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Nutritional problems

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Nutritional problems

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Nutritional problems

  1. 1. NUTRITIONAL PROBLEMS By:- firoz qureshi Dept.psychiatric nursing
  2. 2. INTRODUCTION  Under nutrition is widely recognized as a major health problem in the developing countries of the world ,food is a major concern of the mankind beginning from the time of conception & extending through the entire life span of the individual.  Food supply the energy for physical activity & other metabolic for maintaining growth of the individual & for repair of the ageing tissues.
  3. 3. DEFINITION  Nutritional problem or malnutrition is the condition of improper or inadequate food intake or inadequate absorption of food. And it manifests in so many diseases.
  4. 4. CONT…..  It comprises four forms under nutrition, over nutrition, imbalance and the specific deficiency.
  5. 5. NUTRITIONAL DISORDER Malnutrition –  Kwashiorkor  Marasmus A-vitaminosis-  B vitamins -  B1-Beriberi  B2- Ariboflovinosis  B3 –Pellagra  B6 – Pyridoxine deficiency
  6. 6. CONT…  B7 – Biotin deficiency  B9 – Folate deficiency  B12- Vitamin B 12 deficiency Other Vitamins deficiency- A- Bitot spots  C- Scurvy  D- Ostiomalacia/ Rickets 3)Hyper alimentation –  Hypervitaminosis A  Hypervitaminosis E  Hypervitaminosis D
  7. 7. METHODS OF ASSESSMENTS  Assessment of dietary intake by details history of dietary patterns, specific food consumed and its amount, quality and adequacy in relation of nutrient value.  Anthropometric examinations of the child including weight, length/height, mid upper arm circumference, skin fold thickness, are valuable indicators of nutritional status. In young children, head circumference and chest circumference are also measured to assess patterns of growth and development and deviation from average size.  Clinical examination of the child to assess deficiency signs and associated problems. Through head to foot examination is done to detect the classical signs of various deficiency states.
  8. 8. CONT…  Assessment of associated problems like tuberculosis, mal-absorption syndrome, any infection or infestations should be made to find out the probable cause of nutritional deficiency.  Laboratory investigations to be done to exclude the underlying cause including routine examination of stool, urine, blood and x- rays. Estimation of HB, serum proteins, enzymes, blood level of nutrients like vitamins, iron, amino acid,
  9. 9. CAUSES OF NUTRITIONAL PROBLEM  Assessments of ecological factors, morbidity and mortality patterns in the community help to detect the nutritional status of the particular community, as these situations influence the nutritional status of an individual. Causesof Nutritional Problem–  Poverty  Low birth weight  Infection  Population growth  Feeding habits  Social factor
  10. 10. PROTEIN ENERGY MALNUTRITION  Protein–energy malnutrition (PEM) or protein–calorie malnutrition refers to a form of malnutrition where there is inadequate calorie or protein intake. Types include:  Kwashiorkor (protein malnutrition predominant)  Marasmus (deficiency in calorie intake) Marasmic Kwashiorkor (marked protein deficiency and marked calorie insufficiency signs present, sometimes referred to as the most severe form of malnutrition)
  11. 11. DISCRIPTION  PEM is also referred to as protein-calorie malnutrition. It develops in children and adults whose consumption of protein and energy is insufficient to satisfy the body's nutritional needs. While pure protein deficiency can occur when a person's diet provides enough energy but lacks the protein minimum. PEM may also occur in persons who are unable to absorb vital nutrients or convert them to energy essential for healthy tissue formation and organ function.
  12. 12. CONT…  Although PEM is not prevalent among the general population of the United States, it is often seen in elderly people who live in nursing homes and in children whose parents are poor.  PEM occurs in one of every two surgical patients and in 48% of all other hospital patients.  PEM is fairly common worldwide in both children and adults and accounts for 6 million deaths annually.
  13. 13. CLASSIFICATION WHO classification: -  WHO recommended three terms: stunting, under weight and wasting for assessing the magnitude of malnutrition in under five children. The classification is based on deficit in body weight for age and presence or absence of edema. Children weighing b/w 60-80% percent of their expected weight for age with edema are classified as kwashiorkor.
