LAMPIRAN 1 perhitungan SMRS

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HASIL PERHITUNGAN DIET/
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Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

nasi putih 120 g 156.0 kcal 34.3 g

ikan mujair segar 50 g 41.9 kcal 0.0 g
daging ayam 50 g 142.4 kcal 0.0 g
tahu 40 g 30.4 kcal 0.8 g
sayur bening campur 30 g 9.9 kcal 2.3 g
pepaya 100 g 39.0 kcal 9.8 g
gula pasir 30 g 116.1 kcal 30.0 g
minyak kelapa sawit 25 g 215.5 kcal 0.0 g
pisang goreng 30 g 47.4 kcal 5.3 g
donat 35 g 140.0 kcal 16.2 g
telur ayam 60 g 93.1 kcal 0.7 g

Meal analysis: energy 1031.8 kcal (100 %), carbohydrate 99.2 g (100 %)

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 1031.8 kcal 1900.0 kcal 54 %
water 0.0 g 2600.0 g 0%
protein 39.3 g(15%) 47.0 g(12 %) 84 %
fat 54.3 g(46%) 73.0 g(< 30 %) 74 %
carbohydr. 99.2 g(39%) 332.0 g(> 55 %) 30 %
dietary fiber 4.0 g 30.0 g 13 %
alcohol 0.0 g - -
PUFA 10.6 g 10.0 g 106 %
cholesterol 328.5 mg - -
Vit. A 1676.1 µg 800.0 µg 210 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.3 mg 1.0 mg 26 %
Vit. B2 0.6 mg 1.2 mg 51 %
Vit. B6 0.6 mg 1.2 mg 47 %
folic acid eq. 0.0 µg - -
Vit. C 65.2 mg 100.0 mg 65 %
sodium 162.5 mg 2000.0 mg 8%
potassium 756.0 mg 3500.0 mg 22 %
calcium 130.4 mg 1000.0 mg 13 %
magnesium 115.0 mg 300.0 mg 38 %
phosphorus 377.0 mg 700.0 mg 54 %
iron 4.6 mg 15.0 mg 31 %
zinc 3.0 mg 7.0 mg 42 %
LAMPIRAN 2 Perhitungan Recall 24 jam

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HASIL PERHITUNGAN DIET/
=====================================================================
Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

bubur nasi 100 g 72.9 kcal 16.0 g

telur ayam 60 g 93.1 kcal 0.7 g
sayur bening campur 100 g 33.0 kcal 7.5 g
minyak kelapa sawit 5g 43.1 kcal 0.0 g

Meal analysis: energy 242.1 kcal (27 %), carbohydrate 24.2 g (24 %)

bubur nasi 100 g 72.9 kcal 16.0 g

daging ayam 60 g 170.9 kcal 0.0 g
tempe kedele murni 50 g 99.5 kcal 8.5 g
sayur bening campur 100 g 33.0 kcal 7.5 g
semangka 100 g 32.0 kcal 7.2 g

Meal analysis: energy 408.4 kcal (45 %), carbohydrate 39.2 g (39 %)

bubur nasi 100 g 72.9 kcal 16.0 g

sayur sop 100 g 104.0 kcal 10.5 g
tahu 50 g 38.0 kcal 0.9 g
pepaya 100 g 39.0 kcal 9.8 g

Meal analysis: energy 253.8 kcal (28 %), carbohydrate 37.3 g (37 %)

