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Project Script - I14180078 - Luthfiyah Sri Kusuma Wardhani - Case 1 - Cancer
Project Script - I14180078 - Luthfiyah Sri Kusuma Wardhani - Case 1 - Cancer
By :
Practicum Assistants :
Practicum Coordinator :
BACKGROUND
Cancer in General
Cancer is one of the leading causes of death in the world. In 2012, it was
estimated that there were around 14 million new cancer cases and 8.2 million cancer
deaths in the world (Pusdatin 2015). The World Health Organization in 2015 reported
that the top five types of cancer found in men in the world in 2015 were lung cancer,
prostate cancer, prostate cancer, stomach cancer, and liver cancer. Meanwhile, in
women, the most common types of cancer are breast, correctum, lung, cervical, and
stomach cancer (WHO 2015).
One in three cancer deaths is related to 5 lifestyle habits and diet, the five factors
are obesity , low fruit and vegetable diet, lack of physical activity, tobacco use, and
alcohol use. Tobacco use is a risk factor for cancer death in general with a percentage
value of 20%. Meanwhile, for lung cancer, tobacco is the most dominant risk factor for
lung cancer death, with a percentage value of 70%. It is estimated that there will be an
increase in new cases of cancer by 70% in the next 20 years. Over time, there has been
a shift in the pattern of cancer incidence in the world, where the incidence of cancer
has shifted to lower-middle income countries. Currently, the incidence of new cases of
cancer in the world reaches 57% and 65% of cancer deaths occur in low-middle income
countries (Torre et al. 2015).
The death rate from cancer is higher in developing countries than in developed
countries. This difference reflects differences in risk factors for successful treatment of
detection, as well as drug availability. Lung cancer is the leading cause of cancer death
among men in both developed and developing countries. Meanwhile, for women,
breast cancer is the most common cause of death, both in developed and developing
countries. Another major cause of cancer death in developed countries is colorectal
cancer in men and women and prostate cancer in men. In developing countries, liver
cancer and stomach cancer are the most common types of cancer that cause death
among men. Meanwhile, cervical cancer is the most common cause of death in women
in developing countries (Torre et al. 2015).
The risk factors associated with lung, colorectal, stomach, and liver cancer are
tobacco use. Meanwhile, those associated with lack of physical activity and obesity are
breast and colorectal cancer. Meanwhile, infection risk factors are associated with liver,
stomach, and uterine cervical cancer. Most cancer cases and deaths can be prevented
by implementing effective preventive measures, such as controlling the consumption
of tobacco-related substances, vaccination, and the use of early testing. Based on the
evidence-based strategy (Eviden-Based Strategy), the incidence of cancer can be
prevented and controlled up to 30% by modifying or avoiding key risk factors. By
avoiding or modifying key risk factors that have been studied by the International
Cancer Collaboration at WHO, it is hoped that morbidity and mortality from cancer
can be controlled. The key risk factors are tobacco use, obesity, low intake of
vegetables and fruit, lack of physical activity, alcohol consumption, sex transmitted
human papilloma virus infection, air pollution in cities, and smoke production using
solid fuels in households (Dewi 2016).
According to the World Health Organization (WHO) in 2012, it was estimated
that there were 530,000 new cases of cervical cancer worldwide. More than 270,000
women die every year from this disease, and more than 85% of these deaths occur in
low- and middle-income countries including Indonesia. Data released by the data and
information center of the Ministry of Health of the Republic of Indonesia shows that
in 2013 there were 98,692 cervical cancer patients in Indonesia. This data and
information center also shows an increase in the number of deaths from cervical cancer
in Dharmais Cancer Hospital from year 2011 to 2013. In yaer 2011 self, there were 35
deaths, in 2012 there were 42 deaths, and in 2013 there were 65 deaths (Pusdatin
Ministry of Health 2015).
An increase in deaths due to Cervical cancer is thought to be caused by delayin
handling. Purwoto and Nurrana4said that more than 70 percentcervical cancer patients
who come for treatmentto the hospital is already at an advanced stage, namely stage II
and III. The occurrence of cervical cancer often associated with the Human Papilloma
Virus (HPV). According to Fitzgerald et al. (2014), more than 99% cervical
cancercontain HPV. Infection in time duration of certain types of HPV can cause
cervical cancer (National cancer institute 2012). Aziz et al. (2000) said that the
infection HPV is often found in women who have had sexually active.