  14. 14. CONT… Protein calorie malnutrition is lacking of calorie and other nutrients in child as they are growing. Main two protein deficiency problems are :- Kwashiorkor Marasmus
  15. 15. KWASHIORKOR  It is a clinical syndrome that results from a severe deficiency of protein and an inadequate caloric intake characterized by edema, irritability, anorexia, and an enlarged liver with fatty infiltrates. Either from lack of intake or from excessive losses of or increases in metabolic rate caused by chronic infections secondary vitamin and mineral deficiency may contribute to sign and syndrome.
  16. 16. CONT…  It is most serious and prevalent form of malnutrition in the world today. Especially in the industrially underdeveloped countries.  The term "kwashiorkor" comes from a word used in Ghana that means a "disease of a baby deposed from the breast when the next one is born." Kwashiorkor usually happens when a baby is weaned from protein-rich breast milk (for any reason) and switched to protein-poor foods. In impoverished countries, protein-rich foods are difficult to acquire.
  17. 17. CLINICAL MANIFESTATIONS  Early PEM manifest vague but does include:  Lethargy  Apathy  Irritability  Inadequate growth  Lack of stamina  Loss of muscular tissue  Increased susceptibility for infection.  Edema.  Secondary immunodeficiency is one of the most serious and constant complication.  Failure to gain weight.  Anorexia.
  18. 18. CONT…  Loss of muscle tone.  Hepatomegaly.  Renal functions decreases.  Dermatitis.  Hairs often sparse and thin and loses its elasticity.  Dispigmentations of hairs. Dark hairs changes in streaky red or gray color.  Vomiting and diarrhea.  Mental changes like irritability and apathy are common, stupor, coma and death may follow.
  19. 19. LABORATORY DATA  Decrease in concentration of serum albumin is the most characteristics change.  Ketonuria is common in early stage but frequently disappears by later stage.  Blood glucose level is low, but glucose tolerance curve may be diabetic in type.  Plasma values of essential amino acid are decrease and increased aminoaciduria.  Serum cholesterol level is low.  Bone growth is usually delayed.  Growth hormone secretion may be increased.
  20. 20. PREVENTIONS  Diet containing an adequate quantity of protein of good biological quality.  Adequate dietary instructions and food distribution are urgently needed in endemic areas.
  21. 21. TREATMENT  Immediate management of acute problems such as severe diarrhea, renal failure or shock.  Replacements of missing nutrients.  All symptoms must be treated.  For dehydration intravenous fluid must be administer.  Ringer lactate solution may be life saving.  Effective antibiotic should be given parenterally for 5-10 days.  Yogurt and cow’s milk for lactose intolerant child.  Vitamins and minerals, especially vita A, potassium and magnesium are necessary from the outset of treatment. Iron and folic acid usually corrects the anemia.
  22. 22. MARASMUSE  Marasmus is a from of under nutrition caused by inadequate caloric intake occurring chiefly during the first year of life.  Marasmus is a form of severe malnutrition characterized by energy deficiency. A child with marasmus looks emaciated.
  23. 23. CONT…  Both kwashiorkor and Marasmus are common in underdeveloped countries and in areas in which dietary amino acid content is insufficient to satisfy growth requirements. Kwashiorkor typically occurs at about age 1, after infants are weaned from breast milk to a protein-deficient diet of sugar water, but it can develop at any time during the formative years.  Marasmus affects infant’s ages 6 to 18 months as a result of breast-feeding failure, or a debilitating condition such as chronic diarrhea.
  24. 24. ETIOLOGY  Inadequate caloric intake..  Disturbed parent child relationship.  Congenital malformation.  Metabolic abnormality...  Severe impairment of any body system
  25. 25. CLINICAL MANIFESTATIONS  Failure to gain weight.  Loss of skin turgor .  Distend abdomen or flat.  Atrophy of the muscle.  Hypotonia.  Subnormal temp, slow pulse  Diminished appetite.  Usually constipated.  Tongue abnormality  Short Hight  Muscle wasting
  26. 26. CONT…  Weight loss  Muscle Weakness  Immune deficiency  Red cell production reduced Others symptoms:  Edema,  Skin change  Impaired growth,  Fatty liver characterize this.  There is typical appearance of a Pot belly which gives a false impression of health or over nutrition.
