuminuria of more than
30 mg of urinary albumin per gram of urinary creatinine. ESRD can cause other
complications of congestive heart failure which are caused by hyperthension,
hyperthrophy ventricle, etc. According to the World Health Organization (2012)
shows that 57 million deaths in 2008, 48% came from heart disease. In addition,
one in three of the world's population is at high risk of cardiovascular disease.

BACKGROUND NUTRITION INTERVENTION

Dialysis is preferred way to treat end-stage renal disease (ESRD) and Primary goals are to achieve patient’s adequat intake >80%.
remove accumulated nitrogen toxins from the body. In dialysis- Patient was prescribed 35 kcal/kgBW of energy, 1.0 g/kgBW of
dependent ESRD patient, congestive heart failure (CHF) is the leading protein along with 1500 mg of sodium, 2000 mg of potassium,
cardivascular complication as a consequence of declining kidney 500 ml of fluids consisting of 150 with 150 cc of Nephrisol. A
function. Nutrition care plan for patient CHF and dialysis-dependent meal plan was provided orally with soft diet. In addition, patient
ESRD who experienced loss of appetite are essential to maintain fluid, and caregivers are encouraged to meet their nutritional needs.
electrolyte balance, and prevent malnutrition.

NUTRITION ASSESSMENT

A 59-year-old woman was diagnosed with congestive heart failure. NUTRITION MONITORING & EVALUATION
Patient had underlying ESRD and thirteen years biweekly dyalisis-
dependent. During observation, the patient appeared weak. Patient During hospitalization, patient’s intake increased
experienced dyspnea due to pulmonary oedema and anuria. Patient significantly and was able to consume 80% of the
was at risk of malnutrition as a result of prolonged insufficient oral prescribed diet. Biochemical conditions showed
intake energy, protein, fat, carbohydrates, sodium, and pottasium improvement, BUN and creatinine decreased. Physical
intake deficiencies. Patient had high BUN, creatinine, and low condition was recovered, patient did not indicate dyspnea
hemoglobin, hematocrit levels. and nauseous.

Food Intake

120,00% Day-1 Day-2 Day-3
100,00% 58,59% 64,69% 99,23%
101,25% 91,04% 98,03%
80,00% 50,58% 85,86% 85,69%
60,00% 56,46% 89,50% 97,29%
40,00% 110,92% 108,11% 109,08%
20,00% 81,49% 96,25% 98,00%

0,00% Protein (g) Fat (g) Carbohydrate (g) Sodium (mg) Pottasium (mg)

Energy (kkal)
Protein (g)
Fat (g)
Carbohydrate (g)
Sodium (mg)
Pottasium (mg)

Energy (kkal)

REFERENCES

A Berkowitz (2013) Patofisiologi Klinik. 22 ed. Binarupa Aksara.
Ford, I. et al. (2015) “Top ten risk factors for morbidity and mortality in patients with chronic systolic heart failure and elevated heart rate: The SHIFT Risk Model. © 2015 Elsevier Ireland Ltd. All rights reserved.,” International Journal of Cardiology, 184(1), hal. 163–169. doi: 10.1016/j.ijcard.2015.02.001.
Hospital, R. (2014) “Early Detection of Subclinical Edema in Chronic Kidney Disease Patients by Bioelectrical Impedance Analysis,” 97, hal. 1–10.
Kemenkes (2013) Pelayanan Gizi Rumah Sakit. Jakarta.
Mahan, L. K. dan Raymond, J. L. (2017) Krause’s Food & The Nutrition Care Process. 14 ed, Krause’s Food & The Nutrition Care Process. 14 ed. USA: St.Lois, Missouri. doi: 10.1016/j.jneb.2019.06.022.
McMurray, J. J. V. et al. (2012) “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart,” European heart journal, 33(14), hal. 1787–1847. doi: 10.1093/eurheartj/ehs104.
Nelms, M., Sucher, K. P. dan Lacey, K. (2015) Nutrition And Pathophysiology. Boston, USA: Cengage Learning.
PERNEFRI (2003) Konsensus Dialisis.
Riskesdas, R. K. D. (2018) Riset Kesehatan Dasar Tahun 2018, Badan Penelitian dan Pengembangan Kementerian Kesehatan RI. Jakarta.
Smeltzer, S.C. & Bare, B. . (2013) Buku Ajar Keperawatan Medikal Bedah Brunner & Suddarth. 8 ed. Jakarta: EGC.

