PRELIMINARY REPORT BASIC HUMAN NEEDS WITH NUTRITION NEEDS FULFILLMENT DISORDERS Arranged by: SEKAR AYUDYA DWI PUTRI M NIM: P1337420618014 UNDERGRADUATE NURSING APPLIED SCIENCE HEALTH POLYTECHNIC OF SEMARANG 2019 I. PAGE TITLE : PRELIMINARY REPORT BASIC HUMAN NEED WITH NUTRITION NEEDS FULFILLMENT DISORDERS II. BASIC CONCEPTS A. Anatomy and Physiology of Digestive System The digestive tract consists of the mouth, esophagus, stomach, small intestine, large intestine, rectum and anus. 1. Mouth The function of the teeth is to destroy food at the beginning of the digestive process. Chewing well can prevent scarring on the surface of the digestive tract. After chewing, the tongue pushes the food lumps into the pharynx, where food moves to the upper esophagus and then down into the stomach. 2. Esophagus The esophagus is a long tube. The upper third is composed of bony muscles and the rest are slippery muscles. Its surface is covered in mucous membranes which produce secrete mucoid that is useful for protection. 3. Stomach Food clots enter the stomach, with the largest portion of the digestive tract. The movement of food through the stomach and intestine is made possible by the existence of peristaltic, is alternating contraction and relaxation movements of the muscles that push the food substance in waveslike movements. As food moves toward the pyloric spingter at the distal end of the stomach, the peristalsis increases. Now flabby lumps of food have become a substance called chyme. Chyme is pumped through the pylorus spingter into the duodenum. The average time needed to empty the stomach after eating is 2 to 6 hours. 4. Small Intestine Small intestine consists of duodenum, jejunum, and ileum whose length is approximately 6 meters with a diameter of 2.5 cm. The large intestine consists of the rectum, colon and rectum which then empties into the anus. The length of the large intestine is about 1.5 meters with a diameter of about 6 cm. The intestine receives chime (semi-solid) food from the stomach to absorb water, nutrients, potassium, bicarbonate and enzymes. Chyme moves because of intestinal peristalsis and will gather into feces in the large intestine. From eating to reaching the rectum normally takes 12 hours. The colon movement is divided into 3 parts, namely, first houstral shuffing is the mixing of chyme to help absorb water, the second is the contraction of haustrl which is a movement to push water and semi-solid material along the colon, thirdly the peristaltic movement is the forward movement to the anus in the form of waves. Foods that have passed through the small intestine: Chyme, will arrive at the rectum 4 days after swallowing, the amount of chime that is absorbed is approximately 350 ml. 5. Large Intestine (Colon) Adult colon, approximately 125-150 cm in length or 50-60 inches, consists of: Cecum, which is directly related to the small intestine. The colon consists of ascending, transverse, descending and sigmoid colon. Rectum, 1015 cm / 4-6 inch. The main functions of the large intestine (colon) are: Water and nutrient absorption Protection / protection by secreting mucus which will protect the intestinal wall trauma by feces and bacterial activity. Delivering leftovers to the anus by contraction. External anal / anal / orifice B. Definition of Nutrition Nutrition is nutrients and another substances related to health and disease, including the whole process in the human body to receive food or materials from the environment and use these materials for important activities in the body and remove waste. Nutrition functions to form and maintain body tissues, regulate processes in the body, as a source of energy, and to protect the body from disease. Thus, the main function of nutrition (suitor & hunter, 1980) is to provide energy for bodily activities, form skeletal structures and body tissues, and regulate various chemical processes in the body. Nutrition problems are closely related to food intake and body metabolism and the factors that influence it. In general, factors affecting nutritional requirements are physiological factors for basal metabolic needs, pathophysiological factors such as the presence of certain diseases that interfere with digestion or increase nutritional requirements, socio-economic factors such as the ability of individuals to fulfill the nutritional needs. Nutrient is an element needed for bodily processes and functions. Nutrition is organic and non-organic substances found in food and needed by the body to function properly (Kozier, 2004). C. Nutritional Components 1. Water Water includes 60% - 70% of adult individual body weight and 80% of infant body weight (Potter & Perry, 1992). Adult individuals can lose about 2-3 liters of fluid per day through sweat, urine and breathing. Water has a big role for the body. Apart from being a major component of cell constituents, water also plays a role in channeling food substances to cells. The function of water for the body itself is to assist chemical processes / reactions in the body and play a role in controlling body temperature. There is no single organ that can function without water. 