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 904.3 kcal 1900.0 kcal 48 %
water 0.0 g 2600.0 g 0%
protein 46.5 g(20%) 47.0 g(12 %) 99 %
fat 37.3 g(36%) 73.0 g(< 30 %) 51 %
carbohydr. 100.6 g(44%) 332.0 g(> 55 %) 30 %
dietary fiber 10.5 g 30.0 g 35 %
alcohol 0.0 g - -
PUFA 7.8 g 10.0 g 78 %
cholesterol 301.8 mg - -
Vit. A 1978.9 µg 800.0 µg 247 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.5 mg 1.0 mg 53 %
Vit. B2 0.8 mg 1.2 mg 63 %
Vit. B6 0.9 mg 1.2 mg 77 %
folic acid eq. 0.0 µg - -
Vit. C 81.0 mg 100.0 mg 81 %
sodium 205.7 mg 2000.0 mg 10 %
potassium 1346.8 mg 3500.0 mg 38 %
calcium 238.1 mg 1000.0 mg 24 %
magnesium 206.5 mg 300.0 mg 69 %
phosphorus 559.0 mg 700.0 mg 80 %
iron 8.3 mg 15.0 mg 55 %
zinc 4.7 mg 7.0 mg 68 %
LAMPIRAN 3 Rencana menu 1

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HASIL PERHITUNGAN DIET/
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Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

PAGI
nasi putih 100 g 130.0 kcal 28.6 g
daging ayam 30 g 85.5 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g

Meal analysis: energy 235.3 kcal (28 %), carbohydrate 33.1 g (28 %)

SIANG
nasi putih 100 g 130.0 kcal 28.6 g
daging ayam 30 g 85.5 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g
pepaya 100 g 39.0 kcal 9.8 g

Meal analysis: energy 274.2 kcal (32 %), carbohydrate 42.9 g (37 %)

SORE
nasi putih 100 g 130.0 kcal 28.6 g
ikan segar 30 g 25.2 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g
semangka 100 g 32.0 kcal 7.2 g

Meal analysis: energy 207.0 kcal (24 %), carbohydrate 40.3 g (35 %)

minyak kelapa sawit 15 g 129.3 kcal 0.0 g

Meal analysis: energy 129.3 kcal (15 %), carbohydrate 0.0 g (0 %)

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 845.8 kcal 1900.0 kcal 45 %
water 0.0 g 2600.0 g 0%
protein 32.2 g(15%) 47.0 g(12 %) 68 %
fat 28.2 g(29%) 73.0 g(< 30 %) 39 %
carbohydr. 116.3 g(55%) 332.0 g(> 55 %) 35 %
dietary fiber 5.9 g 30.0 g 20 %
alcohol 0.0 g - -
PUFA 3.5 g 10.0 g 35 %
cholesterol 60.6 mg - -
Vit. A 1800.1 µg 800.0 µg 225 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.4 mg 1.0 mg 35 %
Vit. B2 0.4 mg 1.2 mg 30 %
Vit. B6 0.7 mg 1.2 mg 57 %
folic acid eq. 0.0 µg - -
Vit. C 77.7 mg 100.0 mg 78 %
sodium 110.6 mg 2000.0 mg 6%
potassium 883.3 mg 3500.0 mg 25 %
calcium 89.0 mg 1000.0 mg 9%
magnesium 114.6 mg 300.0 mg 38 %
phosphorus 324.6 mg 700.0 mg 46 %
iron 2.9 mg 15.0 mg 20 %
zinc 3.0 mg 7.0 mg 43 %
LAMPIRAN 4 Perhitungan monev 1

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HASIL PERHITUNGAN DIET/
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Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

PAGI
nasi putih
sayur bening campur
daging ayam

SIANG
nasi putih
sayur bening campur
daging ayam 40 g 114.0 kcal 0.0 g
telur ayam bagian putih 30 g 15.0 kcal 0.3 g

Meal analysis: energy 128.9 kcal (74 %), carbohydrate 0.3 g (3 %)

buah melon

SORE
nasi putih
ikan patin
sayur bening campur 40 g 13.2 kcal 3.0 g
semangka 100 g 32.0 kcal 7.2 g

Meal analysis: energy 45.2 kcal (26 %), carbohydrate 10.2 g (97 %)

