tag:blogger.com,1999:blog-49537571326273758252023-11-15T08:48:44.246-08:00NursingactionWira Wijayahttp://www.blogger.com/profile/16990130477750158469noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-4953757132627375825.post-47138383768525101602010-01-19T01:11:00.001-08:002010-01-19T01:11:39.092-08:00GlaukomaGLAUKOMA<br />PENGERTIAN<br />Glukoma adalah suatu keadaan pada mata dimana terjadi peningkatan tekanan intraokuler yg bila cukup lama dan tekanannya cukup tinggi dapat menyebabkan kerusakan anatomis dan fungsional.<br />ETIOLOGI<br />Untuk glukoma tidak ada penyebab yang spesifik, namun ada bberapa actor resiko yang dapat mengarah pada glukoma, anatara lain :<br />Tekanan darah tinggi<br />Usia > 45 tahun<br />Keluarga mempunyai riwayat glukoma<br />PATOFISIOLOGI<br />Cairan bilik mata yang dihasilkan oleh epitel badan siliar akan masuk ke dalam bilik mata belakang dan berjalan melalui pupil ke bilik mata depan. Cairan bilik mata keluar dari bola mata melalui anyaman traberkulum dlm kanal Sclhemm yang terletak disudut bilik mata. Dari kanal Schlemm yang melingkar di sekeliling sudut bilik mata cairan mata keluar melalui kanal kolektor dan masuk kedalam pembuluh darah vena episklera. Tekanan intra okuler akan naik bila :<br />Badan siliar memproduksi terlalu banyak cairan mata sedang pengeluarannya pd anyaman traberkulum normal (glukoma hipersekresi)<br />Hambatan pengaliran pd pupil waktu pengaliran cairan dr bilik mata belakang ke bilik mata depan<br />Pengeluara di sudut bilik mata terganggu<br />Jadi bola mata yang dimasuki air terlallu banyak tdk akan meledak tetapi akan menggelembung didaerah yang paling lemah pd papil (mangkok) optic atau pd sclera tmp saraf optic keluar. Bila tekanan bola mata naik, serabut saraf akan tertekan dan rusak serta mati. Kematian sel akan mengakibatkan hilangnya penglihatan yang permanen.<br />KLASIFIKASI GLUKOMA<br />Glukoma primer<br />Dimana penyebabnya tdk diketahui, dibagi atas dua bentuk :<br />Glukoma sudut terbuka (glukoma kronik)<br />Gukoma sudut tertutup (glukoma sudut sempit)<br />Glukoma sekunder<br />Timbul akibat kelainan dlm bola mata yang dpt disebabkan oleh:<br />Kelainan lensa, katarak imatur dan hipermatur, dan dislokasi lensa<br />Kelainan uvea, uveitis anterior<br />Trauma, hifemia dan inkarserasi iris<br />Pasca bedah, blockade pupil, goniosinekia<br />Glukoma congenital<br />Congenital primer, dng kelainan kongenital lain<br />Infantile, tanpa kelainan congenital lain<br />MANIFESTASI KLINIK<br />Ada keluha penglihatan kabur/ tdk jelas<br />Rasa sakit kepala bisa sampai berat<br />Rasa mual dan muntah<br />PENATALAKSANAAN MEDIK<br />Pemeriksaan diagnostic :<br />Tonometri untuk mengukur tekanan bola mata<br />Perimetri untuk pemeriksaan lapang pandang<br />Gonioskopi untuk melihat sudut bilik mata<br />Oftalmoskopi untuk memeriksa saraf optic<br />PENGKAJIAN<br />Anamnesis<br />Apakah ada keluarga yang menderita glukoma<br />Riwayat medis dan pribadi (biodata pasien termasuk usia)<br />Pemeriksaan fisik<br />Neurosensori<br />Ada gangguan penglihatan/ kabur<br />Tampak lingkaran cahaya/ pelangi sekitar sinar<br />Kehilangan penglihatan perifer<br />Fotofobia<br />Pupil menyempit dan merah<br />Mata keras dgn kornea berawan<br />Ada peningkatan air mata<br />Makanan cairan<br />Ada mual dan muntah<br />Nyeri/ kenyamanan<br />Nyeri tiba-tiba / menetap atau tekanan pd dan sekitar mata, sakit kepala<br />DIAGNOSA KEPERAWATAN<br />1.Gangguan persepsi sensori : penglihatan b/d penurunan ketajaman lapang penglihatan<br />Tujuan : pasien dpt mempertahankan lapang penglihatan tanpa kehilangan<br />lebih lanjut<br />Intervensi :<br />Pastikan derajat/ tipe kehilangan penglihatan<br />R/ mempengaruhi harapan masa depan pasien dan pilihan intervensi<br />Dorong ekspresi perasaan ttg kehilangan/ kemungkinan kehilangan penglihatan<br />R/ sementara intervensi dini mencegah kebutaan, pasien menghadapi kemungkinan/ mengalami pengalaman kehilangan penglihatan sebagian atau total<br />Tunjukkan pemberian tetes mata, contoh menghitung tetesan, mengikuti jadwal, tdk salah dosis<br />R/ mengontrol TIO, mencegah kehilangan penglihatan lanjut<br />Lakukan tindakan untuk membantu pasien mengalami keterbatasan penglihatan, seperti kurangi kekacauan, atur perabot, ingatka memutar kepala ke subjek yang terlihat, perbaiki sinar suram dan masalah penglihatan malam<br />R/ menurunkan bahaya keamanan b/d perubahan lapang pandang atau kehilangan penglihatan dan akomodasi pupil thd sinar lingkungan<br />Kolaborasi obat sesuai indikasi, contoh Pilokarpin Hidroklorida<br />R/ obat miotik topical ini menyebabkan konstriksi pupil, memudahkan keluarnya akueus humor<br />Kolaborasi bedah sesuai indikasi, contoh Siklodialisis<br />R/ memisahkan badan siliar dr sclera untuk memudahkan aliran keluar akueus humor.<br />2.Ansietas b/d perubahan status kesehatan<br />Tujuan : pasien menunjukan tingkat kecemasan menurun<br />Intervensi :<br />Kaji tingkat ansietas, derajat pengalaman nyeri atau timbulnya gejala tiba-tiba dan pengetahuan kondisi saat ini<br />R/ factor ini mempengaruhi persepsi pasien terhadap ancaman diri, potensial siklus insietas, dan dapat mempengaruhi upaya medik untuk mengontrol TIO<br />Berikan info yang akurat dan jujur<br />R/ menurunkan ansiets b/d ketidak tahuan / harapan yang akan datang dan memberikan dasar fakta untuk membuat pilihan info ttg pengobatan<br />Dorong pasien untuk mengekspresikan perasaan<br />R/ memberi kesempatan pasien menerima situasi nyata, mengklarifikasi salah konsepsi dan pemecahan masalah<br />Identifikasi sumber pendukung<br />R/ memberikan keyakinan bhw pasien tdk sendiri dlm menghadapi masalah.