POST-OPERATIVE NUTRITION CARE FOR PALLIATIVE RADICAL

> CYSTECTOMY WITH PYONEPHROSIS AUTHOR

PICTURE

LULU UMAILA, IN-PATIENT (IPD), POLITEKNIK KESEHATAN KEMENKES SEMARANG

INTRODUCTION NUTRITION DIAGNOSIS

Bladder cancer is the seventh most common malignancy in men where Inadequate oral intake related to physiological causes due to nausea and
cancer cell attacks the bladder mucosa or urothelium. The world abdominal pain as evidenced by severe intake deficiencies (21% of
mortality rate for men and women with bladder cancer in the world energy and 14% of protein requirements), hematuria, anemia, and
reaches 3:2 per 100,000 adult population1. hypoalbuminemia.
Radical cystectomy is the primary surgical treatment for muscle-invasive
bladder cancer2. NUTRITION INTERVENTION

BACKGROUND Intervention aimed to gradually increase patient's food intake by 80% of
energy requirements.
Malnutrition has been linked to complications following surgical Patient prescribed with soft high-energy high-protein diet with 1597,79
procedures as a result of increased energy-protein requirements and kcal energy and 59,92 gram protein requirements.
decreased food intake because of pain, nausea, and gastrointestinal On the third day of intervention, patient received Clinimix N9G15E
disorder3. 1000ml/24 hours. However, on the fourth day his oral intake did not
The purpose of this study is to examine the nutritional care process in showed any improvement (35% of energy and 14% of protein
post-palliative radical cystectomy patients with nephrostomy. requirements) as consequence of lost of appetite due to abdominal pain,
nausea, vomiting, and flatulence.
NUTRITION ASSESMENT Laboratory results showed hypoalbuminemia and decreased hemoglobin
levels due to hematuria and melena. Follow-up was done by modifying
A 41-year-old man with Palliative Radical Cystectomy and the consistency to a liquid diet of 6x150 ml via oral and received Kabiven
Pyonephrosis was admitted because of a detached drain tube and Pheriperal 1440 ml 1 bag/day and transitioned to extra pureed food on
pyuria. the seventh day.
After the nephrostomy bilateral procedure on 2021, patient reported
episodic of nausea, vomiting and diarrhea, thus he experienced NUTRITION MONITORING & EVALUATION
prolonged severe intake deficiencies (<70% of nutritional
requirements)3. Food Intake Monitoring
The assessments showed that patient had a nephrostomy wound.
Patient also classified as severe malnutrition (%MUAC of 46.58)4 90%
and had unintended weight loss.
Laboratory results showed hypoalbuminemia, anemia, and 80%
hyponatremia.
Patient was prescribed with soft diet previously, but his oral intake 70%
was only achieved 21% of energy requirements.
60%

50%

40%

30%

20%

10%

0% Day Day
10 11
Day 1 Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8 Day 9
66%
Energy Intake 29% 31% 26% 35% 53% 41% 61% 65% 59% 59% 77%

Protein Intake 12% 21% 15% 14% 57% 40% 74% 78% 71% 71%

During hospitalization, patient managed to reduced nausea and vomiting.
At the end of the observation, the patient's food intake was able to reach
66% of energy and 77% of protein requirements.

REFERENCES

1 Globocan (2008) Estimated incidence, mortality and 5 ear prevalence : both sexes’
2 Umbas R., Hardjowijoto S., Mochtar C. A., Safriadi F., Djatisoesanto W., Agung A., Oka G., Penta K., Sihombing A. T., Warli S. M., Hendri A.Z. (2014). ‘Panduan penanganan kanker

kandung kemih tipe urotelial’
3 Widyakarya Nasional Pangan Gizi (2012) ‘Pemantapan Ketahanan Pangan dan Perbaikan Gizi Berbasis Kemandirian dan Kearifan Lokal’
4 Abunain, D. (1990) ‘Aplikasi antropometri sebagai alat ukur status gizi di Indonesia’, Gizi Indonesia, XV(2).

Homecare Nutrition Management of Type 2
Diabetes Mellitus Patients

Aisya Milkhatin Hanifah, Poltekkes Kemenke Semarang

Introduction

Diabetes mellitus is the collective term for heterogeneous metabolic disorders whose main finding
is chronic hyperglycemia. Type 2 diabetes has emerged as a major public health and economic
burden of the 21st century. The worldwide prevalence of type 2 diabetes mellitus (T2DM) in adults
has increased from ~150 million affected people in 2000 to >450 million in 2019. Genetics andlifestyle habits
(such as consumption of a high-sugar diet and a sedentary lifestyle) can have a predisposing influence as
T2DM occurs at varying rates in people of different racial and/or ethnic backgrounds.