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 174.2 kcal 1900.0 kcal 9%
water 0.0 g 2700.0 g 0%
protein 15.0 g(35%) 48.0 g(12 %) 31 %
fat 8.1 g(41%) 77.0 g(< 30 %) 10 %
carbohydr. 10.5 g(24%) 351.0 g(> 55 %) 3%
dietary fiber 1.1 g 30.0 g 4%
alcohol 0.0 g - -
PUFA 1.8 g 10.0 g 18 %
cholesterol 31.6 mg - -
Vit. A 241.8 µg 800.0 µg 30 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.1 mg 1.0 mg 14 %
Vit. B2 0.3 mg 1.2 mg 23 %
Vit. B6 0.3 mg 1.2 mg 23 %
folic acid eq. 0.0 µg - -
Vit. C 11.2 mg 100.0 mg 11 %
sodium 90.0 mg 2000.0 mg 5%
potassium 288.5 mg 3500.0 mg 8%
calcium 23.0 mg 1000.0 mg 2%
magnesium 29.5 mg 310.0 mg 10 %
phosphorus 97.7 mg 700.0 mg 14 %
iron 1.0 mg 15.0 mg 7%
zinc 0.9 mg 7.0 mg 13 %
LAMPIRAN 5 Rencana menu 2

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HASIL PERHITUNGAN DIET/
=====================================================================
Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

PAGI
nasi putih 100 g 130.0 kcal 28.6 g
daging ayam 30 g 85.5 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g

Meal analysis: energy 235.3 kcal (26 %), carbohydrate 33.1 g (28 %)

SIANG
nasi putih 100 g 130.0 kcal 28.6 g
daging ayam 30 g 85.5 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g
pepaya 100 g 39.0 kcal 9.8 g

Meal analysis: energy 274.2 kcal (31 %), carbohydrate 42.9 g (37 %)

SORE
nasi putih 100 g 130.0 kcal 28.6 g
ikan segar 30 g 29.4 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g
semangka 100 g 32.0 kcal 7.2 g

Meal analysis: energy 211.2 kcal (24 %), carbohydrate 40.3 g (35 %)

minyak kelapa sawit 20 g 172.4 kcal 0.0 g

Meal analysis: energy 172.4 kcal (19 %), carbohydrate 0.0 g (0 %)

Dan susu nephrisol 2 x 3 takar 100 cc

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 893.2 kcal 1900.0 kcal 47 %
water 0.0 g 2600.0 g 0%
protein 32.1 g(14%) 47.0 g(12 %) 68 %
fat 33.7 g(33%) 73.0 g(< 30 %) 46 %
carbohydr. 116.3 g(52%) 332.0 g(> 55 %) 35 %
dietary fiber 5.9 g 30.0 g 20 %
alcohol 0.0 g - -
PUFA 3.7 g 10.0 g 37 %
cholesterol 60.9 mg - -
Vit. A 2055.2 µg 800.0 µg 257 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.4 mg 1.0 mg 37 %
Vit. B2 0.4 mg 1.2 mg 31 %
Vit. B6 0.7 mg 1.2 mg 57 %
folic acid eq. 0.0 µg - -
Vit. C 77.4 mg 100.0 mg 77 %
sodium 106.4 mg 2000.0 mg 5%
potassium 944.2 mg 3500.0 mg 27 %
calcium 94.4 mg 1000.0 mg 9%
magnesium 120.6 mg 300.0 mg 40 %
phosphorus 362.8 mg 700.0 mg 52 %
iron 3.0 mg 15.0 mg 20 %
zinc 3.0 mg 7.0 mg 42 %
LAMPIRAN 6 Perhitungan monev 2

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HASIL PERHITUNGAN DIET/
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Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

PAGI_
nasi putih 30 g 39.0 kcal 8.6 g
telur ayam 40 g 62.0 kcal 0.4 g

Meal analysis: energy 101.1 kcal (17 %), carbohydrate 9.0 g (11 %)

sayur bening campur

susu nephrisol

SIANG
nasi putih 60 g 78.0 kcal 17.2 g
daging ayam 40 g 114.0 kcal 0.0 g
pisang mas 50 g 46.0 kcal 11.7 g

Meal analysis: energy 238.0 kcal (40 %), carbohydrate 28.9 g (37 %)