<br />3.Kurang pengetahuan b/d kurang memahami kondisi, prognosis dan pengobatan<br />Tujuan : pasien menyatakan pemahamannya ttg kondisi, prognosis dan<br />Pengobatan<br />Intervensi :<br />Tunjukan teknik yang benar untuk pemberian tetes mata, dan izinkan pasien mengulang tindakan<br />R/ meningkatkan keefektifan pengobatan. Memberikan kesempatan pasien menunjukan kompetensi dan menanyakan pertanyaan<br />Kaji pentingnya mempertahankan jadwal obat, diskusikan obat yang harus dihindari dan kelebihan pemakaian steroid topical<br />R/ penyakit ini dapat di control dan mempertahankan konsistensi program obat adalah control vital. Beberapa obat menyebabkan dilatasi pupil, peningkatan TIO dan potensial kehilangan penglihatan tambahan<br />Identifikasi efek samping pengobatan<br />R/ dapat mempengaruhi rentang dari ketidak nyamanan sampai ancaman kesehatan berat<br />Dorong pasien membuat perubahan yang perlu untuk pola hidup<br />R/ pola hidup tenang menurunkan respon emosi thd stres, mencegah perubahan okuler yang mendorong iris kedepan, yang dpt mencetuskan serangan akut<br />Dorong menghindari aktifitas berat<br />R/ dpt meningkatkan TIO yang mencetuskan serangan akut<br />Diskusikan pertimbangan diet, spt makanan berserat<br />R/ mempertahankan konsistensi feses untuk menghindari konstipasi<br />Tekankan pentingnya periksa rutin<br />R/ untuk mengawasi kemajuan penyakit dan memungkinkan intervensi dini dan mencegah kehilangan penglihatan lanjutWira Wijayahttp://www.blogger.com/profile/16990130477750158469noreply@blogger.com1tag:blogger.com,1999:blog-4953757132627375825.post-26240120914998203172009-11-03T08:47:00.000-08:002009-11-03T08:50:57.706-08:00ASUHAN KEPERAWATAN PASIEN DENGAN APPENDICITIS <br /><br />A. KONSEP DASAR APPENDICITIS<br />1.Pengertian<br />Appendiksitis adalah peradangan pada appendiks vermiformis yang merupakan kasus gawat darurat abdomen.<br /><br />2.Epidemiologi<br /> Appendicitis merupakan kasus bedah yang banyak dijumpai, saat ini termasuk <br /> penyakit akut abdomen. Dari laporan Rumah Sakit Sanglah Denpasar padatahun <br /> 2007 menunjukkan angka kejadian yang cukup tinggi( ) .Tingginyaangkakejadian ini ada kaitannya dengan prilaku dan gaya hidup masyarakat kita saat ini seperti pola makan yang tidak teratur, aktivitas yang kurang dan lainnya. <br /><br />3. Etiologi<br />Adanya penyumbatan pada lumen yang dapat disebabkan oleh :<br />- Hiperplasia dari folikel limfoid<br />- Adanya leukosit dalam lumen appendiks<br />- Adanya benda asing seperti cacing ascaris<br />- Striktur karena fibrosis<br /><br />4. Patofisiologi<br />Faktor utama penyebab appendiksitis adalah obstruksi lumen yang diikuti dengan infeksi oleh bakteri. Bila ada obstruksi yang lebih jarang adalah batu, tumor, cacing parasit lain, infeksi virus atau benda asing lain yang mengakibatkan pembengkakan jaringan limfoid, sekret mukus yang terus menerus yang menyebabkan appendiks teregang dan terbendung menyebabkan dinding appendiks oedema serta merangsang tunika serosa dan peritoneum visceral. Oleh karena persarafan appendiks sama dengan usus yaitu torakal maka rangsangan ini dirasakan sebagai rasa sakit di sekitar umbilikus. Mukus yang terkumpul itu lalu terinfeksi oleh bakteri dan menjadi nanah yang menyebabkan apendik semakin meregang kemudian timbul gangguan aliran vena sedangkan arteri belum terganggu. Peradangan yang meluas dan mengenali peritoneum parietal setempat sehingga menimbulkan rasa nyeri di kanan bawah.<br /><br />5. Klasifikasi Appendiksitis<br />a. Appendiksitis supuratif akut<br />b. Appendiksitis gangrenosa<br />c. Appendiksitis perforasi<br />d. Appendiksitis infiltrat<br />e. Appendiksitis abses<br />f. Appendiksitis kronik dan akut<br /><br /><br /><br />6. Gejala Klinik<br />- Nyeri samar-samar dan merupakan nyeri viseral di daerah epigastrium di sekitar umbilikus<br />- Mual dan kadang muntah<br />- Nafsu makan menurun<br />- Dalam beberapa jam nyeri akan berpindah ke kanan bawah ke titik Mc Burney sehingga nyeri dirasakan lebih tajam dan lebih jelas berupa nyeri tekan dan nyeri lepas pada regio iliaka dekstra<br />- Kadang tidak ada nyeri epigastrium tetapi terdapat konstipasi sehingga penderita memerlukan obat pencahar<br />- Demam sekitar 37,5 C – 38,5 C<br /><br /><br />7. Pemeriksaan fisik<br />a. Inspeksi : <br />1. Klien tampak kesakitan dan bertambah berat jika disuruh menekuk kaki kanan<br />2. Pergerakan klien yang sangat hati – hati terutama pada yang akut<br />3. Bila berbaring kaki kanan sedikit ditekuk<br /><br />b. Auskultasi : penurunan peristaltic usus<br />c. Palpasi :<br />1. Temperatur badan hangat<br />2. Nyeri lepas di daerah Mc. Burney yang menjalar ke seluruh perut<br />d. Auskultasi :<br /><br />8. Pemeriksan penunjang :<br />A Pemeriksaan darah lengkap menunjukkan leukositosis ,untuk menegakkan <br />diagnose pada perforasi terjadi peningkatan leukosit yang tinggi antara 10.000 – 18.000 /mm3<br />a. Pemeriksaan urine rutin untuk membedakan appendiksitis dengan kelainan di saluran kencing<br />b. Foto Rontgen/ USG ; ditemukan gambaran tumpukan masa di umbai cacing<br /><br />9. Kreteria Diagnosis<br /><br /><br /><br /><br /><br /><br /><br /><br /><br /><br />10. Penatalaksanaan<br />Pada appendiksitis pengobatan yang paling baik adalah operasi appendiktomy. Dalam waktu 48 jam operasi harus telah dilakukan atau bila tidak mungkin maka dilakukan tindakan konservatif. Penderita diobservasi, istirahat total dalam posisi fowler, beri antibiotik dan beri makanan yang tidak merangsang peristaltik.