Background Nutrition Intervention

Poor monitoring blood glucose levels in Patient was provided with homecare
diabetic patients contribute to increase risk nutrition concerning to maintain blood
factors for its complications. Management in glucose levels within normal ranges
diabetic patients include dietary Patient was prescribed with 1700 kcal; 265
management, physical activity, anti-diabetic grams carbohydrates and 88,5 grams
agents and monitoring blood glucose levels. Patient were encouraged to apply dietary and
lifestyle modifications such as meal-provided for
Nutrition Assesment 3 days, carbohydrate counting, continuous
blood glucose monitoring, increasing physical
A 58-year-old man activity, and nutrition counseling based on the
Diagnosed with T2DM for fifteen years and diabetic dietary management.
regularly took anti-diabetic agent
Patient was classified as obese (BMI 28.8 Nutrition Monitoring & Evaluation
Kg/m2)
Hyperglicemia (blood glucose level 183 Discussion
mg/dl)
High blood pressure level (140/90 mmHg). The patients was suggested to apply modify
Patient claimed never had blood glucose lifestyle behavior such as combined diet and
monitoring regularly and informed physically physical activity. Patients are also given education
inactive about the principles of diet DM (precise schedule,
Patient had high calories and carbohydrate type, and weight). dietary compliance of the
snacks consumption, also low fiber intake patient is one of the success factors in controlling
habitually. blood sugar levels
From diet recall, patient reported excessive
dietary intakes.

Nutrition Diagnosis

Decreased simple carbohydrate needs
related to impaired carbohydrate
metabolism as evidenced by a high blood
glucose level (183 mg/dL).

Conclusion

Monitoring blood glucose level by applying modifications to the principles of diabetic diet, physical
activity, and counseling is important to prevent complications in diabetic patients.

Reference

Petersmann A, Müller-Wieland D, Müller UA, Landgraf R, Nauck M, Freckmann G, Heinemann L, Schleicher E. Definition, Classification and Diagnosis of Diabetes Mellitus. Exp Clin Endocrinol
Diabetes. 2019 Dec;127(S 01):S1-S7. doi: 10.1055/a-1018-9078. Epub 2019 Dec 20. PMID: 31860923.
Pearson ER. Type 2 diabetes: a multifaceted disease. Diabetologia. 2019 Jul;62(7):1107-1112. doi: 10.1007/s00125-019-4909-y. Epub 2019 Jun 3. PMID: 31161345; PMCID: PMC6560016.

CASE STUDY OF NUTRITION THERAPY IN PRE-ELDERLY PATIENTS
WITH TYPE 2 DIABETES MELLITUS AND HYPERTENSION

CAHYANTI ARIWAHYUNI, POLTEKKES KEMENKES SEMARANG

Diabetes Mellitus is a chronic disorder of carbohydrate, protein, Altered nutrition-related laboratory values of blood glucose
and fat metabolism in which there is a difference between the levels (NC-2.2) are related to metabolic disorders, namely
amount of insulin the body needs and the amount of insulin Diabetes Mellitus type 2 which is characterized by blood
available, while hypertension is defined as a persistent or glucose levels at 375 mg/dl.
intermittent increase in systolic arterial blood pressure equal to or Limited adherence to nutrition-related recommendations
above 140 mmHg or diastolic pressure equal to or above 90 (NB-1.6) related to patients not understanding food and
mmHg. Complications from patients with Diabetes Mellitus and nutrition information, indicated by patients still frequently
Hypertension include neuropathy 54.00%, foot ulcers 8.70%, consuming foods high in sodium and simple sugars.
stroke 5.30%, kidney disease 20%, and heart failure 2.70%.