There are several factors that cancauses a person to become infected with HPV
affected by cervical cancer, namely a history of pregnancy,sexual behavior,
contraceptive use, smoke, nutrition, and genetics. Girl who became pregnant before the
age of 18 and had multiple pregnancies are at risk cervical cancer. Regarding sexual
behavior, Fritzgerald et al. (2014) explain that women who have intercourse sexual at
an early age and who have a lot of sexual partners are at risk of cervical cancer. In
addition to a history of pregnancy and sexual behavior, factors of contraceptive use;
smoke; nutrition; and genetics are also factors that associated with the risk of cervical
cancer. Use of oral contraceptives more than four year can increase the risk. The
ingredients that found in tobacco can cause cervical cancer. Regarding nutrition, from
several studies found found to be deficient in folic acid, vitamin C, Vitamin E and beta
carotene are associated with increased risk of cervical cancer
In addition to the above factors, gene factors are alsoalso influence cancer.
Rasjidi on (2013) say, that genes are information genetics passed down from one
generation to the next generation. It means, girl who have a family history of cancer
more at risk of developing cancer, including cancercervix compared with women who
did nothave a family history of cancer. Although malignant and can cause death,
cervical cancer can be prevented. Prevention can be done in various ways ways such
as controlling one's sexual behavior alone and partner; pay attention to contraception
used, do not smoke, and consuming nutritious food. This virus can be prevented by
doing vaccination. In addition, Early detection efforts also can be done, namely by
undergoing an IVA test (Visual Inspection With Acetic Acid Application) and Pap
smear test (Rio and Suci 2017).
OBJECTIVES
General Purposes
Special Purposes
1. Identify the type of nutritional problem from the complaints submitted by the
client and the background of the client related to cancer
2. Analyze the factors that cause nutritional disorders to occur in patients and the
nutritional status of these patients.
3. Provide a nutritional diagnosis related to intake, behavior and habits that cause
nutritional problems to occur in patients based on the results of a physical
examination and medical history tracing.
4. Provide nutritional consulting services and good diet procedures to overcome
nutritional problems experienced by clients.
5. Provide suggestions for sources of food that must be consumed and should be
avoided in order to immediately overcome the anemia.
6. Creating menus and intake settings for clients so that they can immediately
overcome the nutritional problems they are experiencing.
7. Monitor client compliance regarding the intake that must be eaten and provide
predictions for how long the patient can escape from the cancer she is
experiencing.
CLIENT IDENTITY
The client who wants to do a nutrition consultation has the full name of Claudya
Magdalena Harianja. Miss Claudya is a final year student who is 22 years old, weight
is 55 kg, height is 162 cm, so her body mass index is 20.96 kg/m2 and her nutritional
status is normal.
NUTRITION CONSULTATION SCRIPT
Nah, untuk membantu ibu, nantinya saya akan menyakan beberapa hal.
Mrs Caludya : Iya Mbak, jadi sehabis melalukan kemoterapi untuk mengobati
penyakit kanker saya. Namun, setelah melakuakn kemoterapi, berat badan saya
menjadi turun.
Consultant : Baik. Oh iya, kalau boleh tahu, kemoterapi yang ibu jalani
sudah selesai atau masih berjalan?
Consultant : Baik, Ibu, sebelum ibu kesini apakah ibu sudah melakukan
pengukuran berat badan dan tinggi badan ya, Ibu?
Mrs Claudya : 55 cm
Jadi, disini saya mau bertanya, tentang kebiasaan makan Ibu dari Pagi hingga Malam
Setelah makan siang apa ada cemilan Ibu? atau tidak ada?
Nah, jadi begini Ibu. Bagi pasien kanker yang sehabis malukakan kemoterapi
Terjadi penurunan berat badan dan nafsu makan itu adalah hal yang wajar.
Nah, tapii Ibu harus tetap bisa melawan itu, jangan karena tidak nafsu makan, Ibu
enggak makna. Harus makan ya Ibuu.
Nah, kala dilihat dari tinggi badan dan berat badan Ibu. Status gizi Ibu itu sbeenarnya
masuk ke golonga berat badan berlebih, namun hanya sedikit Ibu.
Tapi bila dilihat dari kebiasaan makan Ibu, ini sangat kurang Ibu.
Sedangkan, Ibu posisinya, sebagai pasien yang sedang melakukan pemulihan, Ibu
memerlukan energi yang banyak, asupan yang banya agar pemulihannya menjadi cepat
Ibu.
Nah, ini saya ada leaflet Ibu tentang diet untuk kanker.
Disini, tujuan dietnya yaitu unutk memberikan asupan makanan yang siembang sesuai
dengan keadaan Ibu. Lalu, mencegah atau mengahmbat penurunan berat badan secara
berlebihan.
Nah, memang berat bedan Ibu sekarang lebih, cuman jika Ibu terus-menerus tidak nafsu
makan, itu akan menyebbakan Ibu mengalami penurunan berat badan berlebihan, dan
nanti bisa-bisa niali jauh dibawah berat badan ideal.
Nah, selain itu, tujuan diet kali ini juga untuk mengurangi rasa muntah, mual, dan diare.
Serta mengupayakan perubahan sikap dan perilaku sehat terhadap makanan oleh pasien
dan keluarganya.