<br />Tindakan pre operatif : penderita dirawat, berikan antibiotik dan kompres untuk menurunkan suhu tubuh penderita, bila terlihat adanya gangguan keseimbangan air maka segera diberikan cairan parenteral seperti Na Cl 0,9 % dan Glukosa 5%. Daerah perut bawah dan pubis dibersihkan dan dicukur. Premedikasi diberikan 30 menit sebelum operasi.<br />Tindakan operatif : Appendiktomy<br />Tindakan Post Operatif : observasi tanda vital, penderita dikatakan baik dalam 12 jam tidak terjadi gangguan. Selama itu puasa sampai fungsi usus normal kemudian berikan minum sedikit, keesokan harinya diberikan makanan saring, hari berikutnya makanan lunak dan mobilisasi dini dilakukan satu hari pasca bedah.<br /><br />B. KONSEP DASAR ASUHAN KEPERAWATAN<br />1. Pengkajian<br />Pengkajian yang dilakukan pada pasien <br />a.Pre appendiktomy adalah :<br /> Data subyektif :<br />1. Nyeri daerah pusar menjalar kedaerah perut kanan bawah<br />2. Mual, muntah , kembung<br />3. tidak nafsu makan <br />4. tungkai kanan tidak dapat diluruskan<br />5. Diare atau konstipasi<br />Data obyektif<br />1. Nyeri tekan di titik Mc.burney<br />2. Peningkatan suhu tubuh 38 - 38,5ºc<br />3. Spasme otot<br />4. Takhikardi, takipnea<br />5. pucat, gelisah<br />6. Bising usus berkurang atau tidak ada<br />b. Data post op Appendictomy<br /> Data Subyektif<br />1. Nyeri daerah operasi<br />2. Lemas<br />3. Haus<br />4. Mual, kembung<br />5. pusing<br />Data Obyektif<br />1. Terdapat luka operasi di kuadran kanan bawah abdomen<br />2. Terpasang infuse<br />3. Bising usus berkurang<br />4. Selaput mukosa mulut kering<br /> <br /><br />2. Diagnosa Keperawatan<br />1. Keterbatasan gerak dan aktifitas b/d keadaan umum lemah<br />2. Gangguan rasa nyaman (nyeri) b/d post appendiktomy<br />3. Gangguan rasa aman (cemas) b/d pembedahan atau kurangnya pengetahuan<br />4. Resiko gangguan pemenuhan kebutuhan cairan kurang dari kebutuhan b/d intake kurang<br />5. Resiko terjadi infeksi b/d perawatan luka yang kurang steril<br /><br />Pohon Masalah :<br /><br />3. Perencanaan<br />a Keterbatasan gerak dan aktifitas b/d keadaan umum lemah<br />Rencana Tindakan :<br />1. Rubah posisi secara perlahan<br />2. Anjurkan mobilisasi dini<br />3. Monitor vital signs<br />4. Bantu memenhui kebutuhan sehari-hari<br />b.Gangguan rasa nyaman (nyeri) b/d pre / post appendiktomy<br />Rencana Tindakan :<br /> 1. Evaluasi atau monitor perkembangan nyeri dengan<br /> melihat ekpresi wajah dan skala nyeri<br /> 2. Ukur vital sign<br /> 3. Atur posisi semi fowler<br /> 4. Ajarkan tehnik relaksasi dan distraksi<br />5. Kolabrasi dalam pemberian analgetik<br />c. Gangguan rasa aman (cemas) b/d pembedahan atau kurangnya pengetahuan<br />Rencana Tindakan :<br />1.Beri penjelasan tentang penyakitnya<br />2.Memberitahukan pasien tentang pengobatan dan <br /> perawatan yang diberikan<br />3.Beri dorongan secara psikologis<br />d. Resiko gangguan pemenuhan kebutuhan cairan kurang dari kebutuhan b/d <br /> intake kurang<br />Rencana Tindakan ;<br />1.Catat intake dan output<br />2.Monitor tanda vital<br />3.Kolaborasi dalam pemberian cairan parenteral<br /><br /><br /><br /><br />e. Resiko terjadinya infeksi b/d perawatan luka yang kurang steril <br />Rencana Tindakan :<br />1.Observasi tanda-tanda infeksi<br />2.Pertahankan tindakan pencegahan dengan tehnik septik aseptik<br />1. Pantau tanda-tanda vital<br />2. Rawat luka dengan steril<br />3. Kolaborasi dengan pemberian antibiotik<br /><br />b. Pelaksanaan<br />Pelaksanaan merupakan realisasi dari rencana tindakan yang telah di susun dalam rencana perawatan. Pelaksanaan bertujuan untuk memenuhi kebutuhan akan pelayanan keperawatan sesuai dengan tujuan yang telah ditetapkan<br /><br />c. Evaluasi<br />Evaluasi yang dimaksud adalah evaluasi terhadap keberhasilan dari perencanaan dan pelaksanaan perawatan yang telah ditetapkan tercapai atau tidakWira Wijayahttp://www.blogger.com/profile/16990130477750158469noreply@blogger.com0tag:blogger.com,1999:blog-4953757132627375825.post-2166166636493506962009-08-16T17:50:00.000-07:002009-08-16T17:58:37.512-07:00MANAGEMENT NUTRITION FOR UNCONCIOUS PATIENTS WITH BRAIN INJURY TO IMPROVE ANTIBODY<meta equiv="Content-Type" content="text/html; charset=utf-8"><meta name="ProgId" content="Word.Document"><meta name="Generator" content="Microsoft Word 12"><meta name="Originator" content="Microsoft Word 12"><link rel="File-List" href="file:///C:%5CDOCUME%7E1%5CWira%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_filelist.xml"><link rel="themeData" href="file:///C:%5CDOCUME%7E1%5CWira%5CLOCALS%7E1%5CTemp%5Cmsohtmlclip1%5C01%5Cclip_themedata.thmx"><link rel="colorSchemeMapping" 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style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Introduction<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>Everyday we needs nutrition to growth and develop, and also for our energy nutrition such as glucose, protein and electrolyte. The most common problem that emerge on a perioperative patient<span style=""> </span>is malnutrition. With giving an adequate nutrition will help recovery process and increasing bodies immunity to handle infection. Patient with brain injury and consciousness disorder will easily have a nutrition problem as an effect from neurological deficit and long bed rest.