Pre-elderly is prone to suffer from non-communicable diseases The given intervention aims to achieve temporary blood sugar
such as hypertension or diabetes mellitus. Diabetes Mellitus is a and blood pressure levels within normal limits and increase the
chronic metabolic disorder that can be controlled, characterized client's knowledge about the given diet. Calculation of the
by hyperglycemia due to insulin deficiency and/or inadequate use patient's nutritional needs using PERKENI so that energy is
of insulin. The prevalence of pre-elderly suffering from Diabetes obtained 1129 kcal, protein (15%) 42 grams, fat (25%) 31 grams
Mellitus in Indonesia is 10.3 million and is predicted to continue using saturated fat <7%; polyunsaturated fat <10%; the rest
to increase and reach 16.7 million in 2045. In addition, the monounsaturated fat and carbohydrates (60%) 169 grams.
prevalence of diabetes mellitus in Indonesia is higher in urban Feeding with the principles of the Diabetes Mellitus diet of 1100
areas, which is 2.6%. Irregular blood glucose control will have an kcal using complex carbohydrate sources, high-fiber foods, and
impact on increasing the development of diabetes mellitus in pre- processed foods with less oil and sugar is given <5% of energy
elderly patients. Appropriate diet therapy and nutrition education needs. Patients are also given the DASH (Dietary Approaches to
can improve quality of life. Stop Hypertension) diet rich in fruits and vegetables, nuts, seeds,
and saturated fatty acids (SFA), the DASH diet supports high
A 59-year-old woman was diagnosed with Diabetes Mellitus and potassium consumption and limits sodium intake to 1500 to 2400
Type 2 Hypertension. The results of the MNA (Mini Nutrition mg, saturated fatty acids, and total fat. Frequency of main meals
Assessment) screening obtained a score of 15, which means the 3x and snacks 3x, the usual form of food orally. The food
patient is not at risk of malnutrition. The patient's weight was 70 ingredients provided also contain bioactive compounds such as
kg with a height of 145 cm so the nutritional status of the patient antihypertensive and antidiabetic. Nutrition education using the
was obese with a BMI of 33.3 kg/m2. Recent biochemical data Diabetes Mellitus diet leaflet and the DASH (Dietary Approaches
from the patient showed that the patient's blood glucose level was to Stop Hypertension) diet leaflet. Nutrition education is
high at 374 mg/dl and the patient's blood pressure was high at important to increase patient knowledge.
172/100 mmHg. The patient has a moderate level of physical
activity, namely by working as a teacher but the patient does not Monitoring and evaluation of patients with the first parameter of
do sports. The patient's eating habits every day consume the main dietary history using 1x24 hour recall and looking at the patient's
food 3x/day, 1-2 tablespoons of white rice, animal side dishes leftover food for 3 days with a controlled patient intake target of
consumed are chicken/fish/eggs/beef 2x/week 1 piece with 80%-100%, the second parameter is physical/clinical with direct
processed fried foods or mixed vegetables. The patient consumes patient observation for 3 days with a target patient's blood
vegetable side dishes such as tofu/tempeh 3x/week 1 piece with pressure in normal limits, the third parameter is biochemistry with
fried or mixed vegetables. Patients often consume various a laboratory examination method on the last day of intervention
vegetables with clear sauce or coconut milk 3x/day. The patient with blood glucose targets within normal limits, the fourth
consumes 1 banana and papaya 3x/week. Patients still often parameter is nutrition education with the lecture method which is
consume foods high in sodium and simple sugars. Snacks that are carried out for 3 days with the target client being able to
often consumed by patients are biscuits, crackers, chips, and understand and follow dietary recommendations. The patient was
sweet bread. The results of the patient's recall for 1x24 hours able to reduce energy intake in accordance with the diet therapy
showed that the intake of energy (155%), protein (136%), fat given by monitoring food waste for 3 days. The patient's food
(107%), and carbohydrates (181%) were included in the high intake can be controlled 100% so that it can be ensured that the
category. The drugs that the patient takes every day are patient can adhere to the diet. The patient's blood glucose level
Clopidogrel Birulfate, Candesartan Cilexetil, Simvastatin, and blood pressure have now decreased to 230 mg/dl and 158/119
Serolin, and Glimepiride. The patient takes medication every day mmHg, respectively. During nutrition education, patients can
but does not control blood glucose levels. History of understand and implement the dietary recommendations given.
Hypertension since 2015 and has a family history of disease from
her father having suffered from Diabetes Mellitus and her mother
has suffered from Hypertension and Diabetes Mellitus.

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Kucharska, A., Gajewska, D., Kiedrowski, M., Sińska, B., Juszczyk, G., Czerw, A., Augustynowicz, A., Bobiński, K., Deptała, A., & Niegowska, J, 2018. The impact of individualised nutritional therapy according to DASH diet on blood pressure, body mass, and selected
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