  27. 27. TREATMENT  The best treatment for improving digestive power is to give regular massage with Vata palliating oils like bala oil, narayan oil, and dhanvantari oil every day and exposure to early morning sun for 15 minutes. Herbs of choice are bala , shatavari , ashwgandha , and guduchi . These should be given in dose of 1 gram times day with milk or water. Balarishta 10 ml. 3 times a day for 1 month with chyavan 1 teaspoon 3 times a day. COMPLICATION:  Anorexia Nervosa  Eating disorders.
  28. 28. AVITAMINOSIS
  29. 29. B1 - BERIBERI  Beriberi is a vitamin deficiency disease in which the body does not have enough thiamine (vitamin B1). Causes-> There are two major types of beriberi:  Wet beriberi affects the cardiovascular system. is an adult with difficulty in walking Tingling or loss of sensation (numbness) in hands and feet.  Dry beriberi and Wernicke-Korsakoff syndrome (with both neurologic and psychiatric symptoms) with dyspnea (shortness of breath) on exertion.
  30. 30. SYMPTOMS Pain  Tingling  Loss of feeling (sensation) in hands and feet  Muscle damage with loss of muscle function or paralysis of the lower legs  Vomiting  Mental confusion/speech difficulties  Difficulty walking  Coma  Death  Swelling of the lower legs  Increased heart rate  Lung congestion  Enlarged heart related to congestive heart failure  Shortness of breath with activity  Awakening at night short of breath
  31. 31. TREATMENT  This is done with thiamine supplements. Thiamine supplements are given through a shot (injection) or taken by mouth.  Other types of vitamins may also be recommended.  Blood tests may be done after the person is given thiamine supplements to see how well they are responding to the medicine. Complications   Psychosis  Coma  Congestive heart failure  Death
  32. 32. B2 - ARIBOFLAVINOSIS Ariboflavinosis is the medical condition caused by deficiency of riboflavin (vitamin B2). Ariboflavinosis is most often seen in association with protein-energy malnutrition and also in cases of alcoholism. Signs and symptoms  Sore throat with redness and swelling of the mouth  Throat mucosa, cheilosis and angular stomatitis(cracking of the lips and corners of the mouth),  Glossitis  Decreased red blood cell count with normal cell size and hemoglobin content
  33. 33. B3 - PELLAGRA Pellagra is a vitamin deficiency disease most frequently caused by a chronic lack of niacin The symptoms of pellagrainclude:  High sensitivity to sunlight  Aggression  Dermatitis alopecia,  Smooth, beefy red glossitis  Red skin lesions  Insomnia  Weakness  Mental confusion  Diarrhea  The main results of pellagra can easily be remembered as "the four D's": diarrhea, dermatitis, dementia, and death.
  34. 34. B6 – PYRIDOXINE DEFICIENCY Signs and symptoms  Irritability and neurologic symptoms, such as confusion, are common place. Anemia has also been documented as a symptom. Treatment  Treatment of pyridoxine deficiency lies with replacing the missing vitamin. Penicillamine or hydrazides, such as isoniazid, are rarely used due to their ability to provoke deficiency symptoms.
  35. 35. B7 - BIOTIN DEFICIENCY Biotin deficiency is quite rare. Bacteria in the intestines make biotin, or vitamin B7, is a water soluble vitamin. Many foods also contain biotin, such as liver, cauliflower, carrots, soy products. Symptoms :  Dry skin  Fungal infections  Rashes including red, patchy ones near the mouth  Hair loss or total baldness (alopecia) Treatment:  Biotin deficiency is easily corrected by biotin tablets, which are inexpensive and readily available.