Nah, disini juga Ibu, terdapat anjuran makan bagi pasien. Untuk pasien yang
mengidapa penaykit kanker dianjurkan untuk mengonsumsi jenis pangan yang
mengandung karbohidrat kompleks.
Nah, karbohidrat kompleks itu adalah karbohidrat yang dicerna oleh lambung dalam
waktu yang lama, seperti beras merah, ajgung, dan oatmeal.
Lalu, anjuran makan yang alin adalah makan berbagai jenis sayuran dan buah.
Jadi, Ibu harus banyak makan sayuran dan buah karena itu mengandung antioksidan
dan vitamin yang tinggi.
Tapi haru berbagai acam ya Ibu, harus bervariasi, jangan satu jenis kangkung terus,
harus bervariasi.
Llau penting juga Ibu untukmengonsumsi protein, baik protein hewani, maupun protein
nabati.
Terakhir, konsumsi makan dalam porsi kecil dan sering, hal ini bertujuan unutk
menghindari mual Ibu.
Jadi, makan porsinya sedikit itu gapapa. Tapi usahakan sering ya Ibu.
Kalau saya lihat dari kebiasaan makan ibu tadi. Ibu hanya makan di Pagi siang dan
Malam. Seharunya, waluapun ibu tidak nafsu makan juga Ibu harus sering makan Ibu.
Nah, ini juga ada pedoman untuk mengatasi amasalah dalama makan
Bila Ibu mengalami mual dan muntah, hindari utnuk makan makanan yang beraroma
tajam, berlemal tinggi, atau terlalua manis
Lalu, batasi cairan yang masuk pada waktu kakan, karena ini akan mengakibatkan cepat
kenyang dan Ibu akan muntah bila terlau kentang
Kemudian untuk makan dan minum, dilaukan secara perlahan agar tidak tersedak,
menjadi mual atau muntah
Llau, bilamIbu sedang kurang nafsu makan seperti yang sedang Ibu alami saat ini,
makaIbu boleh makan makanan yang Ibu sukai.
Pokoknya asupan Ibu harus tetap banyak, jadi Ibu makan saja apa yang Ibu sukai
Ini akan mengantisipasi bila ibu tidak nafsu makan, Ibu sudah banyak makan
sebelumnya ketika lapar
Lalu, hindari minum ketika waktu lapar. Ini agar menghindari Ibu kenyag terlebih
dahulu sebelum makan.
Lalu, seperti yang saya jelaskan tadi, banyaklah makan dalam porsi kecil, namun
sering.
Lalu, bila Ibu mengalami sakit dalam menelan atau mengunyah, Ibu dapat melakuakn
banyak minum sebanyak 8-10 gelas per hari ya Ibu
Lalu, hindari makanan yang terlalu asam atau asin, sering berkumur dana makan tiap
2 jam diselingi dengan minum.
Disini juga dijelaskan Ibu apa saja, apa saja yang dapat mencegah kambuhnya kanker.
Jadi, Ibu lebih baik mengonsumsi biji-bijian dan kacang-kacangan, sayur dan buah-
buahan yang berwarna karena itu adalah sumber antioksidan, vitamin, mineral, dan
serat Ibu
Gapapa konsumsi daging merah seperti daging sapi, daging ikan dan lain-lain, cuman
jangan terlalu sering ya Ibu, karena bahan pangan tersebut mengandung lemak yang
tinggi
Lalu, daging yang dipilih yang telah diolah dalam suhu yang tinggi karena itu baik.
Lalu, daging yang diawetkan, memamng makanan yang diawetkan itu kurang baik Ibu,
seperti sosis, kornet.
Llau, batasi konsumsi garam, kalau bisa maksimal konsumi garam 1 sdt per hari.
Consultant : Iyaaa
Lali, hindari makanan cepat saji seperti fast food, itu kurang biak juga Ibu, leih baik
makan makanan yang baru diolah, yang Fresh.
Lalu, hindari makanan tinggi lemak dan gula, serta minuman yang manis dan tinggi
alkohol
Nah, disini ada cara mudahnya Ibu untuk mengahfalnya, yakni CERDIK
Jadi saya harap Ibu selalu cek kesehatan Ibu secara berkala
Lalu, D nya itu Diet seimbang ya ibu. Ibu harus makan dengan Gzi yang seimbang,
jadi jangan berlebihan, tapi jangan kekurangan juga
Jadi Ibu enggak boleh sering stress, harus bahagia terus Ibu
seperti itu
Nah, sebelumnya, apakaha da yang ingin ditanyakan lagi Ibu? Mungkin ada yang
belum jelas. Apakah semuanya sudah jelas?
Jadi, bila Ibu dalam 2 minggu masih kurang nafsu makan, lemas, dan berat badan masih
terus berkurang. nanti kita bisa konsultasi lagi ya Ibu
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