nutritional problems of india is very serious problem ,1/3 of children ,are suffering from malntrition ,PEM IS BEGGEST PROBLEMS of india .

1. NUTRITIONAL
DEFICIENCY
DISORDERS
BY:JAYA SHARMA KGMU COLLEGE OF NURSING

2. INTRODUCTION
 Nutritional deficiency disorders are major
public health Problem in India and other
developing countries .
 They considered as leading killers and
significant cause of childhood mortality and
morbidity .
 They contribute towards various physical and
mental handicapped conditions in later life.

3. MALNUTRITION
 It is defined as a pathological state resulting
from a relative or absolute deficiency or excess
of one or more essential nutrients.
 Comprises four form:
• Undernutrition
• Over nutrition
• Imbalance and specific deficiency .
Protein energy malnutrition ,vitamin deficiency
disorders and mineral deficiency diseases are
important nutritional problems in our country.

4. CAUSES OF MALNUTRITION
Causes
Infections and
disease
condition
Poor
socioeconomic
status
Cultural
influence
Inadequate
health and
other
services

5. ASSESSMENT OF NUTRITIONAL
PROBLEMS
 History of dietary patterns
 Anthropometric examination
 Clinical examination
 Assessment of associated problem
 Laboratory investigations
 Assessment of ecological factors

6. CLASSIFICATION OF PEM
 SYNDROMAL CLASSIFICATION
KWASHIORKAR
NUTRITIONAL MARASMUS
PREKWASHIORKAR
NUTRITIONAL DWARFING

7. CLASSIFICATION BY INDIAN
ACADEMY OF PEDIATRIC
 Weight more than 80 % of expected weight
for age ,considered normal .
 GRADE-1 between 71-80% of expected weight for
the age .
 GRADE-II between 61-70% of expected weight
for that age .
 GRADE-III between 51-60% of expected weight
for that age .
 GRADE-IV 50% or less of weight expected for
that age .

8. GOMEZ CLASSIFICATION
 It is an international classification that age
90% as normal .
 GRADE-I weight between 75-90% of expected
for that age .
 GRADE-II weight between 61-75of expected
for the age .
 GRADE-III weight less than or equal to 60 %
of expected for the age .

9. WHO CLASSIFICATION
 WHO recommended three term -
WASTING
UNDER
WEIGHT
STUNTING

10. CLINICAL FEATURES
 Clinical features of PEM depends upon
severity and duration of nutritional inadequacy
,age ,of the child ,relative lack of different
foods and presence or absence of associated
infections .
 As the nutritional deficiency exaggerates with
infections, the child may become marasmic or
may develop kwashiorkor

11. KWASHIORKAR

12.  Kwashiorkor was first described by dr.cicely
Williams in 1933 ,but the particular term
kwashiorkor was introduced in 1935 ,according
to local name for the disease in Ghana .
 The term was said to mean red boy due to
characterics pigmentry changes .

13. Presenting feature
Essential features :
 Marked growth retardation with low weight
and low height gain.
 Muscles wasting with retention of some
subcutaneous fat.
 Psychomotor changes characterized by mental
apathy with listless ,lack of interest about the
surrounding ,lethargy ,dullness and loss of
appetite.
 Pitting edema

14. Nonessential features
 Hair changes
 Skin changes
 Superadded infections

15. NUTRITIONAL MARASMUS

16.  It is also termed as infantile atrophy or
athrepsia.
 It is common in infants and may found in
toddlers and even in later life .
 Dietary history reveals both proteins and
calories inadequacy in diet in the recent past
with predominant lack of calories .
 The child looks like old person with wizened
and shriveled face due to loss of buccal pad of
fat .

17. Essential features
 Growth retardation
 Gross wasting of muscles
 Marked stunting and absence of edema
Nonessential features :
 Hairs changes
 Skin changes
 Superadded infections
 Liver usually shrunk
 Psychomotor changes

18. Marasmic kwashiorkor
 Marasmic kwashiorkor is caused by acute or
chronic protein deficiency and chronic energy
deficit and is characterized by edema, wasting,
stunting, and mild hepatomegaly. The
distinction
between kwashiorkor and marasmus is
frequently blurred, and many children present
with features of both conditions.

19. Pre kwashiorkor
 it is a condition when the child is having features
of kwashiorkor's without edema . If the early
management is initiated by early diagnosis of the
condition ,the child may be protected from full –
blown kwashiorkor .
NUTRITIONAL DWARFING-
It is condition when the child is having significant
low weight and height for the age without any overt
features of kwashiorkor or marasmus.

20. MANAGEMENT OF PEM
 DOMICILIARY MANAGEMENT-
 Parent should be made aware about the dietary
management and other care .
 Community health nurse or aganwadi worker
should supervise and provide necessary
guidance by regular home visit .
 Follow up visit to be made for medical
supervision .

21. NRC
 When home management is not ensured
adequately government institutions or NGOs
can provide this rehabilitation services to the
malnourished children.

22. MANAGEMENT AT HOSPITAL
 Feeding should be started as early as possible .
 If oral feeding is not possible ,nasogastric tube
feeding to be given .
 Frequent small amount feeding
 To begin with a daily intake of 80 to
100kcal/kg/day for maintenance requirement .
 Which need to be gradually
 increased to 150kcal /kg /day of energy and 2to
g/kg/day .
 Fat should be supplemented to make the food
energy dense.

23. Preventive management of PEM
Prevention
Health
promotion
Specific
protection
Early diagnosis and
treatment
Rehabilitation

24. ANY QUESTION
?

25. ASSIGNMENT
 Nursing responsibilities for the management of
PEM.