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Nursing Problem for Unconscious Patient<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span>Orthostatic pneumonia cause by micro atelectasis<span style=""> </span>and sputum retention <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">2.<span style=""> </span>Fluid and electrolyte defisite <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">3.<span style=""> </span>Neuro muscular paralyse (<span style=""> </span>disphagia<span style=""> </span>)<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">4.<span style=""> </span>Gastrointestinal disorder <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">5.<span style=""> </span>Gastric ulcer <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">6.<span style=""> </span>Decubitus <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Malnutrition Can Caused By<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span>Secondary effect from a long fasting <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">2.<span style=""> </span>Large operation <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">3.<span style=""> </span>Surgery complication that affect oral absorption<span style=""> </span>and septic catabolism <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">The Effect<span style=""> </span>of<span style=""> </span>Malnutrition<span style=""> </span>in<span style=""> </span>Unconscious<span style=""> </span>Patient<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span>Decreasing<span style=""> </span>of<span style=""> </span>immuno system<span style=""> </span>on<span style=""> </span>patients <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">2.<span style=""> </span>Easy<span style=""> </span>to<span style=""> </span>have<span style=""> </span>infection<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">3.<span style=""> </span>Operation<span style=""> </span>wound<span style=""> </span>will<span style=""> </span>be<span style=""> </span>difficult<span style=""> </span>to<span style=""> </span>heal<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">4.<span style=""> </span>Cerebral edema<span style=""> </span>will<span style=""> </span>be<span style=""> </span>expandable<span style=""> </span>to<span style=""> </span>happen <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">Immuno system<span style=""> </span>extremely depends on somebody nutrition status. The giving of ordinary nutrition <span style=""> </span>would<span style=""> </span>not be enough to<span style=""> </span>accomplish<span style=""> </span>bodies need, because of that, it is important to give a specific nutrition that able to modulated<span style=""> </span>immuno response <span style=""> </span>and<span style=""> </span>increase<span style=""> </span>bodies immunity.<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Early feeding<span style=""> </span>of<span style=""> </span>immuno<span style=""> </span>Enhancing<span style=""> </span>formula<span style=""> </span>cotaining<span style=""> </span><o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">L-Arginine,<span style=""> </span>L Glutamine and Fish oil<span style=""> </span>has<span style=""> </span>demonstrated<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Lower<span style=""> </span>risk<span style=""> </span>of<span style=""> </span>infection<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Shorter<span style=""> </span>length<span style=""> </span>of<span style=""> </span>hospital<span style=""> </span>stay<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Fewer<span style=""> </span>days<span style=""> </span>on<span style=""> </span>ventilator<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Accelerates<span style=""> </span>wound<span style=""> </span>healing<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Results<span style=""> </span>of<span style=""> </span>Nutrition<span style=""> </span>Support<span style=""> </span>Are<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></u></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">To<span style=""> </span>maintain<span style=""> </span>body<span style=""> </span>mass (<span style=""> </span>muscle<span style=""> </span>and<span style=""> </span>organ<span style=""> </span>)<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">To accomplish<span style=""> </span>metabolic needs<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">To<span style=""> </span>promotes<span style=""> </span>wound<span style=""> </span>recovery<span style=""> </span>and<span