SORE
nasi putih 100 g 130.0 kcal 28.6 g
ikan tongkol 40 g 44.4 kcal 0.0 g
sayur sop 50 g 52.0 kcal 5.3 g
semangka 100 g 32.0 kcal 7.2 g

Meal analysis: energy 258.4 kcal (43 %), carbohydrate 41.0 g (52 %)

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 597.4 kcal 1900.0 kcal 31 %
water 0.0 g 2600.0 g 0%
protein 32.0 g(22%) 47.0 g(12 %) 68 %
fat 16.7 g(25%) 73.0 g(< 30 %) 23 %
carbohydr. 78.9 g(54%) 332.0 g(> 55 %) 24 %
dietary fiber 3.9 g 30.0 g 13 %
alcohol 0.0 g - -
PUFA 2.7 g 10.0 g 27 %
cholesterol 219.6 mg - -
Vit. A 375.5 µg 800.0 µg 47 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.4 mg 1.0 mg 40 %
Vit. B2 0.5 mg 1.2 mg 38 %
Vit. B6 0.8 mg 1.2 mg 70 %
folic acid eq. 0.0 µg - -
Vit. C 16.0 mg 100.0 mg 16 %
sodium 110.5 mg 2000.0 mg 6%
potassium 674.8 mg 3500.0 mg 19 %
calcium 60.2 mg 1000.0 mg 6%
magnesium 83.0 mg 300.0 mg 28 %
phosphorus 336.0 mg 700.0 mg 48 %
iron 2.6 mg 15.0 mg 17 %
zinc 2.6 mg 7.0 mg 37 %
LAMPIRAN 6 Perhitungan monev 2

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HASIL PERHITUNGAN DIET/
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Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

PAGI
nasi putih 100 g 130.0 kcal 28.6 g
daging ayam 30 g 85.5 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g

Meal analysis: energy 235.3 kcal (25 %), carbohydrate 33.1 g (28 %)

SIANG
nasi putih 100 g 130.0 kcal 28.6 g
daging ayam 30 g 85.5 kcal 0.0 g
sayur bening campur 60 g 19.8 kcal 4.5 g
pepaya 100 g 39.0 kcal 9.8 g

Meal analysis: energy 274.2 kcal (29 %), carbohydrate 42.9 g (36 %)

SORE
nasi putih 100 g 130.0 kcal 28.6 g
ikan segar 30 g 29.4 kcal 0.0 g
sayur sop 60 g 62.4 kcal 6.3 g
semangka 100 g 32.0 kcal 7.2 g

Meal analysis: energy 253.8 kcal (27 %), carbohydrate 42.1 g (36 %)

minyak kelapa sawit 20 g 172.4 kcal 0.0 g

Meal analysis: energy 172.4 kcal (18 %), carbohydrate 0.0 g (0 %)

Dan Susu Nephrisol 2 x 3 100 cc

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HASIL PERHITUNGAN
=====================================================================
Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 935.8 kcal 1900.0 kcal 49 %
water 0.0 g 2600.0 g 0%
protein 32.5 g(14%) 47.0 g(12 %) 69 %
fat 37.7 g(35%) 73.0 g(< 30 %) 52 %
carbohydr. 118.1 g(51%) 332.0 g(> 55 %) 36 %
dietary fiber 7.0 g 30.0 g 23 %
alcohol 0.0 g - -
PUFA 3.7 g 10.0 g 37 %
cholesterol 60.9 mg - -
Vit. A 2055.2 µg 800.0 µg 257 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.4 mg 1.0 mg 38 %
Vit. B2 0.4 mg 1.2 mg 31 %
Vit. B6 0.7 mg 1.2 mg 57 %
folic acid eq. 0.0 µg - -
Vit. C 77.4 mg 100.0 mg 77 %
sodium 108.8 mg 2000.0 mg 5%
potassium 986.8 mg 3500.0 mg 28 %
calcium 96.2 mg 1000.0 mg 10 %
magnesium 124.2 mg 300.0 mg 41 %
phosphorus 376.6 mg 700.0 mg 54 %
iron 3.3 mg 15.0 mg 22 %
zinc 3.1 mg 7.0 mg 45 %
LAMPIRAN 8 Perhitungan monev 3