  36. 36. FOLATE-DEFICIENCY ANEMIA  Folate deficiency is the lack of folic acid (one of the B vitamins) in the blood, which can cause a type of anemia known as megaloblastic (pernicious) anemia. Symptoms  The following are the most common symptoms of folate-deficiency anemia. However, each individual may experience symptoms differently. Symptoms may include the following:  abnormal paleness or lack of color in the skin  decreased appetite  irritability  lack of energy or tiring easily (fatigue)  diarrhea  smooth and tender tongue  The symptoms of folate-deficiency anemia may resemble other blood conditions or medical problems. Always consult your physician for a diagnosis.
  37. 37. CONT… Treatment   Specific treatment for folate-deficiency anemia will be determined by your physician based on:  your age, overall health, and medical history  extent of the disease  your tolerance for specific medications, procedures, or therapies  expectations for the course of the disease  your opinion or preference Treatment may include:  vitamin and mineral supplements  change in diet  medication  treatment of the causative disease
  38. 38. B12 DEFICIENCE Vitamin B12 deficiency, also known as hypocobalaminemia. Symptoms  Osteomalacia: widespread bone pains and sometimes muscle weakness. Fractures can occur. Rickets: aches and pains, and sometimes visible enlargement of bones at joints, such as the wrists. Treatment  Regular daily supplements of vitamin D and calcium are usually used for people with simple vitamin D deficiency.
  39. 39. VITAMIN C - SCURVY vitamin C deficiency can occur as part of general undernutrition, but severe deficiency (causing scurvy) is uncommon. Symptoms   Dark purplish spots on skin; especially the legs, spongy gums; often leading to tooth loss, bleeding from all mucous membranes,  Pallor,  Bleeding gums,  Sunken eyes,  Opening of healed scar , nosebleeds, non- stopping diarrhea, and nail loss.
  40. 40. CAN VITAMIN C DEFICIENCY BE PREVENTED? Vitamin C deficiency can be prevented by making sure that you have a healthy, balanced diet that contains plenty of fruit and vegetables including those high in vitamin C that are listed above. As a rough guide, one large orange a day will provide you with enough vitamin C.
  41. 41. HYPERVITAMINOSIS A Hypervitaminosis A, or vitamin A toxicity, occurs when you have too much vitamin A in your body. Symptoms:-  Birth defects  Liver problems,  Reduced bone mineral density that may result in osteoporosis  Coarse bone growths  Skin discoloration  Hair loss  Excessive skin dryness/peeling
  42. 42. CONT… SignS:-  Nausea and  Vomiting,  Headache,  Dizziness,  Blurred vision, and  Loss of muscular coordination Treatment:-  Treatment involves simply stopping supplements (or rarely, foods) that contain vitamin A.
  43. 43. HYPERVITAMINOSIS D  Hypervitaminosis D is a rare but potentially serious condition. It occurs when you take in too much vitamin D. It’s usually the result of taking high-dose vitamin D supplements.  Too much vitamin D can cause abnormally high levels of calcium in the blood. This can affect bones, tissues, and other organs. It can lead to high blood pressure, bone loss, and kidney damage without treatment. Symptoms of vitamin D poisoning include:  Dehydration  Vomiting  Decreased appetite(anorexia)  Irritability  Constipation  Fatigue
  44. 44. WHAT IS THE TREATMENT FOR HYPERVITAMINOSIS D?  Your doctor will likely advise you to stop taking vitamin D supplements immediately. They may also recommend that you reduce the amount of calcium in your diet temporarily. In some cases, corticosteroids or bisphosphonates may suppress the release of calcium from your bones.  Your doctor will monitor your vitamin D levels frequently until they return to normal
  45. 45. HYPERVITAMINOSIS E  Hypervitaminosis E is a state of vitamin E toxicity. Since vitamin E can act as an anticoagulant and may increase the risk of bleeding problems,V  It is a state of Vitamin E toxicity. Because vitamin E can act as an anticoagulant and may increase the risk of bleeding problems, many agencies have set an upper tolerable intake level for vitamin E at 1,000 mg .
  46. 46. SIGNS AND SYMPTOMS  Blotchy skin  Increased bleeding  Decreased production of thyroid hormones  Decreased activity of vitamin K  Increased bleeding from aspirin or anti- coagulant medications
  47. 47. THANK YOU

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