style=""> </span>to<span style=""> </span>increase<span style=""> </span>immuno system<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Surgery<span style=""> </span>Patient<span style=""> </span>That<span style=""> </span>Need<span style=""> </span>Nutrition<span style=""> </span>Support<span style=""> </span>Are<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Patient<span style=""> </span>that<span style=""> </span>already<span style=""> </span>have a malnutrition, surgery action, traumatic,<span style=""> </span>sepsis <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Patient that<span style=""> </span>will<span style=""> </span>have<span style=""> </span>malnutrition<span style=""> </span>risk <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Patient<span style=""> </span>Which<span style=""> </span>Have Malnutrition Risk Are :<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Patient<span style=""> </span>that<span style=""> </span>can ‘t eat<span style=""> </span>for more than five days <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Patient<span style=""> </span>with <span style=""> </span>nutrition increasing in their body<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Patient<span style=""> </span>with<span style=""> </span>digestive<span style=""> </span>disturbance function<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Patient<span style=""> </span>that<span style=""> </span>have critical disease<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Patient<span style=""> </span>that<span style=""> </span>need intestinal rest for along period<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">Nutrition<span style=""> </span>has<span style=""> </span>given, specially<span style=""> </span>through<span style=""> </span>enteral<span style=""> </span>route<span style=""> </span>to get better<span style=""> </span>out come .<span style=""> </span>According<span style=""> </span>to<span style=""> </span>Moore<span style=""> </span>(<span style=""> </span>1992<span style=""> </span>)<span style=""> </span>TEN<span style=""> </span>(<span style=""> </span>Total Enteral Nutrition<span style=""> </span>) <span style=""> </span>can<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">prevent<span style=""> </span>gastrointestinal mucosa<span style=""> </span>atrophy, easy stress<span style=""> </span>respon, maintains<span style=""> </span>immuno<span style=""> </span>competence, protect intestinal normal flora<span style=""> </span>and<span style=""> </span>relatively cheaper in<span style=""> </span>financing.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">TPN<span style=""> </span>(<span style=""> </span>Total<span style=""> </span>Parenteral<span style=""> </span>Nutrition<span style=""> </span>)<span style=""> </span>needed<span style=""> </span>for<span style=""> </span>a<span style=""> </span>condition<span style=""> </span>that<span style=""> </span>digestive<span style=""> </span>system<span style=""> </span>can<span style=""> </span>not<span style=""> </span>be<span style=""> </span>used,<span style=""> </span>increasing<span style=""> </span>of gastrointestinal function, recovery of preoperation patient that have 10-15% weight loss, patient that can not accomplish energy needs only with oral intake, nitrogen balancing disturbance, non terminal coma.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Formula<span style=""> </span>for Clinical<span style=""> </span>Needs<span style=""> </span>Are :<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Diabetic<span style=""> </span>(<span style=""> </span>high fibre, low sugar, high<span style=""> </span>fat<span style=""> </span>)<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Hepatic<span style=""> </span>(<span style=""> </span>low protein<span style=""> </span>) Aminoleban <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Pulmonary<span style=""> </span>(<span style=""> </span>high calory,high<span style=""> </span>fat<span style=""> </span>) Pan Enteral<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Kidney<span style=""> </span>(<span style=""> </span>high calory, low electrolyte<span style=""> </span>)<span style=""> </span>Kidmin<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Immuno – Enhancing<span style=""> </span>(<span style=""> </span>L- Arginin,<span style=""> </span>glutamine,<span style=""> </span>omega 3 )<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">To determine TPN, the important<span style=""> </span>things<span style=""> </span>is to follow<span style=""> </span>the metabolism<span style=""> </span>change that happen. Remember to begin it with slowly<span style=""> </span>and low dosage, started with titration. The last target is to use total enteral, and always<span style=""> </span>synchronize it<span style=""> </span>with patient situation<span style=""> </span>and<span style=""> </span>condition.