2. Carbohydrate Carbohydrates are the main energy source. Every 1g of carbohydrates produces 4 kcal. Carbohydrates stored in the liver and muscles form glycogen in very small amounts. Glycogen is a synthesis of glucose, a fraction of energy during rest or fasting. Excess energy in carbohydrates in the form of fatty acids. Carbohydrate metabolism contains 3 processes, namely: Catabolism of glycogen to glucose, carbon dioxide and water is called glycogenolysis. Anabolism of glucose formed by glycogen is called glycogenesis. The change from amino acids and glycerol to glucose is called gluconeogenesis. 3. Protein The protein functions is to grow, maintain and replace body tissues. Every 1g of protein produces 4 kcal. The simplest form of protein is amino acids. Amino acids are stored in a network of hormones and enzymes. Essential amino acids cannot be synthesized in the body, but must be obtained from food. 4. Fat Fat is the biggest source of energy. Every 1 grams of fat will produce 9 kcal. Lipids are fats that can freeze at certain room temperatures, where the lipids consist of triglycerides and fatty acids. The process of formation of fatty acids is called lipogenesis. Activities that require energy include: Breathing, blood circulation, body temperature, etc. Mechanical activity by muscles. Brain and nerve activity. Chemical energy to build tissues, enzymes, and hormones. Digestive fluid secretion. Absorption of nutrients in the digestive tract. Expenditures of metabolism. Factors that affect energy needs: Basal Metabolism is increased Body activity Age factor Ambient temperature Disease 5. Vitamin Vitamins are organic compounds that cannot be made by the body and are needed in large quantities as catalysts in metabolic processes. Vitamins are generally classified into: Fat-soluble vitamins, namely: vitamin A, vitamin D, vitamin E, vitamin K. Water-soluble vitamins, namely vitamin B and vitamin C. 6. Mineral Minerals are categorized into 2: Macromineral, that is: a person needs every day an amount of more than 100 mg. For example: calcium, phosphorus, sodium, potassium, magnesium, chloride, and sulfur. Micromineral, namely: a person needs every day an amount of approximately 100 mg. For example: iron, zinc, manganese, iodine, cobalt, chromium, copper, and chloride. D. Nutritional Needs According to the Level of Age Development 1. Infants In infants, digestion and absorption are still simple until the age of 6 months. The calories needed are around 110-120 calories / kg / day. Fluid needs around 140-160 ml / kg / day. Babies before the age of 6 months of suitable nutrition is breast milk. 2. Toddler and Pre School Children The habits that need to be taught at this age include: Provision of food in various variations Limit sweet foods Eat a balanced diet. Serving food time regularly. Calorie requirements for each age: 1 year = 100 kcal / day 3 years = 300-500 kcal / day 3. School (6-12 years old) Age (Years) Calories Protein Calcium Fe Vit. A Vit. B1 Vit. C (Grams) (Grams) (mg) (U. I) (mg) (mg) 5-6 1400 40 0,50 6 2500 0,6 25 7-9 1600 50 0,75 7 2500 0,6 25 10 - 12 1900 60 0,75 8 2500 0,7 25 4. Teen Very high calorie, protein, mineral and vitamin requirements are related to the continued growth process. Increased body fat will cause obesity so that it will cause stress on body image. 5. Early Adult (23-30 years old) Nutrition needs in young adulthood, in addition to the maintenance and repair process of the body rather than growth. Nutritional requirements generally take precedence over type and quality over quantity. 6. Adult (31-45 years old) Adulthood is a productive period, especially related to physical activity. Nutrition needs at this time need to get great attention and must be differentiated between levels of work. Nutritional needs for adults based on occupational level: Work State Nutritional Light Elements Moderate Hard Man Woman Man Woman Man Woman Calories 2100 1750 2500 2100 3000 2500 Protein 60 55 65 65 70 70 Calcium 0,5 0,5 0,5 0,5 0,5 0,5 Ferum 8 10 8 8 10 8 Vit. A 2500 2500 2500 2500 2500 2500 Vit. B1 1 0,8 1,2 1 1,5 1,5 III. PATHWAYS Digestive tract diseases Decreasing health status Lifestyle and habits Metabolic needs for growth gastric mucosal erosion swallowed muscular weakness unhealthy eating habits Increased nutrition intake swallowed