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HASIL PERHITUNGAN DIET/
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Nama Makanan Jumlah energy carbohydr.
______________________________________________________________________________

PAGI
nasi putih 90 g 117.0 kcal 25.7 g
telur ayam 40 g 62.0 kcal 0.4 g
sayur bening campur 50 g 16.5 kcal 3.8 g

Meal analysis: energy 195.6 kcal (27 %), carbohydrate 29.9 g (27 %)

susu nephrisol

SIANG
nasi putih 100 g 130.0 kcal 28.6 g
sayur bening campur 50 g 16.5 kcal 3.8 g
daging ayam 30 g 85.5 kcal 0.0 g
pepaya 80 g 31.2 kcal 7.8 g

Meal analysis: energy 263.1 kcal (36 %), carbohydrate 40.2 g (36 %)

susu nephrisol

SORE
nasi putih 100 g 130.0 kcal 28.6 g
ikan gabus segar 30 g 25.2 kcal 0.0 g
semangka 90 g 28.8 kcal 6.5 g
sayur sop 50 g 52.0 kcal 5.3 g
minyak kelapa sawit 5g 43.1 kcal 0.0 g

Meal analysis: energy 279.1 kcal (38 %), carbohydrate 40.3 g (37 %)

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HASIL PERHITUNGAN
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Zat Gizi hasil analisis rekomendasi persentase
nilai nilai/hari pemenuhan
______________________________________________________________________________
energy 1.127,8 kcal 1900.0 kcal 39 %
water 0.0 g 2700.0 g 0%
protein 32 g(16%) 48.0 g(12 %) 60 %
fat 29 g(24%) 77.0 g(< 30 %) 26 %
carbohydr. 190 g(61%) 351.0 g(> 55 %) 31 %
dietary fiber 5.9 g 30.0 g 20 %
alcohol 0.0 g - -
PUFA 2.5 g 10.0 g 25 %
cholesterol 206.5 mg - -
Vit. A 1191.8 µg 800.0 µg 149 %
carotene 0.0 mg - -
Vit. E 0.0 mg - -
Vit. B1 0.3 mg 1.0 mg 33 %
Vit. B2 0.5 mg 1.2 mg 39 %
Vit. B6 0.6 mg 1.2 mg 51 %
folic acid eq. 0.0 µg - -
Vit. C 63.4 mg 100.0 mg 63 %
sodium 132.3 mg 2000.0 mg 7%
potassium 806.1 mg 3500.0 mg 23 %
calcium 94.1 mg 1000.0 mg 9%
magnesium 105.8 mg 310.0 mg 34 %
phosphorus 335.1 mg 700.0 mg 48 %
iron 3.0 mg 15.0 mg 20 %
zinc 2.9 mg 7.0 mg 42 %
LAMPIRAN 9 Dokumentasi kegiatan

1. Dokumentasi Makanan Pasien Hari ke 1

Makan pagi (sebelum dimakan)

Makan siang (sebelum dimakan)

Makan siang (sesudah dimakan)

Makan sore (sebelum dimakan) Makan sore (sesudah dimakan)

2. Dokumentasi Makanan Pasien Hari ke 2

Makan pagi (sebelum dimakan)

Makan pagi (sesudah dimakan)

Makan siang (sebelum dimakan) Makan siang (sesudah dimakan)

Makan sore (sebelum dimakan)

Makan sore (sesudah dimakan)
3. Dokumentasi Makanan Pasien Har3 ke 2

Makan pagi (sebelum dimakan) Makan pagi (sesudah dimakan)

Makan siang (sebelum dimakan) Makan siang (sesudah dimakan)

Makan sore (sebelum dimakan)

Makan sore (sesudah dimakan)