<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">The<span style=""> </span>Types<span style=""> </span>of<span style=""> </span>Immuno Nutrition<span style=""> </span>at<span style=""> </span>Present<span style=""> </span>Day<span style=""> </span>Are<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span><u>L-Glutamine<o:p></o:p></u></span></p> <p class="MsoNormal" style="text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span><span style=""> </span>-<span style=""> </span>Muscle<span style=""> </span>metabolism<span style=""> </span>and<span style=""> </span>growth <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Energy<span style=""> </span>source<span style=""> </span>for<span style=""> </span>cells of<span style=""> </span>the intestinal mucosa<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Immuno<span style=""> </span>system<span style=""> </span>:<span style=""> </span>macrophage<span style=""> </span>and lymphocyte <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Oxidative<span style=""> </span>fuel for<span style=""> </span>rapidly<span style=""> </span>replicating<span style=""> </span>cells <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">2.<span style=""> </span><u>L-Arginine<o:p></o:p></u></span></p> <p class="MsoNormal" style="text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></u></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Accelerates wound<span style=""> </span>healing <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Reduces<span style=""> </span>translocation<span style=""> </span>of<span style=""> </span>bacteria<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>As<span style=""> </span>metabolic<span style=""> </span>intermediate <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Improves<span style=""> </span>immune system competence <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";">3.<span style=""> </span><u>Omega 3 fatty acid <o:p></o:p></u></span></p> <p class="MsoNormal" style="text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Mayor component of the cell membrane <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>An immune modulating <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Anti inflammatory agents <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Prevents essential<span style=""> </span>fatty<span style=""> </span>acids<span style=""> </span>deficiency <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Arginine Function <span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <ol style="margin-top: 0in;" start="1" type="1"><li class="MsoNormal" style=""><b style=""><u><span style="font-family: "Arial","sans-serif";">Immunomodulation<o:p></o:p></span></u></b></li></ol> <p class="MsoNormal"><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Lymphocytes increased <span style=""> </span>:<span style=""> </span><span style=""> </span>-<span style=""> </span>Thymic weight increased<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span><span style=""> </span>-<span style=""> </span>Mitotic stimulation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Improve neutrophyl function<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Induction macrophage <span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <ol style="margin-top: 0in;" start="2" type="1"><li class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Increased gut function<o:p></o:p></span></u></b></li></ol> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Promote mucosal growth + repair<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Healing of gastric ulcer,by supporting polyamine synthesis gastrin level <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <ol style="margin-top: 0in;" start="3" type="1"><li class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Wound Healing<o:p></o:p></span></u></b></li></ol> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Increased collagen deposition causing scars tissue, increased wound<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span>strength<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Muscle metabolism<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Neo bone and tendon cells<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Glutamine Function<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.25in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Muscle metabolism and growth<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.25in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Energy source for cells of the intestinal mucosa<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.25in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Immune systems<span style=""> </span><span style=""> </span>:<span style=""> </span><span style=""> </span>-<span style=""> </span>Macrophage<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span><span style=""> </span><span style=""> </span>-<span style=""> </span>Lymphocyte<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.25in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Precursor of antioxidant <span style=""> </span>: <span style=""> </span>Glutathione<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.25in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Precursor ornithine<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify; text-indent: 0.25in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Can readly passé Blood Brain Barrier<span style=""> </span><span style=""> </span>:<span style=""> </span>As brain fuel <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span>GABA<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Prevention<span