muscular weakness decreased gastric tone and peristalsis reflux duodenum to the stomach swallowing disorders excess unnecessary things in the body nutritional intake is not fulfilled energy demand unhealthy eating increases habits increased nutrition intake get hungry easily absorption in the body is not perfect weight loss increased appetite nausea risk of nutritional imbalance: more than the body needs vomiting eat often weight gain nutritional imbalance: less than the body's needs nutritional imbalance : more than the body’s needs IV. ASSESSMENT A. PATIENT IDENTITY (Age, sex, occupation and education). The patient's age can indicate the stage of development of the patient both physically and psychologically, sex and occupation need to be examined to determine the relationship and its influence on the occurrence of problems / illnesses, and the level of education can affect the client's knowledge about the problem / disease. B. PATIENT ADMISSION Patient admission is data or exactly when the patient entered the hospital to undergo inpatient or outpatient care. C. NURSING HISTORY Nursing history is data collected about the level of client's welfare (current and past), family history, changes in life patterns, socio-cultural history, spiritual health, and mental and emotional reactions to illness. D. HEAD TO TOE PHYSICAL EXAMINATION Anthropometry Ideal Body Weight: (Height-100) ± 10% Wrist Circles Upper arm circumference (MAC / Mid Aid Circumstances) Normal value of women: 28.5 cm Normal male values: 28.3 cm Skin folds in the triceps muscle (TSP / Triceps Skin Fold) Normal value of women: 16.5-18 cm Normal male values: 12.5-16.5 cm Body mass index = Weight (kg) : Height (m2) Biochemical (Laboratory) Albumin (Normal: 4-4.5 mg / 100ml) Transferrin (Normal: 170-250 mg / 100ml) Hemoglobin / Hb (Normal: 12 mg%) BUN (Normal: 10-20 mg / 100ml) Creatinine excretion for 24 hours (Normal: male: 0.6-13 mg / 100ml, female: 0.5-1.0 mg / 100ml) Clinical Sign Disease History: A history of overweight or underweight Weight Loss and Height Experiencing certain diseases History of surgery in the gastrointestinal system Anorexia Nausea and vomiting Diarrhea Alcoholism Mental Disability Radiation therapy Dietary History Impaired function of chewing and swallowing Inadequate food intake Incorrect or strict diet Lack of food supplies for 10 days or more Inadequate funds for food supply Inadequate food preparation facilities Lack of storage for groceries Physical disability Elderly who live and feed themselves Assessment Area General appearance Weight Normal Sign Abnormal Sign Agile, energetic, able to rest well apathetic, lethargic, within the normal range according to age and height obesity, underweight looking tired Hair E. D Nail radiant, oily, and not dry dry, faded, reddish, thin, dull branched Pink, hard break easily, shaped like a I A spoon Eye G N Lip clear, moist, pink pale, dry conjunctiva, conjunctiva there are signs of infection moist, pink Dry, cracked, swollen, O lesions, S mucous membranes T Gum Pink, moist I C bleeding, stomatitis, pale inflammation, shaped like a spoon Muscle chewy, well-developed weak, lack of tone, unable to work ECardiovascular system X pulse and blood pressure pulse rate more than 100x are normal, heart rhythm / A is normal rhythm, low / high blood M I minute, abnormal pressure Digestive system good appetite, normal and anorexia, regular elimination diarrhea, liver enlargement normal reflexes, alert, confused, T good attention, stable decreased reflexes I emotions N A Nervous system constipation, paresthesia, O N 1. Laboratory examination 2. Upper gastrointestinal endoscopy is the standard for the diagnosis of GERD with the discovery of mucosal breaks in the esophagus (reflux esophagitis). If no mucosal break is found in upper gastrointestinal endoscopy in patients with typical symptoms of GERD, this condition is called non-erosive reflux disease (NERD). 3. Rongent, is a detection device that is already familiar in the medical world. But for ordinary people or who have never known this tool usually hear immediately feel fear and worry. Though this tool is needed to detect diseases or abnormalities suffered in our body. F. DATA ANALYSIS AND SYNTHESIS According to the KBBI, analysis is an investigation of an event (writing, deed, etc.) to find out the real situation. While synthesis is a mixture (mixture) of various meanings or things so that it becomes a harmonious unity. V. NURSING DIAGNOSIS FORMULATION (PROBLEM LIST) A. Fluid volume deficiency is related to: Failure of regulatory mechanisms Lack of active fluid B. An imbalance of nutrients less than the body's needs is related to: Inability to digest food Inability to absorb nutrients Lack of food intake Vomiting, anorexia, digestive disorders VI. No PLANNING Nursing Diagnose 1.Lack of fluid volume Definition : decrease in intravascular, interstitial, and / or intracellular fluid. This refers to dehydration, fluid loss alone without changes in sodium levels. Limitation of characteristics: Thirsty Weaknesses Dry skin Dry mucous membranes Increased pulse frequency Increased hematocrit Increased urine concentration Increase in body temperature Sudden weight loss Decreased urine output Decreased venous filling Decreased blood pressure Decreased pulse pressure Decreased skin turgor Decreased tongue turgor Decrease in pulse volume Change in mental status Related factors: Failure of regulatory mechanisms Loss of active fluid Purpose and Expected Result NOC: Fluid balance Hydration Nutritional Status: Food and Fluid Intakes Nausea and vomiting control Results Criteria: Maintain urine output according to age and body weight, normal urine BJ, normal HT Blood pressure, pulse, body temperature are within normal limits There are no signs of dehydration, good skin turgor elasticity, moist mucous membrane, no excessive thirst, CRT normal. Nausea and vomiting overcome can be Intervention NIC: Fluid management Maintain accurate intake and output records Monitor hydration status (mucous membrane moisture, adequate pulse, orthostatic blood pressure), if needed Monitor lab results according to fluid retention (BUN, Hmt, urine osmolality) Vital sign monitor Monitor food / fluid intake and calculate daily calorie intake Fluid collaboration IV Monitor nutritional status Give liquid Give diuretics according to instructions Give IV fluids at room temperature Push oral input Give nasogastric replacement according to the output Encourage the family to help patients eat Offer snacks (fruit juice, fresh fruit) Collaborate doctor if signs of excess fluid appear / worsen Set the possibility of transfusion Nausea management Assess for nausea related to frequency, duration, severity and triggers for nausea Nonverbal observation of discomfort Assess the dietary history of food, likes, dislikes, and eating culture Identification of drugrelated factors and procedures that may cause nausea. Collaborative administration of antiemetic drugs to prevent nausea. Control environmental factors that might trigger nausea (sound or light stimulation. Reduce and avoid personal factors that might trigger nausea (fear, anxiety, fatigue). Identify successful strategies for managing nausea. Promote adequate rest and sleep to reduce nausea. Eat small but frequent portions Encourage eating high in carbohydrates and low in fat. Monitor the adequacy of nutrients calories. and 2. Nutritional imbalances: less than the body's needs NIC Nutrition management Assess for food Definition: nutrient intake is allergies not enough to meet metabolic Collaboration with needs. Results Criteria: nutritionists to determine the number An increase in body Limitation of Characteristics: weight in of calories and Weight 20% or more below accordance with the nutrients needed by the ideal body weight range objectives patients Hyperactive bowel sounds Ideal body weight Instruct the patient to Full soon after eating according to height increase Fe intake Diarrhea Able to identify Instruct the patient to increase protein and Disorders of taste sensation nutritional needs vitamin C Excessive hair loss Give sugar substance Chewing muscle weakness Make sure the diet Muscle weakness to you eat contains high swallow fiber to prevent Capillary fragility constipation Misinformation Give selected food Misperception Teach patients how to Inability to eat food make daily food Abdominal cramps records Less information Monitor the amount Lack of interest in food of nutrition and Pale mucous membranes calorie content Abdominal pain Provide information Weight loss with adequate food intake about nutritional Oral thrush needs Decreased muscle tone Related factors: Biological factors Economic factors Psychosocial disorders Inability to eat Inability to digest food Inability to absorb nutrients Lack of food intake NOC Nutritional Status: Food and Fluid Intakes Nutrition monitoring BB patients are within normal limits Monitor for weight loss Monitor the type and amount of activity that is normally done Monitor the environment during meals Monitor dry skin and pigmentation changes Monitor skin turgor Monitor dryness, dull hair, break easily Monitor nausea and vomiting Monitor favorite foods Monitor growth and development Monitor pale, reddish, and dry conjunctival tissue Monitor calorie and nutrient intake Note the presence of edema, hyperemic, hypertonic papillae of the tongue and oral cavity VII. 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