style=""> </span><span style=""> </span>: <span style=""> </span><span style=""> </span>Uremia</span></u></b><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">The body need<span style=""> </span>N<span style=""> </span>but free<span style=""> </span>N<span style=""> </span>produce ammonia that causing <o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>toxic to brain tissue<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>In the liver<span style=""> </span>:<span style=""> </span>N<span style=""> </span>+<span style=""> </span>Glutamic acid produce urea causing excreted in<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>the urine<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Omega 3 Fatty Acids<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Fatty acids <span style=""> </span>:<span style=""> </span>Major component of the cell membrane<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Involved in process<span style=""> </span><span style=""> </span>:<span style=""> </span><b style=""><u><o:p></o:p></u></b></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Vessel <span style=""> </span>:<span style=""> </span>Dilatation and constriction<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Inhibition and clotting<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Cell devision and growth<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">-<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">High level in fish oil and rape seed ( canola oil )<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 0.25in; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span><b style=""><u><o:p></o:p></u></b></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Nutrition<span style=""> </span>Support<span style=""> </span>Can<span style=""> </span>Give<span style=""> </span>Away<span style=""> </span>On<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Enteral<span style=""> </span>:<span style=""> </span>Given on patient that not have peristaltic<span style=""> </span>function<span style=""> </span>disorder <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Parenteral<span style=""> </span>:<span style=""> </span>Given<span style=""> </span>through central<span style=""> </span>peripheral <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">The<span style=""> </span>Need<span style=""> </span>of Calory and<span style=""> </span>Protein<span style=""> </span>on Enteral Nutrition<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><b style="">Calory<o:p></o:p></b></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Adult<span style=""> </span>:<span style=""> </span>25<span style=""> </span>-<span style=""> </span>35 k cal /kg weigh /<span style=""> </span>24<span style=""> </span>hours<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Old – adult<span style=""> </span>:<span style=""> </span>23<span style=""> </span>-<span style=""> </span>30 k cal /kg weigh /<span style=""> </span>24<span style=""> </span>hours<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span>Protein <o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>-<span style=""> </span>Depends on<span style=""> </span>patient condition, generally<span style=""> </span>0,6 – 1,8 g/ kg weigh / 24 hours<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";">The Selection and Number of Formulas<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>1.<span style=""> </span>Generally the formula contains 1 k<span style=""> </span>cal / cc, if limited<span style=""> </span>number was used, <span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>it can also contains 1,5 – 2 k cal / cc<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">2.<span style=""> </span>Fibrous<span style=""> </span>or<span style=""> </span>not<span style=""> </span>fibrous, factory made<span style=""> </span>formula<span style=""> </span>containing<span style=""> </span>fiber that can <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>loose on water <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">3.<span style=""> </span>Contains protein, factory made formula, protein made casein soya and<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>eggs<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">4.<span style=""> </span>Fat, normally fat composition contains 30 – 40<span style=""> </span>% from the daily need<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">5.<span style=""> </span>Electrolyte,ideally<span style=""> </span>before<span style=""> </span>enteral nutrition was given, it has to be check <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>the containing<span style=""> </span>of<span style=""> </span>k, Na,Cl,Mg,Ca and phosphor<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 24pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">6.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Vitamin and trace elements<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 6pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 6pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Use Direction<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span>Bollus, contains 250 – 300 cc, given 5 – 8 times on more and 10 minutes <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>speed <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">2. <span style=""> </span>Giving continue on 24 hours, which can give through the drip or using <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span>pump nutrition<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><b style=""><u><span style=""> </span>Complication<span style=""> </span>:<span style=""> </span><o:p></o:p></u></b></span></p> <p class="MsoNormal" style="text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 30.75pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">1.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Aspiration<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 30.75pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">2.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Vomiting<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 30.75pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">3.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Diarhoea<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 30.75pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">4.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Obstipation<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 30.75pt; text-align: justify; text-indent: -0.25in;"><!--[if !supportLists]--><span style="font-family: "Arial","sans-serif";"><span style="">5.<span style="font-family: "Times New Roman"; font-style: normal; font-variant: normal; font-weight: normal; font-size: 7pt; line-height: normal; font-size-adjust: none; font-stretch: normal;"> </span></span></span><!--[endif]--><span style="font-family: "Arial","sans-serif";">Dehidration<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 12.75pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="margin-left: 12.75pt; text-align: justify;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Nutrition<span style=""> </span>Parenteral<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><u><span style="font-family: "Arial","sans-serif";"><o:p><span style="text-decoration: none;"> </span></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><span style="font-family: "Arial","sans-serif";">Use Indication<span style=""> </span>:<o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span>Patient that can not allowed to use digestive system as a nutrition<span style=""> </span>path<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";">2.<span style=""> </span>Patient<span style=""> </span>with very high nutrition need<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><u><span style="font-family: "Arial","sans-serif";">Types of<span style=""> </span>Liquid Are<span style=""> </span>:<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><span style="font-family: "Arial","sans-serif";">1.<span style=""> </span>Perypheral<span style=""> </span>:</span></b><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span><span style=""> </span>Dextrose <span style=""> </span>5%<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span>-<span style=""> </span>Martos<span style=""> </span>10 %<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><span style=""> </span>-<span style=""> </span><span style=""> </span>Pan amin G 2,8%<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><span style="font-family: "Arial","sans-serif";"><span style=""> </span>2<span style=""> </span>Central<span style=""> </span>:<span style=""> </span><o:p></o:p></span></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Dextrose<span style=""> </span>20 %<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Triofusin 1000<o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Amiparen<o:p></o:p></span></p> <p class="MsoNormal" style="margin-left: 0.5in; text-align: justify;"><span style="font-family: "Arial","sans-serif";">-<span style=""> </span>Aminofel, aminofusin <o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><b style=""><u><span style="font-family: "Arial","sans-serif";">SUMMARY<o:p></o:p></span></u></b></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><o:p> </o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 0.5in;"><span style="font-family: "Arial","sans-serif";">It is very<span style=""> </span>important, to use nutrition enhancing on<span style=""> </span>unconsciousness<span style=""> </span>patient. Malnutrition can cause the increasing of clinical recovery cost, instead of<span style=""> </span>worst<span style=""> </span>condition because of the complication<span style=""> </span>on a patient, so that it needs more day for clinical<span style=""> </span>recovery, Which can increase clinical recovery<span style=""> </span>cost . A good<span style=""> </span>cooperation<span style=""> </span>between doctor, nurse, family and hospital as a facilities<span style=""> </span>supplier will result an optimal<span style=""> </span>nursing<span style=""> </span>for the<span style=""> </span>patient.<span style=""> </span><o:p></o:p></span></p> <p class="MsoNormal" style="text-align: justify; text-indent: 6pt;"><span style="font-family: "Arial","sans-serif";"><span style=""> </span><o:p></o:p></span></p> Wira Wijayahttp://www.blogger.com/profile/16990130477750158469noreply@blogger.com0